The Role of the Maternal Diet and Supplements in the Prevention of Infant Food Allergies
by Anne Eglash MD, IBCLC, FABM
Can diet and/or supplements during pregnancy and lactation prevent infant food allergies?
Childhood food allergies have increased in the last few decades and according to the authors of this week’s study, several of these allergies are life long, including fish, tree nut, sesame, and peanut. It has been found that earlier exposure to food allergens in the infant diet helps to prevent allergies, such as introducing peanut protein and hen eggs to infants before rather than after 12 months of age. Conversely, avoidance of allergenic food proteins in the infant diet combined with early skin exposure to the allergens increases the risk of food allergy.
The authors for this week’s study review evidence on the role of vitamin D, prebiotics, probiotics, maternal diet elimination, maternal allergen ingestion, exclusive breastfeeding, and timing of infant allergen introduction in the prevention of infant food allergies.
Check out the question to check your knowledge!
- Vitamin D supplementation during pregnancy and lactation is now routinely recommended to decrease the risk of infant food allergies.
- Omega 3 supplementation during pregnancy is recommended to prevent infant egg allergy.
- The American Academy of Allergy, Asthma and Immunology recommends against food elimination diets during pregnancy and lactation to prevent infant food allergies.
- Maternal probiotic ingestion during pregnancy and lactation has been found to decrease the risk of infantile eczema but not infant food allergies.
- Exclusive breastfeeding with no exposure to cow’s milk protein formula decreases the risk of cow’s milk allergy.
- Routine maternal ingestion of peanuts during breastfeeding protects from peanut allergy, even if the infant does not ingest peanut until after 12 months of age.
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There is increased focus on the role of maternal interventions in the prevention of food allergy in infancy. There is no role for maternal dietary modifications during pregnancy or lactation, such as allergen avoidance, as a means of infant allergy prevention. Although exclusive breastfeeding is the recommended infant nutrition source globally, the effect of breastfeeding on infant allergy prevention remains unclear. There is emerging evidence that irregular cow’s milk exposure (ie, infrequent formula supplementation) might increase the risk of cow’s milk allergy. Although further studies are required, there is also emerging evidence that maternal peanut ingestion during breastfeeding along with early peanut introduction in infancy might have a preventive role. The effect of maternal dietary supplementation with vitamin D, omega-3, and prebiotics or probiotics remains unclear.
Vitamin D, omega 3 fatty acids, and probiotics taken during pregnancy and lactation have not been found to consistently prevent infant food allergies. Maternal avoidance of food allergens during pregnancy and lactation clearly does not prevent infant food allergy, so it is advised that pregnant and lactating parents not restrict their diets for this purpose.
Breastfed infants who receive early limited cow’s milk-based formula have an increased risk of cow’s milk allergy if they don’t continue low grade exposure to cow’s milk protein to develop tolerance. One study demonstrated that if infants are exclusively breastfed or supplemented with elemental formula and not cow’s milk formula, they have a much lower risk of cow’s milk allergy.
So far, research on the role of maternal diet and supplements on the prevention of infant food allergy is conflicting and lacks clarity. There are clues that maternal allergen ingestion during pregnancy and lactation plays a role in the prevention of food allergies, but the evidence is not sufficiently robust to make recommendations because research results conflict. The studies are heterogeneous regarding variables such as the amount of food protein in the maternal diet, the extent to which the child is breastfed, and the timing and amount of food proteins introduced to the infant.
A trend in this research is the ‘triple exposure hypothesis’ as proposed by Dr. Azad and colleagues. The theory postulates that breastfeeding modulates the immune response to food allergens (e.g. peanut) in the maternal diet, allowing food allergen tolerance when the infant is fed the allergen at a critical time period. This essentially means that the stars need to align in some way regarding the maternal diet, exclusive breastfeeding and timing of infant allergen food introduction to prevent food allergies. Stay tuned for more exciting research in this field.