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New Guidelines to Help Prevent Food Allergy in Children

By Beth Fontenot, MS, RD, LDN

Your baby is seven months old. You have introduced her to solid foods, and she is healthy and happy, sitting up, and about to start crawling. Should you feed her a little scrambled egg? A few years ago the answer would have been, "No." But today, the answer is, "Yes."

Basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between four and six months of age, according to the new guidelines.

The best way to prevent food allergies, according to a new report by the American Academy of Allergy, Asthma, & Immunology (AAAAI) is to expose babies to more foods early, rather than delaying them. The recommendations, based on several studies and expert opinions, are a complete reversal of the guidelines of a decade ago.

The Guidelines for Mothers and Children Change

The report also presents research showing how gradual and early exposure to a variety of foods can prevent food allergies rather than cause them. The recommendations also mean that women who are pregnant and mothers who are breastfeeding are freer to eat what they want.

The American Academy of Pediatrics published guidelines in 2000 recommending that infants not consume milk until they were one year old, eggs until age two, and peanuts, tree nuts, fish, or shellfish until their third birthdays. The lack of evidence that delaying those foods prevented eczema and food allergies, however, meant that in 2008 those guidelines were changed.

Left unclear was when and how to begin giving those foods to young children. As a result, many parents were confused about how to protect their children and remained cautious. Mothers-to-be cut certain foods out of their diets and left them out as they began nursing.

The Benefits of Early and Gradual Exposure to Wheat, Peanuts, Eggs

The 2013 report recommends that basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between four and six months of age, according to these new guidelines. The AAAAI recommends that allergenic foods like eggs and cow's milk be given for the first time at home, rather than at day care or in a restaurant and can be introduced after an infant has successfully tolerated a few of the basic complementary foods.

Introducing foods early can actually prevent food allergy in infants and children. Two studies found that there was a higher rate of wheat allergy in 5-year-olds who had not been fed wheat until after they were six months old. Another found that delaying wheat in the diet until the age of six months did not protect against wheat allergy.

The report offers a review of a number of studies, including one which showed that small amounts of cow’s milk in foods like baked goods, cheese, or yogurt appear to be safe to feed infants before the age of one. But this should not be interpreted as permission to replace formula or breast milk with cow’s milk. That should be avoided until after the first birthday for reasons unrelated to food allergy.

Feeding an infant fish before the age of nine months reduced the risk of eczema at one year of age.

Infants who ate eggs at four to six months appeared to have a lower risk of egg allergy than infants who first ate eggs later in life. And according to yet another study, children whose parents avoided feeding them peanut butter had a ten-fold higher rate of peanut allergy than those whose parents offered it.

It should be noted, however, that both peanuts and peanut butter are choking hazards in infants and young children, and a child who has a sibling with peanut allergy should be tested before eating peanuts because they are seven times more likely to have a peanut allergy. Lastly, a study found that feeding an infant fish before the age of nine months reduced the risk of eczema at one year of age.

No one understands why, but food allergies in children are an increasing occurrence. At this time, approximately five percent of preschoolers in the United States have been diagnosed with a food allergy. The foods that cause 90 percent of allergic reactions in the United States are milk, egg, peanut, tree nut, shellfish, fish, soy, and wheat.

The report was published in the Journal of Allergy and Clinical Immunology: In Practice.

March 19, 2013



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