When to Wean? The Relationship Between Solid Foods and Allergies
October 19, 2006—A recent review of 52 studies found that introducing certain foods to infants too soon can increase risk of food allergies. The review also found that some foods are more allergenic than others, and some food allergies are more persistent than others.
“Pediatricians and allergists should cautiously individualize the introduction of solids into the infants’ diet,” said Alessandro Fiocchi, MD, of the University of Milan Medical School, in Milan, Italy. Dr. Fiocchi is chair of the Adverse Reactions to Foods Committee of the American College of Allergy, Asthma and Immunology (ACAAI), which reviewed the studies and created a consensus document, published in the journal Annals of Allergy, Asthma and Immunology. The document recommends that dairy products not be introduced before age one, hen’s egg not before age two, and peanut, tree nuts, fish, and seafood not be introduced before age three.
It is now beyond any reasonable dispute that early introduction of cow’s milk and other dairy products increases the risk of allergies and possibly diabetes in at-risk infants. However, no evidence- or consensus-based guidance is available and there is no standard schedule for weaning infants, whether they are healthy or at risk for allergy.
The American Academy of Pediatrics (AAP) recommends exclusive breast-feeding for at least 6 months, followed by the gradual introduction of solid foods in the second half of the first year and continued breast-feeding for up to 12 months or as long as is desired thereafter by both mother and child. Similar recommendations have been made by UNICEF and the World Health Organization (WHO). A variety of cultural and social pressures cause many parents to follow a different schedule; however, many parents may be more willing to buck some of the common practices (such as early weaning to enable return to the workplace) if they understand that their child’s health may be at stake.
The new study assessed the available evidence of allergy risk from introduction of various foods at different times, and came up with the following recommendations for food introduction:
- Exclusive breast-feeding, excluding cow’s milk formulas and any supplemental foods, for the first six months of life protects against allergy development far beyond the period of breast-feeding.
- Consistent with current WHO recommendations, introducing foods during the first four months raises a child’s risk of allergies through age ten. If necessary, some foods in addition to continued breast milk can be introduced starting at six months.
- The main foods posing an allergy risk are cow’s milk, eggs, peanuts, tree nuts, fish, and seafood. Other foods can become significant allergens if they are introduced early. Foods should be introduced individually and gradually.
- Mixed foods containing various food allergens (such as pizza, which has dairy and wheat) should not be given unless tolerance to every ingredient has been demonstrated.
“The optimal age for the introduction of selected supplemental food should be six months,” concluded Dr. Fiocchi. “Particularly in children with family history of allergic disease, attention must be paid to the introduction of hen’s egg, peanut, tree nuts, fish, and seafood.”
(Ann Allergy Asthma Immunol 2006;97:10–21)
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Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.
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