It advises against restricting maternal diet during pregnancy and lactation, affirms the immunological role of breastfeeding, and offers some guidance on the choice of formula for mothers who cannot or choose not to breastfeed. The recommendations in this statement do not apply to infants with an established food allergy. An infant at high risk for developing allergy usually has a first-degree relative at least one parent or sibling with an allergic condition such as atopic dermatitis, a food allergy, asthma or allergic rhinitis. While recommendations in the present statement are intended for high-risk infants, some of the studies cited below included infants from the general population who were not considered to be at high risk for developing allergy.
Evidence to support maternal dietary restrictions during pregnancy is contradictory and insufficient to change best practice. Higher-quality studies are needed. Health Canada, the Canadian Paediatric Society CPS , the Dietitians of Canada and the Breastfeeding Committee of Canada have reiterated the manifest health benefits of exclusive breastfeeding for the first six months of life — which include immunological protection — in a recent position statement.
To date, studies have been largely observational, nonuniform in terms of breastfeeding duration, and too variable in the diagnostic criteria for allergic conditions. Some specialists have proposed a compromise: A recent randomized study has suggested that introducing solid foods at four months of age while maintaining breastfeeding for at least six months has no impact on growth and improves iron status.
More research needs to be conducted to confirm these findings. An article published in by the American Academy of Allergy, Asthma and Immunology has similarly focused on breastfeeding for four to six months of age and the introduction of complementary foods during the same interval in preventing allergy.
Consommation alimentaire et apports nutritionnels chez les femmes allaitantes, en France
All current recommendations favour breastfeeding over formula feeding. There have been no long-term studies comparing exclusive breastfeeding with formula feeding in allergy prevention because it would be unethical to randomize infants to breast- or formula feeding. Therefore, only different infant formulas can be compared in relation to allergy development. No studies have examined the role of amino-acid formulas in allergy prevention, and there is consensus in the literature that soy formula does not have a role.
No clear recommendations for choice of formula can be made, given the lack of conclusive evidence related to allergy prevention.
Since , however, accumulating observational evidence has suggested that delaying the introduction of certain foods does not prevent food allergy; rather, it may actually promote allergy development. One study in the United Kingdom showed that the prevalence of peanut allergy tripled during the period when public health practitioners were advising parents to delay peanut intro-duction.
Most infants in Israel were ingesting peanut protein during the first year of life, while infants born in the United Kingdom consumed almost none.
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Delaying introduction to the same food does not permit the infant to derive potential benefits from regular oral and gastrointestinal exposure, or to develop tolerance via regulatory T cell pathways. In support of sensitization via the skin, a recent study has shown that mutations in filaggrin, a gene key to maintenance of the skin barrier, are a risk factor for IgE-mediated peanut allergy. The American Academy of Pediatrics issued a new guideline in that concluded there was no convincing evidence that delaying the introduction of solid foods, including peanut, egg and fish, beyond four to six months of age has a significant protective effect on allergy prevention.
Whether an earlier introduction of solid foods eg, at or before four to six months of age has a truly preventive effect also remains to be established. However, emerging data suggests that it is possible. A Swedish study published in involving a cohort of infants concluded that regular fish consumption in the first year of life was associated with lower risk of allergic disease OR 0.
This is a prospective trial randomly assigning high-risk infants to either an early introduction of peanut protein at four to 10 months of age or delayed introduction until three years of age , with ongoing exposures of three times per week once introduced. The same investigators have created the Enquiring About Tolerance EAT study to determine whether even earlier introduction of specific foods decreases the risk of food allergy. It appears that early introduction alone is insufficient to achieve a preventive effect; regular exposure is equally important. Deciding whether to introduce potentially allergenic solid foods to high-risk infants early should be individualized and based on parental comfort level.
Other factors, such as having an older sibling with peanut allergy or parental reluctance to introduce peanut until testing by a certified allergist has occurred, may complicate decision making. It is worth noting that routine screening for allergy to a food using a skin test or specific IgE blood test without a history of the child ever ingesting the food in question is generally discouraged. The high risk of false-positive results can be confusing. A specialist can decide whether an oral food challenge is warranted.
Regardless of timing, once a new food is introduced by parents, it appears prudent to recommend regular exposures eg, several times per week and with a soft mashed consistency to avoid risk of choking to maintain oral tolerance. There has been a recent shift in evidence-based practice to prevent food allergy in high-risk infants. While the benefits of introducing these foods to infants earlier, at four to six months of age, are yet to be determined, the immunological mechanisms of sensitization and tolerance tend to support the latter approach.
Regardless of the optimal timing for introduction, current understanding of immunological tolerance also appears to suggest that regular, frequent oral consumption may be just as important as when a food is first introduced. Based on current evidence, and always conceding that much more research needs to be performed, the CPS and the Canadian Society of Allergy and Clinical Immunology recommend the following approach to prevent allergy in infants who have a first-degree relative with an allergic condition, and are, therefore, considered to be high risk.
The levels of evidence reported in the recommendations have been described using the evaluation of evidence criteria outlined by the Canadian Task Force on Preventive Health Care.
Dietary exposures and allergy prevention in high-risk infants
It has been reviewed and endorsed by Dietitians of Canada. The recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.
All Canadian Paediatric Society position statements and practice points are reviewed on a regular basis. Retired statements are removed from the website. National Center for Biotechnology Information , U. Journal List Paediatr Child Health v. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Allergic conditions in children are a prevalent health concern in Canada. Allergy prevention, Atopic dermatitis, Breastfeeding, Food allergy, Formula feeding, Solid food introduction.
DEFINING RISK An infant at high risk for developing allergy usually has a first-degree relative at least one parent or sibling with an allergic condition such as atopic dermatitis, a food allergy, asthma or allergic rhinitis. There is no evidence that avoiding milk, egg, peanut or other potential allergens during pregnancy helps to prevent allergy, while the risks of maternal undernutrition and potential harm to the infant may be significant.
Breastfeed exclusively for the first six months of life. Whether breastfeeding prevents allergy as well as providing optimal infant nutrition and other manifest benefits is not known. The total duration of breastfeeding at least six months may be more protective than exclusive breastfeeding for six months. Extensively hydrolyzed casein formula is likely to be more effective than partially hydrolyzed whey formula in preventing atopic dermatitis.
Dietary exposures and allergy prevention in high-risk infants
Amino acid-based formula has not been studied for allergy prevention, and there is no role for soy formula in allergy prevention. It is unclear whether any infant formula has a protective effect for allergic conditions other than atopic dermatitis. Do not delay the introduction of any specific solid food beyond six months of age. Later introduction of peanut, fish or egg does not prevent, and may even increase, the risk of developing food allergy.
Almost all mothers had the essential fatty acids intakes below the recommendations. The study suggests that Bf women may be at risk of food and nutrient inadequacies. Consommation alimentaire et apports nutritionnels chez les femmes allaitantes, en France. Data correspond to usage on the plateform after The current usage metrics is available hours after online publication and is updated daily on week days. Indian J Med Res 2: Nutritional assessment of lactating women in Shiraz in relation to recommended dietary allowances.
East Mediterr Health J 10 6: The sensitivity and specificity of the Goldberg cut-off for EI: BMR for identifying diet reports of poor validity. Eur J Clin Nutr Inserm, Drees, p. French food composition table https: Sun exposure and vitamin D supplementation in relation to vitamin D status of breastfeeding mothers and infants in the global exploration of human milk study.
General Principles for the collection of national food consumption data in the view of a pan-European dietary survey. Guidance on the EU Menu methodology. Adherence to the French Programme National Nutrition Sante Guideline Score is associated with better nutrient intake and nutritional status.
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