Tuesday , November 24 2020

There is new advice to prevent food allergies in children



On Monday, based on a detailed review of all available evidence on the subject, the American Academy of Pediatrics published updated guidance on what works and what does not do when it comes to preventing food allergies and other allergic conditions. The new guidelines continue to liberalize the introduction of what is believed to be highly allergenic foods such as peanuts, fish and milk.

There is no convincing evidence that the delay in the introduction of allergenic foods over 4 to 6 months works to prevent food allergies, the report says. In addition, there are strong indications that targeted, early introduction of peanuts as early as 4 months can prevent the development of a peanut allergy in high-risk infants, as defined in this report as those with a close relative with a history of an allergic condition .

"There is no need to delay giving your baby food that is considered allergens such as peanut products, eggs or fish," Scott Sicherer, co-author of the report, said in a statement. "These foods can be added to the diet early, like foods that are not common allergens, such as rice, fruit or vegetables."

The gastrointestinal tract is home to a unique set of immune system cells, and when these cells taste the allergenic proteins in different foods, they take up these proteins and become tolerant to them. Dr. David Stukus, a pediatric allergy sufferer and an assistant professor in the Division of Allergy and Immunology at the Nationwide Children's Hospital, said it is true "as long as it is introduced early and on-going", meaning there is a critical window window during which Introduced these foods can cause the body to become tolerant.

And early on means 4 months to 6 months, said Stukus, who was not involved in the new guidelines.

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The report also examined whether breastfeeding protects against eczema, wheezing, asthma and food allergies.

Exclusive breastfeeding during the first three to four months of life proved to be protective of eczema, the authors concluded. Any amount of breastfeeding beyond that time, although not exclusive, proved to be protective against wheezing for the first two years of life and asthma during the first five years and even later. The report says it could not be concluded when it comes to breastfeeding and its effect on food allergy prevention.

No evidence was found to avoid allergenic food during pregnancy or during breastfeeding prevention of allergic conditions. Also, no special hydrolyzed formulas were used, even in children at high risk.

"I really appreciated this clinical report," said Dr. Wendy Sue Swanson, a general pediatrician and head of digital innovation at Seattle Children's Hospital.

Swanson, who has long spoken for the early introduction of a variety of foods in young children, describes the feeling grateful for the guidance given the ongoing changes in the understanding of allergy prevention.

How the thinking changed

In 2000, the American Academy of Pediatrics recommended delays in the introduction of cow's milk until children were 1 year old, eggs up to 2 years and peanuts, nuts and fish for up to 3 years.

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"Recommendations were to avoid allergenic foods until children were older," Stukus said. "The thought process at that time was good if we avoid any exposure, the allergic response might not develop."

In 2008, following a review of the available literature, the organization published a report saying that there were no convincing signs that delay of allergenic food intake prevented food allergies. The report did not provide specific guidance on when these foods should be introduced.

Nearly 10 years later, after a study was published in the New England Journal of Medicine, the Academy recommended that babies at high risk of developing peanut allergy be introduced into peanuts as early as 4 months. Infants are considered at high risk including those with eczema and / or egg allergy.

This study – known as Learning Early About Peanut or LEAP trial – showed that high-risk children who develop peanut allergy introduced to peanuts at 4 months to 6 months of age had a significantly lower risk of developing a peanut allergy than them. who waited until 5 years of age 1.9% of the children who had peanuts developed an allergy early on compared to 13.7% of the children waiting.

The LEAP test formed the basis for Monday's new recommendations, which encourage early introduction of peanut products in infants at high risk of allergy.

But most babies are not at high risk, and peanuts are just one of the eight culprits; the others are milk, eggs, fish, crustaceans, wheat, soy and wood nuts, according to the American Centers for Disease Control and Prevention.

Evidence for other foods and children

The latest report explains that the same mechanism that protects high-risk infants is likely to protect infants with low or standard risk of developing food allergies.

A study investigating these other foods, known as the issue of tolerance or EAT trials, recruited 1,303 3-month and randomly assigned them to receive six allergenic foods – peanut, boiled eggs, cow's milk, sesame, whitefish and wheat – in the age or waiting for 6 months The team then measured whether these infants developed food allergies between 1 and 3 years.
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Only 40% of parents were able to keep up with the different food frequency recommended by the study protocol. When the researchers looked at the data from all the children in the study, no difference was found in the amount of food allergies. Since they only looked at the children whose parents had been able to watch the food, there was a significant reduction in peanut and egg allergies.

"The EAT study provides some evidence but is less powerful than the LEAP evidence," said Dr. Elizabeth Matsui, Pediatric Allergy and Chairman of the American Academy of Pediatrics Section on Allergy and Immunology, comparing the experiment with the various foods to peanuts involved. When the risk of a disease is relatively low, which turns out to be reduced, it is very difficult, she added.

An important pick-up from the trial is to introduce a variety of foods as early as 4 months is safe, Stukus explained.

Overwhelmingly, the data points to the benefits of early feeding, Swanson says. "I don't want the kids to delay the introduction. Stop adding this medicine and let babies eat," she added.

Main line for parents

"It's not just early introduction, it's routine feeding. It's habituating. We have to make a habit of eating very different foods," Swanson said. "It's a great habit to have your whole life because 50% of people who develop a food allergy develop in adulthood."

In his practice, Stukus has begun to recommend early introduction – between 4 and 6 months – of allergenic foods to all babies, regardless of their individual risk. He encourages parents to continue giving these foods several times a week to babies who tolerate them.

"I think the benefits far outweigh the risks in this situation," he said.

The most serious risk is anaphylaxis, a serious allergic reaction that can be life-threatening. But in most young infants, Stukus explains that anaphylaxis manifests as vomiting and river haemorrhage, without breathing and closed airways that can be seen in older children.

Parents who discover vomiting or river leaves – especially together – still need to seek medical attention. But both pediatricians and parents can be sure that these foods can be introduced freely at home, turning decades of fear into the introduction of new foods, he added.

"We come from a place of restriction and medical treatment," Swanson said. Pediatricians were strong in telling parents to be cautious, and now they need to be strong by telling parents not to be careful.

"No, I don't want you to be careful. In fact, waiting can cause harm," she said.


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