Disclosure :: this post is sponsored by Children’s Hospital.
My oldest child is now 11 years old. I vividly remember the food-allergy challenges our family faced during my son’s preschool years. Times have changed, and the approach to infant feeding has changed drastically. Only a decade ago, the medical community recommended to delay the introduction of highly allergenic foods. We now know that those old recommendations, by which I raised my son, are not the best action to take.
Introduce peanut early
Regarding early food introduction, the most convincing research comes from a large study conducted by leading experts in the field of allergy: Learning Early About Peanut Allergy (LEAP) study. The study showed that introducing peanut at 4 months of age may reduce the relative risk of developing peanut allergy by as much as 80%. Early introduction of highly allergenic foods is the right choice. Once a new food such as peanut is tolerated, it should continue to be consumed on a regular basis.
Use strict elimination diets only when necessary
Foods such as milk and egg cause eczema to flare in some children. An allergist can help in determining if foods are a trigger. However, it is important to allow tiny amounts of the food as a baked ingredient. The vast majority of children are able to tolerate milk and egg in this form. Research shows that in the setting of eczema, strict avoidance of foods (reading all labels to avoid the food completely) may place a child at higher risk for anaphylaxis (life threatening food reaction) once the food is reintroduced.
Moisturize baby’s skin
One of the simplest of recommendations is to use a fragrance-free emollient (skin moisturizer) beginning early in life. Applying emollient to baby’s skin at least once daily produced a 50% relative risk reduction for the development of eczema at age 6 months in one study. The importance of this prevention measure goes beyond the skin. Allergies often develop when a person is exposed to food proteins through inflamed skin. Therefore, protecting the integrity of the skin barrier may be a valuable tool in the prevention of food allergy.
If breastfeeding, do not alter your diet unnecessarily
Regarding breastfeeding, there are very few scenarios in which restrictions should be placed on mom’s diet. It is important to understand that intact food proteins are not passed through breast milk. However, small peptides (tiny fragments of the original food protein) do pass through breast milk. Such peptides are of the perfect (natural) size to be absorbed and processed by the infant’s digestive tract. In addition, exposure to these peptides may allow the infant’s immune system to learn that these materials are safe and that there is no need to form a reaction. Limiting the maternal diet unnecessarily only takes away an opportunity for the baby to develop this immunologic tolerance.
Question: “I am a breastfeeding mom. Should I remove cow’s milk from my diet?”
Answer: Only in very specific circumstances:
- If you, the mom, have severe allergy to milk
- If your baby has proven severe intolerance to milk*
- Infantile proctocolitis (bloody stool)
- Severe uncontrolled vomiting and diarrhea
*Infant’s symptoms are attributed to a food in mom’s diet only if symptoms resolve with a maternal food elimination trial. Consultation with an allergist or gastroenterologist may be needed.
If your newborn baby requires formula before you can breastfeed, consider special formula
A common scenario in the allergy clinic :: A mother brings in her one-year-old child due to immediate allergic reaction to cow’s milk. The mother asks, “I did everything I could, and my child has always been breastfed. How could she develop a food allergy?”
Often, on the first day of life, an infant born to a mother who intends to breastfeed is given a bottle of cow’s milk based formula. Following this exposure, some infants might develop an allergy antibody to cow’s milk. The best recommendation to prevent this scenario is this: for mothers who intend to breastfeed, talk to your pediatrician in advance to make sure that a partially-hydrolyzed formula (commercially available formula in which the milk proteins are partially broken down) is available in case your baby needs a bottle before you are able to produce breast milk. In addition, a lactation consultant may be very helpful with the initiation of breastfeeding as early as possible, thereby avoiding the need for formula. For infants who are not breastfed, starting feeds with a partially-hydrolyzed formula may be of benefit, especially for high-risk infants (those with significant family history of food allergy). Examples of partially-hydrolyzed formula include: Gentlease, Goodstart, and Total Comfort, among others.
Actions which may reduce the risk of food allergy:
- Introduction of foods, including peanut, should begin at 4 to 6 months of age.
- Once a new food is successfully introduced, continue to consume on a regular basis.
- Use fragrance-free emollients on the infant skin daily.
- Mothers who are pregnant and those who are breastfeeding should eat an unrestricted diet.
- Infants who briefly require formula at birth, prior to initiation of breastfeeding, should be given partially-hydrolyzed formula.
As the medical community, we learn and we grow as we weigh the best evidence and gain experience. Our current best insight is this: Introduce foods early. Avoid foods only when necessary.
- Some allergic conditions may require strict avoidance of foods:
- Previous anaphylaxis to a specific food
- Severe gastrointestinal symptoms (bloody stool or profound vomiting and diarrhea)
- Allergy to peanut, tree nuts, seafood
- Infants who have already demonstrated significant food allergy (such as immediate reaction to egg) or severe eczema may benefit from evaluation by an allergist prior to peanut introduction.
- Because infants cannot chew solid foods, textures/forms which can be safely swallowed must be chosen (for example, mixing a small amount of peanut butter into a bowl of rice cereal).
Disclaimer: This article summarizes current evidence and opinions from the allergist’s perspective. All comments are intended for the sole purpose of expanding general knowledge. Comments should not be taken as medical advice for specific patient scenarios. These concepts must be weighed in the context of the patient’s unique situation by the medical expert, in direct clinical consultation.
About Dr. Luke Wall
Dr. Luke Wall, a husband and father of three children, is board certified in both Pediatrics and Allergy/Immunology. He is a Clinical Assistant Professor at LSU Health New Orleans. He treats all types of allergic conditions as well as primary immunodeficiency at Children’s Hospital, New Orleans. His clinic locations include New Orleans, Metairie, Covington and Baton Rouge.