Abstract
Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk of developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula-feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. This article has already been published (Paediatr Child Health. 2013 Dec;18(10):545–54), and is being re-published with permission from the original publisher, the Canadian Paediatric Society.
Highlights
The prevalence of food allergy in Canada, based on selfreported data, is estimated to be approximately 7%, a number sufficient to make primary prevention a desirable health care goal [1]
There has been a recent shift in evidence-based practice to prevent food allergy in high-risk infants
Delaying the introduction of certain ‘trigger’ foods for periods previously recommended has been shown to have no protective effect on allergic sensitization and disease development
Summary
The prevalence of food allergy in Canada, based on selfreported data, is estimated to be approximately 7%, a number sufficient to make primary prevention a desirable health care goal [1]. Introducing solid foods In 2000, the American Academy of Pediatrics recommended delaying the introduction of potential ‘trigger’ foods (eg, cow’s milk protein until one year of age, egg until two years of age, and peanut or seafood until 3 years of age) for infants at high risk of developing allergy [25] This advice was based on expert opinion because there were no convincing data to support this position at the time. The same investigators have created the EAT (Enquiring About Tolerance) study to determine whether even earlier introduction of specific foods decreases the risk of food allergy Their prospective trial randomly assigned unselected infants with no increased risk of allergy to regular consumption (ie, several times per week) of allergenic foods (eg, cow’s milk, egg, peanut, fish, sesame, wheat) starting at either three or six months of age [36]. Regardless of timing, once a new food is introduced by parents, it appears prudent to recommend regular exposures (eg, several times a week and with a soft mashed consistency to avoid risk of choking) to maintain oral tolerance
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