Food Allergy Prevention

Background

Food Allergy (FA) prevalence is very high across the developed world with the highest prevalence in infants and young children.  Prevalence in Irish children is 4.45%.
FA, especially nut, seed and fish allergy is usually a lifelong condition associated with impaired quality of life for those affected and their families. This is due to the restrictions imposed to prevent severe accidental reactions and the burden of having to remain emergency prepared.
High levels of FA also bring with it substantial healthcare costs for hospital visits, ED attendances, Food Challenges, medication costs etc.
There is no straightforward FA cure. Oral Immunotherapy (OIT) is a labour-intensive process for both families and health care professionals. Its risks include anaphylaxis and the development of Eosinophilic Oesophagitis.
Allergy prevention strategies aim to direct the infant human immune system to develop tolerance to a food allergen before it can develop allergy antibody responses. This is most difficult to achieve in infants with moderated to severe eczema as their immune system can be exposed to food allergens, in early infancy, through their defective skin barrier. This exposure pathway promotes the development of an allergic response. In contrast, early oral exposure fosters tolerance.

All health care professionals involved in the care of expectant, and new mothers and infants have a role in promoting evidence based allergy prevention strategies.

Current Recommendations

Pregnancy

  • Mothers should be discouraged from restricting consumption of any potential food allergens during pregnancy  as there is no evidence that this will prevent food allergy.
  • There is currently no satisfactory evidence base that consumption of pro or prebiotics,or synbiotics  in pregnant can  prevent infant FA.

The first 6 months of infancy

  • All infants should be exclusively breast fed until 6 months of age and breast feeding should be encouraged and supported in conjunction with weaning to solids for up to 2 yrs.
  •  There are no evidence based strategies for FA prevention during breast feeding. Mothers should be encouraged to eat a healthy balanced diet.
  •  There is no evidence that extensively hydrolysed formula prevent the development of FA. There is currently no satisfactory evidence base that consumption of pro or prebiotics,or synbiotics  in breastfeeding women can  prevent infant FA.

Introducing solid food

  • Well-cooked hen’s egg (mashed hard bolied), should be introduced into an infants diet as part of complementary feeding as soon as weaning begins to prevent egg allergy.
  • Peanut should be introduced into the infant diet in an age-appropriate form (butter or crushed nuts) as part of complementary feeding to prevent peanut allergy. This should occur as soon as weaning begins and definitely before 1 year of life. A heaped teaspoonful 2-3 times per week is recommended. This should be continued throughout preschool years.
  • It is recommended to avoiding supplementing with cow’s milk formula in breastfed infants in the first week of life to prevent cow’s milk allergy in infants and young children.
  • There is no evidence that delaying introduction of any other allergenic foods; tree nuts, soy, sesame, wheat, fish and other seafood beyond 1 year of age can be recommended and so early introduction of these is also advised.

 

Screening

Screening for food allergy using sIgE and or skin prick testing before embarking on food allergy prevention is discouraged as it risks false positive results and delays introduction.

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