New recommendations for preventing food allergies

Pediatricians and other healthcare providers should follow the guidelines published in 2008 by the American Academy of Pediatrics (AAP) that concluded there is no convincing evidence for delaying the introduction of specific, highly allergenic foods.

Since the 2008 guidelines, new data from randomized clinical trials (RCTs) in Europe and Australia now show that delaying introduction of highly allergenic foods, such as peanuts and eggs, actually may increase the risk of developing allergies to these foods.

Although similar RCTs have not yet been performed in the United States, David M. Fleischer, MD, in his presentation “Preventing food allergy through maternal or infant diet: New recommendations” on Monday, October 24, emphasized that the current data support not delaying introducing these foods.

“Data at this time demonstrate there is no reason to delay the introduction of any food, including all highly allergenic foods, into an infant’s diet beyond 4 to 6 months of age,” said Fleischer, who is associate professor of Pediatrics, director, Food Challenge Unit, and associate medical director of the Children’s Hospital Colorado Research Institute, University of Colorado Denver School of Medicine, Children’s Hospital Colorado, Aurora.

Lacking in the 2008 guidelines, however, was information on when and how to introduce highly allergenic foods, such as peanuts and eggs, into an infant’s diet. New data since the 2008 guidelines have shed some light on these issues that will be soon published in new recommendations.

Included in the revised guidance will be the recommendation to introduce peanuts early, around 6 months but not before 4 months in all children, especially in high-risk infants. Fleischer said that the National Institute of Allergy and Infectious Diseases (NIAID) has already changed its policy on peanut introduction with its recent update on peanut allergy prevention.

When to introduce eggs, Fleisher explained, is more difficult to determine based on the current data that offers no firm conclusion about the benefits of early egg introduction or its optimal timing. He cited data from a meta-analysis, however, that supports early introduction and emphasized that data from future trials will provide more clear guidance.

Fleischer also provided recommendations on how to introduce highly allergenic foods, including safe forms and ways to introduce peanuts to infants in the home, as well as advice for which infants should be seen by an allergist or pediatrician prior to a peanut introduction.

Of critical importance is implementation of these new recommendations. “Without the aid of primary care physicians to disseminate early introduction guidelines to the parents of young infants at 2- and 4-month well-child visits, the implementation of such recommendations will continue to fall short of their goal to reduce the risk of developing food allergy,” Fleisher said. 

Ms Nierengarten, a medical writer in Minneapolis, Minnesota, has over 25 years of medical writing experience, authoring articles for a number of online and print publications, including various Lancet supplements, and Medscape. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.