When we become parents, one of the essential questions we ask allergies? How to prevent them? How to feed our babies? Should we be careful with highly allergenic foods?
So the guidelines that were published by the American Academy of Pediatrics (AAP) in year 2000, where they advised to delay the introduction of these highly allergenic foods to infants with high risk in order to prevent the development of allergies. Cow’s milk and dairy products to be delayed for one year, eggs for two years, fish for three years as well as nuts and peanuts. However there was an article that was released quietly last year that contrasts the AAP guidelines.
This conflicting article was published in the Journal of Allergy and Clinical Immunology (JACI) in January 2013 about food allergens, affecting how parents introduce allergenic foods to their babies. It is a much regarded journal from the American Academy of Asthma, Allergy and Immunology (AAAAI). There is no feasible current evidence that shows that delaying weaning onto solid foods beyond 4 to 6 months will prevent allergic diseases, and the it if the introduction of solids, especially those that are highly allergenic, if delayed, may INCREASE the risk of food allergies or eczema.
There was an updated report by AAP where no strong evidence was shown about the delay of these foods, and still AAP didn’t provide new guidelines about how and when to introduce the foods. The article from January 2013, provides the general guidelines and advices for the practicing primary care physicians who must answer the question on daily basis – what to tell parents when they ask about this topic.
Why this contradictory statement?
The professor of Pediatrics and director of Pediatric Allergy Clinical Services at Riley Hospital for Children-IU Health in Indianapolis, Dr. Frederick E. Leickly, states that there is a wonderful moment in time when the immune system of those allergy – prone children will develop tolerance instead of sensitivity to those foods. The guidelines that were followed so far were not really based on evidence. When the allergies from food became a more common diagnosis in the 90s, doctors advised that if these highly allergenic foods are delayed, they would decrease the prevalence of allergies. But in contrast, allergies became even more prevalent over the next decade. The doctor stressed that with the article, they are making meaningful contribution to the world facing the food allergies, and will make quite a difference in public health issues with them.
And this big change cannot be easy for the parents to practice, especially those parents who have experience with serious food allergies. But there are some advices on how to slowly introduce small amounts of the foods under medical supervision, done in Leickly’s clinic.
It can make a big difference with these recommendations, it can get us to primary prevention.
So now, how to slowly introduce these foods?
*Important notice – these recommendations from the article of JACI are not meant for children who already have developed allergic condition.
Don’t start immediately with the highly allergenic foods. First start with offering some complementary foods, and once they are tolerated, you can start introducing the highly allergenic ones.
Acidic fruits do not need to be delayed (some may cause rashes or hives because of acid irritation on the skin, or the chemicals in the fruits) because usually they don’t result in serious reactions.
Until the age of 1 you should avoid whole cow’s milk. Some dairy products that are cow milk based, like infant formulas, cheese, yogurt can be consumed before age of 1.
You should avoid whole peanuts and tree nuts because of the aspiration risk, you don’t want to risk your baby swallowing a whole peanut, however, you can give them peanut butter (and other nut butters)
Complementary foods (one ingredient)
*Rice or oat cereal
*Yellow or orange vegetables
*Age-appropriate staged foods with meats
How to introduce the highly allergenic foods:
Be at home when you initially taste these foods, do not do it out in a restaurant or similar.
Have in mind that some foods, as peanuts, will have a reaction mostly with the first ingestion.
If you don’t notice a reaction, you can give the food step by step, increasing amounts gradually.
Don’t give new foods at once, one by one new food should be introduced every 3 to 5 days.