|July 26, 2006
Feeding solid foods to infants before 6 months
of age can increase the risk of allergies, while exclusive
breastfeeding for at least 6 months may prevent the onset of
allergic symptoms later in life, according to a paper published in
the Annals of Allergy, Asthma and Immunology.
The paper is the first consensus document
published in a peer-reviewed journal to recommend allergy-avoiding
strategies for introducing solid foods to the infant diet.
"This report reinforces the consensus of
organizations such as the American Academy of Pediatrics and the
World Health Organization, which recommend exclusive breastfeeding
for at least six months as optimal for infant and maternal
health," said lead author Alessandro Fiocchi, MD, University of
Milan Medical School, Milan, Italy. Dr. Fiocchi is chair of the
Adverse Reactions to Foods Committee of the American College of
Allergy, Asthma and Immunology (ACAAI), which prepared the consensus
Specific recommendations of the committee
- Exclusive breastfeeding (with no cow's milk
formulas or any supplemental food) is indicated during the first
six months of life because it has a preventive effect against
the onset of allergic symptoms that extends far beyond the
period of breastfeeding.
- Supplemental foods should not be introduced
during the first four months of life, as it is associated with a
higher risk of allergic diseases up to the age of 10 years.
- The avoidance of cow's milk in the early
months of life has been shown to be an effective means of
preventing allergies. "We concluded that delayed exposure
to solid foods should be similarly useful in preventing food
allergies," said co-author Amal Assa'ad, MD, Cincinnati
Children's Hospital Medical Center, Ohio.
- The main foods that pose a high allergy
risk include cow's milk, eggs, peanuts, tree nuts (such as
hazelnuts, walnuts, cashews, almonds, chestnuts, macadamias and
pistachios), fish and other seafood. "Other foods – even
staples such as fruits, vegetables, meats, soy and cereals –
also have the potential to cause allergies if introduced too
early," said co-author Sami L. Bahna, MD, DrPH, Louisiana
State University School of Medicine, Shreveport. The authors
noted that it seems "reasonable that foods should be
introduced selectively, individually and gradually" to
lessen the risk of allergy.
- Mixed foods containing a variety of
potential food allergens should not be given to infants until
tolerance to every ingredient has been evaluated individually.
- Cooked, homogenized foods are preferred to
their fresh counterparts when a reduced potential for causing
allergies has been clinically demonstrated, such as in the cases
of beef, vegetables and fruit.
"The timing after age 6 months at which
specific foods should be introduced depends on a number of factors,
including the individual infant's nutritional needs and risk for
allergies," Dr. Fiocchi said. It is generally considered
prudent not to introduce hen's eggs, fish, peanuts and nuts before
the age of 12 months, or later in infants at high risk of allergy,
the authors said.
The committee reached its consensus based on
an evidence-based review of published research related to food
allergies in infants.
The Annals of Allergy, Asthma and Immunology
is the official journal of ACAAI, a professional medical
organization headquartered in Arlington Heights, Ill., that promotes
excellence in the practice of the subspecialty of allergy and
immunology. The College, comprising more than 5,000
allergists-immunologists and related health care professionals,
fosters a culture of collaboration and congeniality in which its
members work together and with others toward the common goals of
patient care, education, advocacy and research.
Fiocchi A, Assa'ad A, Bahna S. Food allergy
and the introduction of solid foods to infants: a consensus
document. Ann Allergy Asthma Immunol 2006;97;10-21.
SOURCE: American College of Allergy, Asthma