Abstract
BackgroundThe timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. The American Academy of Pediatrics offers dietary recommendations that were updated in 2008.ObjectiveIdentify the recommendations that general pediatricians and registered dietitians provide to parents and delineate any differences in counselling.MethodsA 9-item survey was distributed to pediatricians and dietitians online and by mail. Information on practitioner type, gender, length of practice and specific recommendations regarding complementary food introduction and exposure was collected.Results181 surveys were returned with a 54% response rate from pediatricians. It was not possible to calculate a meaningful dietitian response rate due to overlapping email databases. 52.5% of all respondents were pediatricians and 45.9% were dietitians. The majority of pediatricians and dietitians advise mothers that peanut abstinence during pregnancy and lactation is unnecessary. Dietitians were more likely to counsel mothers to breastfeed their infants to prevent development of atopic dermatitis than pediatricians. Hydrolyzed formulas for infants at risk of developing allergy were the top choice of formula amongst both practitioners. For food allergy prevention, pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction.ConclusionsIn the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months. More dietitians than pediatricians believe that breastfeeding decreases the risk of atopic dermatitis. Practitioners may benefit from increased awareness of current guidelines.
Highlights
The timing of complementary food introduction is controversial
Pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction
In the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months
Summary
The timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. IgE-mediated food allergy (type I), forms the bulk of food-induced allergic responses and results in elevated allergen-specific serum IgE antibodies. It is not clear how the gut mucosal immune system is oriented toward sensitization versus immune tolerance when exposed to dietary. The timing of the first introduction of complementary foods (food other than breast milk or infant formula) has been of great interest. Eczema is often the first manifestation of atopic disease, manifesting at 6 12 months old. Those with systemic allergic disease often have more than one food allergy, as well as asthma and allergic rhinosinusitis [6]
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