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September 21, 2016

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Australian children now have the highest rate of food allergy in the world. Up to one in ten infants and two in ten school-aged children have a proven food allergy.

In the 14 years to 2012, there was a 50% increase in hospital visits for anaphylaxis, the most severe allergic reaction. Infants and toddlers accounted for much of this increase.

The most common food allergies are to nine main food proteins: cow’s milk, soy, egg, wheat, peanut, tree nuts, sesame, fish and seafood. Egg and peanut allergies are the most common in infants and toddlers.

New research published today in the Journal of the American Medical Association (JAMA) shows the early introduction of egg (from four to six months) and peanuts (from four to 11 months) is linked to lower rates of egg and peanut allergy.

The researchers analysed the combined results of trials investigating whether food allergens in babies’ diets prevent the development of allergies to these foods. They concluded there was “moderate” certainty that early introduction of egg or peanut was associated with lower risks of egg and peanut allergy.

They also found that early introduction of gluten (wheat) was not associated with an increased risk of coeliac disease.


Further reading: Everything you need to know about coeliac disease (and whether you really have it)


The researchers used the term “moderate certainty” because the review is based on a mix of studies with different designs and of varying quality. Feeding studies can also be difficult to “blind”; for some studies participants and researchers knew who was given egg or peanut, so were open to some bias.

As a result, the authors say more work needs to be done to better understand the precise optimal timing for introducing eggs and peanuts.

Nonetheless, these findings affirm the recently updated Australian infant feeding consensus guidelines. These state that when parents introduce solids – at around six months but not before four months – they should also introduce previously avoided foods such as peanut and egg. This should occur in the baby’s first year of life.

The problem is, there have been so many changes to guidelines over the last few decades that parents are no longer sure what to believe.

In Australia, dietary recommendations aiming to reduce the risk of food allergies began to appear in the early 1990s. They recommended infants avoid certain foods such as egg and peanut. These guidelines were largely based on outcomes of trials focusing on the mother avoiding allergens during pregnancy and while breastfeeding.

In 2008, a number of research projects (including our own) questioned whether these older studies were flawed because they had not adequately adjusted the results to account for the fact that those with a family history of allergies adhere to recommendations better than those without, thus biasing the result.

These new studies accounted for this fact. We found, paradoxically, that earlier introduction of foods such as egg and peanut, at around six months, appeared to protect against food allergy. This has resulted in a complete rethink in our approach to preventing food allergy.

(Note that these findings relate to the prevention of food allergies, not the management, which remains unchanged. Children with food allergies should continue to avoid those foods.)

Based on this research, feeding guidelines began stating that earlier introduction did not increase the risk of food allergy and may indeed be protective.

These recommendations were strengthened this year after research trials tested the effect of eating common allergens (in particular, peanut) in the first year of life compared with completely avoiding them. The guidelines now recommend that exposure to egg, peanut and other foods frequently associated with food allergy should occur in the first year of life to offer protection.

It’s still not clear if this approach alone will prevent the whole food allergy epidemic. Some children will still develop food allergies despite following the feeding guidelines.

We know the tendency to develop allergic disease is inherited, but environmental factors, including the microbiome, vitamin D levels, migration effects, the number of siblings and exposure to pets also all appear to play influential roles, as does the presence of early onset eczema. Research trials are investigating the role these factors play in the development of food allergy risk.

In the meantime, experts agree there appears to be a window of opportunity in the first year of life where exposure to foods such as peanut and egg decreases the risk of allergy to these foods. Diet diversity remains an important part of a healthy diet.

For the most recent infant feeding guidelines and information about introducing solid foods to infants, visit the Australasian Society of Clinical Immunology and Allergy website.

The ConversationShare your comments below.

Merryn Netting, Postdoctoral Research Fellow, Healthy Mothers, Babies and Children’s Theme; South Australian Health and Medical Research Institute; Affiliate Lecturer, The University of Adelaide, University of Adelaide and Katie Allen, Paediatric Gastroenterologist and Allergist, Murdoch Childrens Research Institute

This article was originally published on The Conversation. Read the original article.

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  • Information needs to be updated frequently.

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  • So important this info is updated and clearly communicated all the time ! People need to take more initiative in getting informed themselves as well.

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  • These things ought to be updated all the time.

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  • Such an interesting read. I guess with so much research they need to re-assess and ensure we are doing the best for our babies

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  • Coelic Disease is potentially fatal if not treated. It can lead to bowel cancer.
    Coelic Disease in most cases is genetic. The protein in wheat, rye, barley and most cases also oats cause damage to the vili, part of the bowel. Some of the symptoms are constipation, vomitting, stomach cramps, migraine headaches, nausea, some get the “runs” instead of constipation. This condition can show up at any age from a baby to well into adulthood. It is not normally diagnosed in young babies as the results are not accurate enough. In small children they usually start with a blood test to see if they carry any of the genes connected to Coelic Disease. It is not simply an allergy to grains containing gluten…it is a disease. Anything made including any of those grains can make a person with Coelic Disease ill for several days, not just a few hours or 1 – 2 days. Food they are allowed to eat must not come into contact with anything containing gluten at all……………One of the reasons people don’t give children peanuts at an early age is because they don’t chew them properly and can choke on them.

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  • So glad we have not had to combat allergies like this yet! I feel for those that have kids with allergies would be very scary!! We introduced egg and peanut butter at 6months

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  • Allergies are truly awful and there is so much research that needs to be done in this area.

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  • Think indeed unfamiliarity with the new guidelines is a big obstacle here !
    We introduced eggs and peanuts early and don’t experience problems so far.
    I would love to read more about the influential roles as they mention here environmental factors, including the microbiome, vitamin D levels, migration effects, the number of siblings and exposure to pets, early onset eczema

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  • It is so hard to know what to do that’s right, there have been so many different studies. I’m scared to feed peanuts, eggs, cows milk etc just in case :( It’s a real minefield

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  • So hard what to do with so many different opinions out there. Which research do we follow.

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  • I remember Dr Karl Krulseniski saying that there are almost no peanut allergies in Chinese children and this is because mothers are not told to avoid peanuts.

    Reply

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