Many parents worry about whether their children will develop food allergies. Doctors once recommended keeping kids away from peanuts and other foods commonly linked to allergic reactions. Dr. Natalia Vernon of Kaiser Permanente explains why that has changed.
What were the old recommendations for parents concerning food allergies?
In 2000, guidelines suggested delaying introduction of highly allergenic foods to at-risk infants to prevent the development of a future allergy. For example, specific suggestions included delaying cow's milk until age 1, eggs until age 2, and peanuts, tree nuts and fish until age 3. "At-risk" was defined as infants with pre-existing severe allergic diseases or a family history of food allergy.
Since then, new data suggests that the early introduction of allergenic foods may prevent future food allergies from developing. The 2010 National Institute of Allergy and Infectious Diseases guidelines do not recommend restricting maternal diet during pregnancy or lactation to prevent the development of food allergy. The NIAID guidelines suggest that the introduction of solid foods — including potentially allergenic foods — should not be delayed beyond four to six months of age. These guidelines are not for at-risk infants.
Evidence does not recommend routine food-allergy testing before introducing highly allergenic foods to children who are at a high risk of reacting to these foods. However, the guidelines suggest considering limited food-allergy testing if the child has persistent eczema despite medical treatment or if the child has a reliable history of an immediate allergic reaction after eating certain foods.
Current pediatric guidelines suggest first introducing solid foods between 4 and 6 months of age, when an infant's development allows him or her to sit with support and have adequate neck control. Most guidelines suggest introducing one new food every three to five days and introducing highly allergenic foods — cow's milk, soy, eggs, wheat, peanut, tree nuts, fish and shellfish — after other complementary foods have been tolerated. Guidelines also suggest a gradual increase of the highly allergenic food if there is no reaction. Parents should notify their child's physician if their child has had an allergic reaction, which may include hives, rash, swelling in the face, tongue or lips and difficulty breathing.
What are the new recommendations and why did the recommendations change?
The official addendum to the 2010 NIAID food allergy guidelines is expected later this year, and it is expected to primarily focus on peanut allergy management. This will be one of the most significant new recommendations in the last six years.
In 2015, the Learning Early about Peanut [LEAP] study was published in the New England Journal of Medicine and examined the effect of peanut consumption in infants with severe eczema and/or egg allergy. The study found that early introduction, rather than avoidance, of peanuts into the diets of infants might be an effective strategy to prevent the development of a peanut allergy. A follow-up study showed that allergy protection lasted at least through age five.
What should a parent do if they introduce foods under the new guidelines and their child has an allergic reaction?
It is important for parents to know that any food can cause an allergic reaction. If a child has an allergic reaction, parents should seek medical attention immediately. Some parents may already have a food allergy action plan provided by their doctor that outlines symptoms of an allergic reaction and appropriate treatment. Parents and guardians should also follow up with a primary health care provider and consider consulting with an allergist.
What are the chances that a parent follows the new recommendations and the child has a dangerous or potentially life-threatening allergic reaction?
The prevalence of food allergies has increased and allergic reactions can be serious and sometimes fatal. The severity of reactions cannot be predicted. Infants in the LEAP study were evaluated by an allergist with skin testing for peanut before appropriate recommendations were made about peanut introduction.
Are there foods that should still be avoided?
Current guidelines suggest the early introduction of allergenic foods may prevent the development of future food allergy. Infants with severe eczema and/or egg allergy in the first for to six months of life may benefit from evaluation by an allergist to assist in early peanut introduction. Children with existing food allergies should follow the recommendations of their primary health care provider or allergist.
How could the new guidelines help lower the prevalence of food allergies?
About 1 percent to 2 percent of U.S. kids have a peanut allergy. The LEAP study has shown that for at-risk infants early introduction rather than avoidance may significantly decrease the risk of developing a peanut allergy.