With food allergies on the rise, parents often struggle with what is the right time to introduce potentially allergenic or so-called trigger foods to their baby – foods like milk, eggs, peanuts, tree nuts, wheat, soya and fish.
The old advice – wait. New advice – don’t wait.
“If parents ask how to prevent allergy in their children, our current advice is to introduce the allergenic foods at four to six months of age,” according to allergist Elissa Abrams.
In 2000, the American Academy of Pediatrics recommended the avoidance of cow’s milk until the age of 12 months, eggs until 24 months, and nuts and fish until 36 months in infants at high risk.
“We thought that if you allowed your gut and your immune system more time to mature, children were less likely to become allergic when they ate these foods,” Abrams told Global News.
Since then food allergy rates have skyrocketed and are still increasing: according to Food Allergy Canada the incidence is highest among young children (under three years of age) with close to six to eight per cent affected by food allergy.
More research has been conducted that supports the case for early introduction, according to Abrams.
“There is a growing body of evidence that waiting is not helpful and in fact may be harmful especially in these high-risk children,” said Abrams.
“In fact waiting seemed to increase the risk that you would become allergic,” said Abrams.
Abrams says the focus has shifted.
“We are actually in the middle of a food allergy epidemic, which is why it is so important that we focus on prevention.”
Once you introduce a food – your baby should eat it regularly
Another important recommendation Abrams makes – once you introduce a food, keep it coming.
“Once these infants start eating these foods they need to be exposed to them regularly – meaning it’s not enough to give an infant peanut once – and then say ‘great they did not react, they are not allergic’ and not keeping feeding it to them,” Abrams said.
“There actually is a chance if you wait a long time they could react when they eat it again, so once they are eating these foods they need to eat it regularly.”
Abrams and colleague allergist, Allan Becker, from the department of Pediatric Allergy and Clinical Immunology at the University of Manitoba, reviewed more than 100 studies, including a newly published trial — the Learning Early About Peanut (LEAP) study. It found that “introducing peanut early, rather than late, in high-risk children reduced the risk of food allergy by as much as 80 per cent. However, children at high risk of peanut allergy may benefit from an allergist’s evaluation before peanut introduction.”
Abrams and Becker’s review is published in the Canadian Medical Association Journal (CMAJ).
According to the review, “as a result of the LEAP study, groups such as the American Academy of Allergy, Asthma and Immunology, the American Academy of Pediatrics and the Canadian Society of Allergy and Clinical Immunology, now state that for infants at high risk, there is strong evidence to support the introduction of peanut between four and 11 months.”
The Canadian Paediatric Society came out with guidelines in 2013 recommending introducing allergenic foods at 6 months.
“The take-home message for families is that infants do not need to delay introduction of these foods that are commonly allergenic,” said Abrams. “So things like milk, peanut, eggs, wheat — once families start feeding their infants solid foods, they can feed them, with very few exceptions, the foods that commonly cause allergies.”