Maternal and infant diets: Do food choices affect food allergies?

February 5, 2016 Kevin Dooms, MD

In recent years, there has been a lot of discussion about which foods are appropriate for infants and moms. Families often get confused and ask questions such as: Can you eat peanuts while you’re pregnant? What solid foods should I give my infant, and when?

One reason for the confusion is changing recommendations from medical experts. For example, in 2000 the American Academy of Pediatrics (AAP) made several recommendations in an attempt to help prevent food allergies. At the time, pregnant and breast-feeding moms were asked not to eat peanuts. Infants who were at risk for food allergies were supposed to wait before eating high-risk foods such as milk, eggs, nuts and seafood. Despite the AAP’s best efforts, these recommendations did not appear to help: Allergy rates kept climbing at an alarming pace.

In 2008, the AAP's recommendations changed dramatically. For one, pregnant and breast-feeding moms are no longer advised to avoid certain foods for allergy reasons. Also, as infants begin trying solids, it is no longer necessary to delay introducing foods for allergy reasons. Unfortunately, the updated 2008 recommendations did not get a lot of press. In fact, much of the related information on the Internet and many health care providers still recommend avoiding certain foods as a way to “prevent food allergies”—outdated information.

From an allergy perspective, what is the best diet for infants and mothers?

According to the AAP and food allergy experts, breast-feeding is still optimal nutrition for the first year of life. When infants start eating solid foods at around 6 months, there is no reason to delay complementary foods such as dairy, eggs, peanuts, tree nuts or seafood. Infants should be introduced to a variety of flavors and textures, but avoid choking hazards like nut pieces or thick peanut butter. For infants who are at risk of developing allergies but cannot have breast milk, a “hypoallergenic” formula (Nutramigen or Alimentum, for example) might be safer than traditional cow’s milk formulas. Moms who are pregnant or breast-feeding do not need to avoid particular foods to prevent food allergies (yes, have a peanut butter-and-jelly sandwich!).

What about high-risk infants and peanuts?

In early 2015, a landmark study suggested that early introduction to peanuts may actually help prevent peanut allergy (see my blog post on Feb. 24, 2015). In this study, we learned that infants who are at high risk for developing a peanut allergy may not become allergic to the nuts if they start eating them at around 6 months of age. This result was very encouraging and has spawned further research into the topic. Many food allergy experts also recommend that infants 4 to 11 months of age see an allergist if they have severe eczema or an egg allergy. These infants are at high risk for developing a peanut allergy. They may be candidates for peanut testing, and possibly trying peanuts for the first time in a supervised medical setting.

What’s in store for food allergies?

Based on our understanding of early peanut introduction, we expect to see other studies about early introduction to milk, eggs, wheat, tree nuts and other foods. Experts are hopeful that early food introduction may become a means of preventing food allergies. If that’s the case, we may actually see a downward trend in food allergies for the first time.

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