Timing of Introduction of Allergenic Complementary Foodsby Daniel Burns
FROM THE AMERICAN ACADEMY OF PEDIATRICS | CLINICAL REPORT | APRIL 01 2019
The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods
This clinical report updates and replaces a 2008 clinical report from the American Academy of Pediatrics, which addressed the roles of maternal and early infant diet on the prevention of atopic disease, including atopic dermatitis, asthma, and food allergy.
As with the previous report, the available data still limit the ability to draw firm conclusions about various aspects of atopy prevention through early dietary interventions.
Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation. Although there is evidence that exclusive breastfeeding for 3 to 4 months decreases the incidence of eczema in the first 2 years of life, there are no short- or long-term advantages for exclusive breastfeeding beyond 3 to 4 months for prevention of atopic disease. The evidence now suggests that any duration of breastfeeding ≥3 to 4 months is protective against wheezing in the first 2 years of life, and some evidence suggests that longer duration of any breastfeeding protects against asthma even after 5 years of age. No conclusions can be made about the role of breastfeeding in either preventing or delaying the onset of specific food allergies. There is a lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease.
There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease. There is now evidence that early introduction of peanuts may prevent peanut allergy.
The incidence of pediatric atopic diseases, particularly allergic skin disease and food allergy, have appeared to increase from 1997 to 2011.1 Although atopic diseases have a clear genetic basis, environmental factors, including early infant nutrition, have an important influence on their development. Thus, for pediatric health care providers, there is great interest in early nutritional strategies that may ameliorate or prevent this disease.
This clinical report updates and replaces a 2008 clinical report from the American Academy of Pediatrics (AAP), which addressed the roles of maternal and early infant diet on the prevention of atopic disease, including atopic dermatitis, asthma, and food allergy.2
The literature reviewed for this revised clinical report has largely been focused on new randomized controlled investigations, systematic reviews and meta-analyses, and recent recommendations from other professional groups. Of special note for this updated clinical report are the recently published investigations in which the relationship between the introduction (timing and amount) of complementary foods containing peanut and egg proteins and the development of food allergy is evaluated. On the other hand, information regarding the role of prebiotics and probiotics, vitamin D, and long-chain polyunsaturated fatty acids in the prevention of atopic disease is limited at this time and will not be discussed. This report is not directed at the treatment of atopic disease once an infant or child has developed specific atopic symptoms.
To read the AAP's full report and recommendation for introducing allergenic foods to infants, click here.