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SAN FRANCISCO -- The American College of Allergy, Asthma & Immunology will release updated guidelines that will recommend early introduction of peanuts to the diets of infants at high risk for peanut allergies, according to an announcement at the ACAAI annual meeting.
There is growing evidence that introducing allergenic foods to babies long before their first birthday protects against food allergies, but the optimal timing of introduction remains to be determined for foods other than peanuts.
Action Points
- Note that these guidelines were presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
However, in the landmark , infants at high risk for developing food allergies who were introduced to peanuts between the ages of 4 and 6 months were significantly less likely to develop peanut allergy, and they showed a modified immune response to peanuts.
The guidelines, slated for release in early 2017, will offer several methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. According to an ACAAI statement, "it is extremely important that parents understand the choking hazard posed by whole peanuts and to not give whole peanuts to infants. Peanut-containing foods should not be the first solid food your infant tries, and an introduction should be made only when your child is healthy. Do not do the first feeding if he or she has a cold, vomiting, diarrhea or other illness."
The ACAAI has released the "Peanuts and your baby: How to introduce the two."
High-risk infants also include those with severe eczema and/or recognized egg allergy. While the updated guidelines only address peanuts, "an infant at high risk of developing peanut allergy is one with severe eczema and/or egg allergy," according to the statement. The ACAAI stressed that, when appropriate, infants should undergo testing for allergies before introducing certain foods.
In a presentation at the meeting, , of the University of Melbourne and Royal Children's Hospital in Australia, said observational data, along with combined results from several clinical trials, suggest that the protection from early introduction extends beyond peanuts.
"There is consensus that delaying the introduction of allergenic solids beyond 1 year is probably harmful, and that we should probably not be allowing that to happen," she said.
In her group's of around 5,300 high-risk and normal-risk infants, babies introduced to cooked egg between 4 and 6 months had the lowest risk for developing egg allergies (OR=1.0). Babies introduced to eggs after their first birthday had a three-fold higher risk for developing egg allergies (OR 3.4, 95% CI 1.8-6.5).
A of randomized trials examining food introduction timing also found early egg introduction to be associated with lower risk of developing egg allergy.
"Even though the randomized, controlled trials haven't shown significance [individually], when you put them together, it appears that there is a protective effect for the early introduction of egg," she said.
She noted that this is certainly true for peanut allergies, based on the LEAP findings, but added that early introduction of cow's milk has not been shown to be as protective.
"It may well be that there are different windows of opportunity for introducing milk and egg and peanut, but we really don't know what they are at this point in time," she said.
Allen noted that the shifting timing of solid food introduction, and guidelines recommending delayed introduction of eggs, wheat, milk and other allergenic foods, may have played a part in the rising incidence of childhood food allergies.
"There seems to be an association between the two events. There has been a change in exposure to allergenic solids because of the progressive delay in the timing of exposure to solid foods," she said.
In the 1960s, the average age of introduction to solid foods was 2-months-old, but recommendations in the 1970s called for delaying solid food introduction until after 4 months.
Concerned about the increase reliance on formula feeding in developing countries, the World Health Organization (WHO) recommended exclusive breast feeding for the first 6 months of life in the 1990s, and in the early 2000s, WHO allergy guidelines recommended delaying cow's milk introduction until after the first birthday, while introducing egg after age 2 years, and introducing peanuts between ages 3 and 5 years, she said.
But subsequent studies suggested that delaying allergenic food introduction
"This remains a very controversial area, and it is important that we, as allergists and pediatricians, remain on top of this very important debate," Allen said.
, of Cincinnati Children's Hospital, who co-authored the ACAAI's peanut introduction guidelines, cautioned that the evidence for the early introduction of foods other than peanuts remains inconclusive.
"There is a lot we don't know, so I think it is premature to be making recommendations about these [non-peanut] foods," she told 51˶.
Disclosures
The guidelines are sponsored by ACAAI and the National Institute of Allergy and Infectious Diseases.
Primary Source
American College of Allergy, Asthma & Immunology
Allen K "Do LEAP results extend to other foods?" ACAAI 2016.