With the increased occurrence of allergic disease, I thought it might be useful to review the current advice regarding allergies and introducing solids to babies and children. Over the recent years, the occurrence of allergic disease has increased at the same time as many societal and lifestyle changes. It is apparent that these environmental changes must be responsible for the increases we have witnessed in allergic disease. There is on-going research into the exact reasons for the increased number. However as Mums we seek to be able to prevent these allergies occurring in our children. Unfortunately at this stage, most allergy prevention strategies are relatively crude with small or unconfirmed effects, and newer strategies are still in experimental stages. This Australasian Society of Clinical Immunology and Allergy (ASCIA) position statement reviews current evidence and generates revised national guidelines for primary allergy prevention.
I have summarised some of the key points of this position paper, to help navigate this complex area:
|Identifying infants at risk of allergic disease||A family history of allergy and asthma can be used to identify children at increased risk of allergic disease|
|Allergen avoidance in pregnancy||Dietary restrictions in pregnancy are not recommended.Aeroallergen (dust mites) avoidance in pregnancy has not been shown to reduce allergic disease, and is not recommended.|
|Breastfeeding||Breastfeeding should be recommended because of other beneficial effects.Maternal dietary restrictions during breastfeeding are not recommended.|
|Infant formulae||In high risk infants only, If breast feeding is not possible a hydrolysed formulae is recommended (rather than conventional cows milk based formulae). Partially hydrolysed formula is available in Australia without prescription. Extensively hydrolyzed formula is more expensive, only available on prescription, and only subsidised for treatment of combined cow’s milk and soy allergic infants.Soy formulae and other formulae (eg. Goat’s milk) are not recommended for the reduction of food allergy risk.|
|Infant diet||Complementary foods (including normal cows milk formulae) should be delayed for at least 4-6 monthsThis preventive effect has only been demonstrated in high-risk infants
There is no evidence that an elimination diet after the age of 4-6 months provides a protective effect, though this needs additional investigation
Avoidance of peanut, tree nuts, and shellfish may be recommended in high risk children during the first years of life pending further study as this is unlikely to cause harm, however it must be emphasised that there is no evidence to support this recommendation.
Sally Muir – Dietitian