Advice on what to do about feeding potentially allergenic food to infants has in the past been variable with many parents simply avoiding to feed their babies with ‘suspect’ foodstuffs (the most common causes of food allergies are: cow’s milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish). The latest research from the University of Manitoba, Winnipeg, contradicts this approach with the authors recommending that, in order to prevent allergies developing, infants should be introduced to a broad range of foodstuffs from the age of 4 months.
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I remember from my immunology studies many years ago in the Manchester University Medical School that if the human immune system was introduced to sufficient dosage of an allergen (something that causes an allergic reaction) very early in life the body may recognise that substance as ‘non-dangerous’. It becomes tolerant or desensitised. As a result later encounters with the same substance did not develop a full blown allergic reaction. The body’s response is quite different when, later in life, bacteria and viruses enter the body for the first time – these are normally recognised as dangerous and stimulate the white blood cells and antibodies to develop a proper defensive reaction. Vaccines can be used to prime the body against these harmful bugs thus accelerating and enhancing this full blown defensive response.
The immune system is complex and can sometimes provide researchers with unexpected results. For example in 1989 Erika von Mutius an epidemiologist at Munich University carried out asthma research by comparing residents in the former East German communist states with their counterparts in West Germany. Considering the amount of pollution in East Germany, the lower general levels of cleanliness (fewer vacuum cleaners!) and the tendency to offload infants as early as possible into State run kindergartens she expected to find a much higher rate of asthma and other similar allergic conditions like hay fever in the former communist states. In fact the opposite was true – the ‘clean’ West German States had much higher rates of asthma and hay fever. It looked as though the early exposure to ‘dirt’ in the east (like faeces from communist dust mites) was helping the infants to become desensitised and thereby prevent the allergic reactions that were more common in the west. Now living conditions in the east have improved guess what has happened to the allergy rates – perhaps vacuum cleaners cause allergies!
This week’s publication of research into food allergies from Canada appears to be following this trend of throwing out the previously assumed ‘wisdom’. In the past babies considered to be at a high risk of developing food allergies were recommended to avoid potentially allergenic foods until 12 to 36 months of age. The new research by Ellisa Abrams and Allan Becker, at the Department of Pediatric Allergy and Clinical Immunology in the University of Manitoba, contradicts this and indicates a much earlier exposure to these allergens is beneficial – starting as early as 4 to 6 months of age. They also concluded that: “Once highly allergenic foods are introduced, regular exposure is important for maintenance of tolerance — children should eat these foods on a regular basis.”
Their findings point to a recent randomized controlled trial known as the LEAP (Learning Early About Peanut) study. This concluded that giving peanuts early, rather than late, to children at high risk of peanut allergy reduced the incidence of the food allergy by 80%. Following on from this study the American Academy of Allergy Asthma and Immunology (AAAAI) now advises that high-risk infants should be introduced to peanuts between 4-11 months of age (subject to evaluation from their allergy specialist).
In addition some mothers previously avoided eating potential allergens during pregnancy and breast feeding. The new advice does not support this ‘avoidance’ diet approach. The American Academy of Allergy, Asthma and Immunology now recommends:
- Introduce a new food every 3 to 5 days in an age-appropriate manner (e.g., prepared in such a way as to avoid the risk of choking).
- Start with grains, yellow and orange vegetables and fruit.
- Introduce one of the potentially allergenic foods, if well tolerated, in small amounts (e.g., cow’s milk, soy, eggs)
- Introduce highly allergenic foods at home.
- Increase the quantity of food over several days.
Drs. Abrams and Becker explained: ”If parents ask how to prevent allergy in their children, our current advice is to introduce the allergenic foods at 4-6 months of age. Once highly allergenic foods are introduced, regular exposure is important for maintenance of tolerance – children should eat these foods on a regular basis.” In other words if the child appears not to initially like the new food you should persevere – it can take a while for the child to become accustomed to the new taste. In other words the desensitisation of the immune system requires a sufficient, sustained dosage of the allergen for the allergy ‘prevention’ to become effective.
As with all medical developments it is important to always have the most recent and comprehensive research before making important decisions. Sadly there has been quite an industry that has been built up by exploiting the fears of parents for their children’s well being. For example the marketing of IgG tests which ‘identify everything your child is allergic to‘ feeds on this fear. These tests identify immunoglobulins (Ig or antibodies) that the body has developed simply in response to contact with a substance – it does not mean that these substances will actually cause a full blown hypersensitivity or anaphylactic reaction. Sadly some parents take these results as being a ‘don’t eat under any circumstances’ list. Based on this latest research they could be doing their children more harm than good.
In an attempt to present dangerous allergic reaction risks in context Robert Boyle at Imperial College recently provided some statistics in the scientific journal Clinical and Experimental Allergy. The incidence of fatal food anaphylaxis in people with food allergies is 1.81 deaths per million (rising to 3.25 in children). This is about one tenth of the risk in the general population of accidental death (if you would like to see more of Dr Boyle’s statistics please visit the link here). The original article by Drs. Abrams and Becker can be found here.
If you would like to read another report I have prepared on skin allergies why not take a look at the following (apologies for the gruesome ‘human guinea pig’ pictures of yours truly):
In addition if you are interested in recent research into how multivitamins and antioxidants may be helping cancers to become malignant the following may be worth a read:
As with all medical issues you should always consult with your family’s medical practitioner if you have any concerns about potential allergy problems.
Chris Duggleby started his scientific career studying Bacteriology, Virology and Immunology at the Manchester University Medical School. From there he went on to spend over 35 in the chemicals and oil industries which included setting up a polymers research and development group in Geneva, Switzerland for a major international chemicals company. Following an MBA from Warwick University he went on to lead a number of international manufacturing and marketing operations in the Chemicals, Plastics and Oil industries. His work involved living and working in Europe, Asia, the USA, the Middle East, and Russia. More recently he was invited to take on a senior leadership position in the Audit Department of the BP International Oil Group. Here he used his global change and risk management experience to help the group reshape its management structures and processes following a major environmental disaster in the Gulf of Mexico. He has now retired to focus on writing about risk management and producing music in his studios near London, in the Alps and Cape Town. If you are interested in risk management check out his RiskTuition.com or BizChangers.com (management of change) sites.
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