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

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