New tips to prevent food allergies in children

Giving a baby a new food to try is fun, and that should be the case. The only concerns that parents should have: find their phone quickly enough to document the grimaces and clean up any damage that might result. However, in recent years, scientific evidence has quickly accumulated on the foods to introduce, when and how best to prevent allergies, leaving the parents to follow everything.

On Monday, after a detailed review of all available evidence on the subject, the American Academy of Pediatrics has issued updated guidelines on what works and what does not work in the prevention of food allergies and other allergic conditions. The new guidelines continue to liberalize the introduction of what are thought to be highly allergenic foods such as peanuts, fish and milk.

There is no convincing evidence that delaying the introduction of allergenic foods beyond 4 to 6 months helps prevent food allergies, the report says. In addition, there is strong evidence that a voluntary and targeted introduction of peanuts as early as 4 months of age could prevent the occurrence of an allergy to peanut in high-risk infants, defined in this report as those with a close relative with a history of allergic disease. .

"There is no reason to delay giving your baby foods that are considered allergens like peanut products, eggs or fish," said Dr. Scott. Sicherer, co-author of the report, in a statement. "These foods can be added to the diet early, just like foods that are not common allergens, like rice, fruits or vegetables."

The gastrointestinal tract is home to a unique set of immune system cells, and when these cells taste allergenic proteins in different foods, they absorb these proteins and become tolerant to them. Dr. David Stukus, pediatric allergist and associate professor of pediatrics at the Division of Allergies and Immunology at the Nationwide Children's Hospital, said that it was true "as long as it is introduced early and from continuous way ", which means that there is a critical time window. during which the introduction of these foods can cause the body to become tolerant.

And early means from the age of 4 to 6 months, said Stukus, who was not involved in the new guidelines.

The report also examined whether breastfeeding protects against eczema, wheezing, asthma and food allergies.

The authors concluded that exclusive breastfeeding during the first three to four months of life was protective against eczema. Any amount of breastfeeding beyond this period, although not exclusive, was considered protective against wheezing during the first two years of life and asthma in the first five years and even later . The report says that no conclusion can be drawn regarding breastfeeding and its effect on the prevention of food allergies.

No evidence was found stating that avoiding allergenic foods during pregnancy or breastfeeding contributed to the prevention of allergic conditions. The use of special hydrolyzed formulas has also not been used, even in children at high risk.

"I really appreciated the completeness of this clinical report," said Dr. Wendy Sue Swanson, General Pediatrician and Head of Digital Innovation at Seattle Children's Hospital.

Swanson, who has long advocated the early introduction of a variety of foods in young children, expressed gratitude for the advice given, given the ongoing changes in the understanding of allergy prevention.

How thought has changed

In 2000, the American Academy of Pediatrics recommended to postpone the introduction of cow's milk until the age of 1 year, the egg up to 2 years old and peanuts, nuts and fish up to 3 years old.

"The recommendations were to avoid allergenic foods until the kids are older," Stukus said. "The thought process at the time was, well, if we avoid any exposure, maybe the allergic response will not develop."

In 2008, after a review of the available literature, the organization released a report that there was no convincing evidence that delaying the introduction of allergenic foods prevented allergies food. The report did not give a precise indication of when these foods should be introduced.

Nearly 10 years later, following the publication of a study in the New England Journal of Medicine, the academy recommended that babies at high risk of developing peanut allergy be introduced to peanuts as early as four months. Infants considered high risk included those with eczema and / or egg allergy.

This study, known as LEAP Peanut Learning or Early Early Peanut, found that children at high risk of developing peanut allergy introduced into peanuts at 4 to 6 months of age a much lower risk of developing a peanut allergy than up to the age of 5; 1.9% of children who had peanuts in the beginning developed an allergy, compared to 13.7% of children who waited.

The LEAP trial served as a basis for Monday's new recommendations, which encourage the early introduction of peanut products in infants at high risk of allergy.

But most babies are not at risk and peanuts are just one of eight responsible foods; the others are milk, eggs, fish, crustaceans, wheat, soy and nuts, according to US Centers for Disease Control and Prevention.

Proof for other foods and children

The latest report explains that the same mechanism that protects high-risk infants is likely to protect infants at low or standard risk of developing food allergies.

A study of these other foods, known as the Tolerance Investigation Study (TES), recruited 1,303 3-month-olds and randomly assigned them to six allergenic foods – peanut, boiled egg, cow's milk , sesame, whitefish and wheat – at this age or wait until 6 months. The team then measured whether these infants had developed food allergies between 1 and 3 years of age.

Only 40% of parents were able to track the diversified meal frequency recommended by the study protocol. When researchers looked at data from all children in the study, no difference was found in food allergy rates. When they only looked at children whose parents had been able to keep pace with food, there was a significant reduction in peanut and egg allergies.

"The EAT study provides some evidence but is less robust than the evidence from the LEAP trial," said Dr. Elizabeth Matsui, pediatric allergist and chair of the section on allergy and respiratory disease. Immunology of the American Academy of Pediatrics, comparing the trial comparing different foods to the test. it involved peanuts. When the risk of illness is relatively low, it is very difficult to prove that it can be further reduced, she added.

An important test to draw from the test is that it is safe to introduce a variety of foods as early as 4 months of age, Stukus explained.

Most of the time, the data indicates the benefit of an early introduction of food products, Swanson said. "I do not want kids to delay the introduction. Stop medicalizing that and let the babies eat, "she added.

The essential for parents

"It's not just an early introduction. It's the routine diet. It's getting used to it. We must make the habit of eating a very wide variety of foods, "said Swanson. "It's a good habit to live all your life because 50% of people who develop a food allergy develop it into adulthood."

In his practice, Stukus began to recommend the early introduction, between 4 and 6 months, of allergenic foods for all babies, regardless of their individual risk. He encourages parents to continue giving these foods several times a week to babies who tolerate them.

"I think the benefits far outweigh the risks in this situation," he said.

The most serious risk is anaphylaxis, a serious allergic reaction that can be life threatening. But in most young children, Stukus says, anaphylaxis is manifested by vomiting and hives, without difficulty breathing and closing the airways in older children.

Parents who detect vomiting or hives – especially together – should always consult a doctor. But pediatricians and parents can rest assured that these foods can be introduced freely at home, reversing decades of fear when introducing new foods, he added.

"We come from a place of restriction and medicalization," Swanson said. Pediatricians were good at telling parents to be cautious, and now they must be strong enough to tell parents not to pay attention.

"No, I do not want you to be careful. In fact, waiting could cause damage, "she said.

This content has been republished with CNN's permission.