Essential tips for preventing food allergies
On day two of the 2021 American Academy of Pediatrics National Virtual Conference and Exhibition, Dr. Hernandez-Trujillo, Division Director, Allergy and Immunology, and Fellowship Training Program Directory, Allergy and Immunology in Hospital for Kids Nicklaus of Miami, Florida began his session on Essential Tips for Preventing Food Allergies in Children by explaining, “Food allergies affect about 8% of kids, or about 2 kids per class in the US. “As the pediatrician plays a key role in early nutrition, discussion with parents regarding the introduction of solid foods is essential. “
New parents and families often ask questions about the need for dietary restriction during pregnancy, Hernandez-Trujillo noted, but there is actually a lack of evidence supporting dietary restriction during pregnancy and breastfeeding. However, Hernandez-Trujillo pointed out, “exclusive breastfeeding for the first 3-4 months of a child’s life decreases the incidence of eczema in the child’s first 2 years.” Breastfeeding beyond 3 to 4 months also protects against wheezing for the first 2 years.
Other questions parents often ask pediatricians relate to the choice of formulas and the late introduction of foods, says Hernandez-Trujillo. On these points, there is no convincing evidence for the use of soy formulas in the prevention of allergies, little evidence that hydrolyzed formulas prevent atopic disease, and no evidence supporting the delayed introduction of solid foods beyond 4-6 months in protection against atopic disease.
“Times are changing: recommendations to avoid solid and ‘allergenic’ foods for up to 3 to 5 years are no longer recommended,” explains Hernandez-Trujillo, but breastfeeding for 4 to 6 months is recommended, without introduction solid until at least 4 months. Noting the Learning Early About Peanut Allergy (LEAP) study, Hernandez-Trujillo said: “The take-home message from this study was that the early introduction of peanuts significantly decreased the frequency of peanut allergy development in children. high risk children. “
Next, Hernandez-Trujillo highlighted the 2016 Inquiring About Tolerance (EAT) study, which was designed to investigate the best time to introduce 6 allergenic foods into infant diets: cow’s milk, peanut, egg, sesame, fish and wheat. The study proved that the early introduction of this food group resulted in a lower prevalence of food allergies, was feasible and safe.
Hernandez-Trujillo then discussed additional guidelines for peanut allergy prevention in the United States, a report from the National Institute of Allergy and Infectious Diseases. The rough guidelines state that infants with an egg allergy, severe eczema, or both should be assessed by testing peanuts prior to introduction; infants with mild to moderate eczema should be introduced to peanuts at 6 months; and infants without eczema or egg allergy should be introduced at parental preference.
When it comes to introducing peanuts, says Hernandez-Trujillo, “always keep in mind the form of food given to an infant or toddler, and remember the risk of suffocation.” In addition, “regular consumption from the start is necessary to ensure tolerance: encourage the consumption of 2 teaspoons of peanut butter 3 times per week,” she said. There should be no introduction of food if the child is sick, and finally, she adds, “adults should spend at least 2 hours after feeding to watch for a possible allergic reaction.” Good peanut products to try, she suggested, include peanut sprouts, diluted smooth peanut butter, smooth peanut butter puree, and peanut flour or powder. peanut. And “although allergic reactions are rare at the time of introduction,” she warns, “if there is a severe allergic reaction, the child should avoid food and be evaluated and tested, without reintroduction until. until the test is complete. ” She also reminded healthcare professionals that “anaphylaxis can be difficult to diagnose in infants because they are not verbal, so adults should be able to monitor and identify any potential allergic reactions.” Finally, she noted: “Be careful with panel testing. Large panels of foods can lead to unnecessary avoidance of foods. Additionally, children who eat a food and tolerate it should continue to consume that food, which should be kept in mind because while panel testing can be easy, it really leads to unnecessary food avoidance and can have an impact on the overall nutrition of the child. . “
Hernandez-Trujillo concluded the session by highlighting overall strategies for a safe introduction of foods, including open communication with parents regarding the benefits of early introduction; providing in-office meals to patients who may be at risk for a reaction; examination of signs and symptoms of allergic reactions; and what to do if you have an allergic reaction. She also reminded practitioners to discourage dietary restrictions during pregnancy or breastfeeding to prevent atopic disease and to remember that “if a child has developed a food allergy, treatment requires identification of the allergen and food restriction ”.
1. Hernandez-Trujillo V. Essential tips for preventing food allergies. AAP 2021 national conference and exhibition, virtual. Accessed October 9, 2021.