New Recommendations from the American Academy of Allergy, Asthma and Immunology
With the rising prevalence of atopic disease (or diseases that pertain to allergies), primary prevention may play a role in reducing its incidence, especially in high risk infants. The Adverse Reactions to Foods Committee of the AAAAI (American Academy of Allergy, Asthma, and Immunology) was charged with the task of helping allergists, primary care and specialist physicians with guidelines about nutritional interventions based on current available literature and expert opinion.
The recommendations supported by current data are the following:
- Avoidance diets during pregnancy and lactation are NOT recommended, but more research is necessary for peanut allergies.
- Maternal avoidance of cow’s milk and egg during pregnancy and lactation does not affect the incidence of allergic disease.
- There is no clear evidence that either early maternal exposure to, or avoidance of exposure to peanuts has an effect on the later development of peanut allergy, but more studies are needed in order to provide a conclusive recommendation.
- Exclusive breast-feeding for at least 4, and up to 6 months of age, is endorsed.
- This may possibly reduce the incidence of atopic dermatitis in children younger than 2 years.
- May reduce early onset wheezing before the age of 4.
- Does reduce the incidence of cow’s milk allergy (but not food allergy) in the first 2 years.
- For high risk infants (asthma, eczema) who cannot exclusively breastfeed, it is recommended that hydrolyzed formulas (Alimentum, Nutramigen) offer an advantage in preventing allergic disease and cow milk allergy.
- Reduces the risk of atopic dermatitis up to the age of 6 when used as a supplement or substitute for breast milk.
- No effect was observed on asthma or food allergy.
- Studies are needed to see if the benefit persists beyond age 6.
- There is NO advantage of soy formula.
- Complementary foods (solids) can be introduced between 4-6 months of age.
- They are necessary to support growth and to supplement nutritional needs.
- New foods should be introduced at a rate of one new food every 3-5 days.
- A baby should be able to sit with support and have sufficient head and neck control before starting solids.
- AAP recommends NOT giving solids before 4 months of age and exclusive breast feeding is preferred until 6 months of age.
- Feeding solids before 4 months of age associated with a higher incidence of atopic dermatitis – with an effect detected 10 years later.
- No current evidence suggests that delaying solids beyond 6 months will prevent allergic disease.
