Lactation and Prevention of Food Allergy
by Anne Eglash MD, IBCLC, FABM
According to the authors of this week’s article, approximately 8% of children in the USA, and 7% in Canada, have food allergies. Until now, in the USA, we have only had guidance on prevention of peanut allergy, but not on prevention of other food allergies.
This week’s article is a consensus statement on the prevention of food allergies from 3 major professional allergy associations, the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, and the Canadian Society for Allergy and Clinical Immunology.
The recommendations state that infants with severe eczema are at highest risk for developing food allergy. Eczema is considered severe if the infant requires frequent use of prescription topical steroid treatment, or other anti-inflammatory medications to control the eczema. Other at-risk infants include those with mild-moderate eczema, a family history of allergies, or at least one other known food allergy. However, food allergies often develop in infants who have no identifiable risk factors.
This consensus statement recommends that peanut-containing products and cooked forms of egg be introduced to all infants starting at around 6 months of age, despite their risks of developing peanut allergy. For infants at high risk of allergy, consider a supervised oral food challenge in a physician’s office.
In addition, they recommend not delaying introduction of other allergenic complementary foods such as cow’s milk, soy, wheat, tree nuts, sesame, fish, and shellfish. These should be introduced within the first year.
What about breastfeeding and prevention of allergies? See the question below!
- If an infant has a sibling with a peanut allergy, the mother should avoid peanuts in her diet during lactation.
- Continuing to breastfeed at the time of peanut introduction at 6 months of age has been shown to reduce the risk of peanut allergy.
- Breastfed infants who need ongoing formula supplementation and who are at higher risk for food allergies, should be given hypoallergenic formula, to prevent cow’s milk allergy.
- A diverse diet after 6 months of age may help reduce the risk of food allergy.
- Offer peanut and egg containing foods at least once a week, starting at around 6 months of age, to prevent food allergies.
- Early introduction of raw egg is associated with a higher risk of allergic reaction as compared to introduction of baked/cooked eggs or foods with egg in them.
See the Answer
Recently published data from high-impact randomized controlled trials indicate the strong potential of strategies to prevent the development of food allergy in high-risk individuals, but guidance in the United States at present is limited to a policy for only the prevention of peanut allergy, despite other data being available and several other countries advocating early egg and peanut introduction. Eczema is considered the highest risk factor for developing IgE-mediated food allergy, but children without risk factors still develop food allergy. To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months. Screening before introduction is not required, but may be preferred by some families. Other allergens should be introduced around this time as well. Upon introducing complementary foods, infants should be fed a diverse diet, because this may help foster prevention of food allergy. There is no protective benefit from the use of hydrolyzed formula in the first year of life against food allergy or food sensitization. Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended. Although exclusive breast-feeding is universally recommended for all mothers, there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy.
This consensus statement states that individuals who are pregnant and/or lactating should not avoid allergenic foods in their diet to prevent food allergies in their infants, even if a previous child has food allergies. Early and frequent exposure seems to be the key to allergy prevention. Hypoallergenic formula for those breastfed infants who need ongoing supplementation does not prevent cow’s milk or other food allergies.
They did not address the risk of cow’s milk allergy in exclusively breastfed infants, who are exposed to small amounts of formula supplementation in the first few days of life only. There is good evidence that this strategy increases the risk of cow’s milk allergy.
The consensus statement also did not address what to advise a lactating individual about their own diet if their infant is diagnosed with a food allergy. I have seen lactating parents stop milk and peanuts in their diet, with marked improvement in the infant’s eczema. However I also have had infants in my practice who developed food allergies after starting complementary foods, but never had allergy symptoms to their parent’s breastmilk despite the parent consuming those same allergens. This does not appear to be a well-researched topic, without clear recommendations. It would therefore be wise to consider each dyad’s individual situation before making recommendations on whether the lactating parent should take the allergenic food(s) out of their diet.