7 things we should know about nutrition & prevention of allergic diseases in at-risk infants

Throughout the last two decades, there has been a steady upsurge in allergic disease, notably food allergies, that it has “emerged over the last 10-15 years as a ‘second wave’ of the allergy epidemic.¹

We are aware that allergic diseases have a genetic basis, but other factors are instrumental to its development. As a result, numerous studies recommend strategies such as early nutritional components and dietary interventions, to prevent allergies in the pre-natal stage to infancy. Evolving information has also led to the redefinition on high-risk infants, the use of hydrolyzed formulas, and the fundamental practice of early introduction of allergenic foods.²

Various international medical groups and societies regularly equip us with a good number of evidence-based guidelines and viable recommendations which this article hopes to underscore.

1.     MATERNAL AVOIDANCE OF ALLERGENIC FOOD

• Maternal avoidance of allergenic food during pregnancy & lactation is not recommended. There is insufficient evidence on the assertion that modifying the mother’s diet may help reduce the risk of allergy.^3,4

• A healthy and balanced diet for the mother is vitally important, notwithstanding the risk of food allergy.⁴

2.     BREASTFEEDING

• Exclusive breastfeeding is recommended for infants who are at least 4 months up to 6 months of age.³

• There is no recommendation for or against using breastfeeding to prevent food allergy, but knowing its benefits, it should be encouraged whenever possible.⁴

3.     USE OF HYDROLYZED FORMULAS

• There is no recommendation for or against the use of a hydrolyzed formula (partial or extensive) in preventing cow milk allergy in infants.⁴

• If a breastmilk substitute is needed, physicians should give proper advice for the best alternative; these choices could allow the use of a hydrolyzed formula.⁴

4.     INTRODUCTION OF COMPLEMENTARY FOOD

• The introduction of allergenic foods (peanuts, well-cooked egg) is recommended at about 6 months and not before 4 months of age, in a safe & developmentally-appropriate way at home.²

5.     ROLE OF PRE-, PRO- OR SYNBIOTICS

• There is no recommendation for or against pre-, pro- or synbiotics for pregnant/lactating women &/or infants alone or in combination with other approaches to prevent food allergy in infants & young children.⁴

6.     COW MILK FORMULA SUPPLEMENTATION

• There are no recommendations for or against the use of regular infant cow milk-based formula after the first week of life to prevent food allergy.⁴

• Doctors and families should be aware that infrequent supplementing with a cow milk formula may increase their infant’s risk for cow milk protein allergy.²

7.     VITAMIN D SUPPLEMENTATION

• There is currently not enough evidence to recommend vitamin D supplementation in preventing food allergies in infants.⁴

Through ongoing research, our understanding of the influence of early nutritional interventions in the management and prevention of food allergies is further enriched.

Improving accessibility of these reliable resources and educating parents with practical information is a step towards the right direction in reducing the risk of allergic disease.

REFERENCES:

1 Prescott S, Allen KJ. Food allergy: riding the second wave of the allergy epidemic. Pediatr Allergy Immunol. 2011 Mar;22(2):155-60. 

2 Abrams EM, Orkin J, Cummings C, Blair B, Chan ES. Dietary exposures and allergy prevention in high-risk infants. Paediatr Child Health. 2021 Dec 27;26(8):504-505.

3 Greer FR, Sicherer SH, Burks AW; COMMITTEE ON NUTRITION; SECTION ON ALLERGY AND IMMUNOLOGY. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics. 2019 Apr;143(4):e20190281.

4 Halken S, Muraro A, de Silva D, Khaleva E, Angier E, Arasi S, Arshad H, Bahnson HT, Beyer K, Boyle R, du Toit G, Ebisawa M, Eigenmann P, Grimshaw K, Hoest A, Jones C, Lack G, Nadeau K, O'Mahony L, Szajewska H, Venter C, Verhasselt V, Wong GWK, Roberts G; European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021 Jul;32(5):843-858.