Preventing food allergy in your baby - Q & A session
In July 2018, a report on preventing food allergy in babies was released by the British Society of Allergy and Clinical Immunology and the Food Allergy Specialist Group of the British Dietetic Association following the results of the long awaited "EAT study - early introduction of allergenic foods to induce tolerance". Check out my summary of this report below in the form of a question and answer session. Many of these questions I am frequently asked in allergy clinic.
Should I use a low allergen or "hypoallergenic" infant formula to prevent my baby from developing a milk allergy?
No, choose a standard cow's milk infant formulae eg SMA Pro First, Aptamil First, Cow and Gate First and Hipp Organic First milks if not breastfeeding. If you think your baby may be allergic to this formula, contact your GP or Health Visitor or contact me for further advice. Using extensively hydrolysed hypoallergenic formulae such as Nutramigen, Similac Alimentum or Aptamil Pepti will not prevent a milk allergy. These are prescribable formulae only used as first line treatment by your GP for cow's milk allergy once your baby has been diagnosed. More readily available partially hydrolysed formulae such as "Comfort" formulae, SMA H.A. formula or other whole protein formulae such as soya formula or goats milk formula will also not prevent development of cow's milk allergy and in fact their use may actually delay diagnosis and treatment. If breastfeeding, do not remove milk or dairy from your diet without seeking advice from a healthcare professional.
What age should I wean my baby onto solids?
Exclusive breastfeeding is still recommended for the first six months of your baby's life (1). However, from around 6 months but not before 4 months of age (17 weeks old), solids can be introduced. Recent research (2) and associated guidance (3) suggests that early introduction of allergenic foods between 4-6 months of age in babies who are at risk of having a food allergy may prevent that allergy from developing.
How do I know if my baby is at risk of having a food allergy?
One in forty children has an egg allergy and one in twenty children has a peanut allergy. If you or baby's father has asthma, eczema or hay fever, there is an increased risk of your baby having a food allergy. If your baby has severe eczema that requires daily steroid treatment and/or already has a milk allergy, there is a greater risk of them having another food allergy in particular egg and/or peanut allergy. For these babies, allergy tests are recommended before weaning (see allergy tests below). For all other babies, recent research (4) has shown that egg and peanut allergy can be prevented in babies at risk of food allergy, by introducing egg and smooth peanut butter between the ages of 4 - 6 months alongside other weaning solids. It is also recommended that other allergenic foods such as wheat, seeds (in the form of hummus or tahini), fish, well cooked seafood, tree nuts (in the form of almond or cashew butter) should be introduced by 12 months of age, if they form part of your family's usual diet, unless you are advised otherwise by a health professional. Once successfully introduced, give these foods regularly in your baby's diet.
I am really concerned about giving my baby egg and peanut butter to eat in case they react. How should I give it?
This is a completely understandable feeling to have however, a recent study showed that if babies under 1 year react to a food on introduction, 98% of them will either vomit the food or develop hives on their skin rather than suffer a more severe reaction.
“reassuring news to parents who are about to introduce their baby to potentially allergenic foods like peanuts ”
It is important to introduce allergenic foods slowly by starting with one new food at a time. Begin with 1/4-1/2 teaspoon of boiled egg blended or mashed into pureed vegetables or baby rice and increase slowly over the next few days up to one egg every week as a minimum. Then follow the same process with smooth peanut butter, aiming for 2 teaspoons every week as a minimum. Once allergenic foods are introduced into your baby's diet, continue to give these foods regularly. Only ever give your baby food that is in an age appropriate form to avoid risk of choking. If you think your baby may be having an allergic reaction such as an itchy red rash or vomiting within 30 minutes of eating the food, stop giving the food and seek medical advice.
Can my baby be tested for food allergies before weaning onto food?
Allergy testing using blood or skin prick tests is advised for high risk babies with severe eczema and/or with milk allergy prior to weaning (5). Allergy testing is a useful method of identifying if your baby is at risk of food allergy, which makes planning the weaning diet easier and more relaxed for you. Testing is available at the Spire Hospital Southampton upon GP or self referral and at NHS allergy clinics upon GP referral only. As it is important to introduce egg and peanut butter to your baby's diet between 4-6 months to prevent these allergies developing, speak to your GP or Health Visitor if allergy testing is not readily available in your area.
Does my baby require any extra vitamin supplements?
All breastfed babies require a daily vitamin D supplement (8.5-10 micrograms/d) from birth to 4 years old even if you are taking a Vitamin D supplement whilst breastfeeding. These supplements can be purchased over the counter from pharmacies or large supermarkets. Examples are Abidec (0.3ml/day until 1 year of age then 0.6ml/day until 4 years) or Haliborange multivitamin syrup (2.5ml/day from 1 month-4 months old then 0.5ml/day until 4 years) or Baby D Drops (1 drop per day from birth to 4 years) or Wellkid Vitamin D Drops (0.5ml/d) from birth to 4 years). Healthy Start Vitamins (5 drops/day) are available on the NHS for those families receiving benefits. Speak to your Health Visitor about a voucher for NHS vitamins if applicable. Formula fed babies should take a Vitamin D supplement once they are drinking less than 500ml / 17floz per day, normally around 6 months of age.
Note: Abidec contains allergen free peanut oil which does not pose a risk to children with peanut allergy.
References
1. Scientific Advisory Committee on Nutrition report: Feeding in the first year of life (2018) https://www.gov.uk/government/news/sacn-publishes-feeding-in-the-first-year-of-life-report
2. British Society of Allergy and Clinical Immunology and Food Allergy Specialist Group of British Dietetic Association: Early Feeding Guidance (2018) http://www.bsaci.org/about/early-feeding-guidance
3. EAT study: Early introduction of allergenic foods to induce tolerance (2018) https://www.food.gov.uk/research/food-allergy-and-intolerance-research/eat-study-early-introduction-of-allergenic-foods-to-induce-tolerance
4.Food induced anaphylaxis in infants and children. Samady et al (2018). Annals of Allergy, Asthma and Immunology: https://www.annallergy.org/article/S1081-1206(18)30391-0/fulltext
5. The Challenges of Preventing Food Allergy: lessons learned from LEAP and EAT. Fisher et al. (2018). Annals of Allergy, Asthma and Immunology: https://www.annallergy.org/article/S1081-1206(18)30468-X/fulltext