The Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak body for allergy and critical immunology in Australia, has updated the infant feeding advice and guidelines for allergy prevention in infants.
"Allergic disorders are often life long, and although treatable, there is currently no cure. It therefore makes sense to try to prevent allergic diseases in infants or children, if possible." said Professor Dianne Campbell, Chair of the ASCIA Paediatric Committee.
Allergic diseases have more than doubled in western countries over the last 25 years. The most common allergic conditions in children are food allergies, eczema, asthma and hay fever (allergic rhinitis).
"Up to 2 in 5 children in Australia and New Zealand are affected by allergic disorders some time during childhood, with 1 in 5 having current symptoms", says Prof Campbell.
The reason for the continued rise in allergic diseases in developed countries is complex and research in this area is ongoing. Although children with a family history of allergy are at higher risk of allergy, many children with no family history of allergy also develop allergy. Therefore, these guidelines are relevant for all families. Many previous allergy prevention strategies have been ineffective, including delayed introduction of allergenic foods.
Important issues addressed in the guidelines focus on maternal diet during pregnancy, breastfeeding and the introduction of complementary foods to infants.
- Up to 3 serves of oily fish per week during pregnancy and breastfeeding may be beneficial in preventing eczema in early life.
- There is no consistent, convincing evidence to support that hydrolysed formulas (usually labelled HA or hypoallergenic) assists in allergy prevention in infants or children.
- There is evidence that for infants at high risk of food allergies, such as those with severe eczema or who already had a food allergy reaction to egg, introduction of regular peanut before 12 months of age can reduce subsequent peanut allergy.
- It is not recommended that infants are fed raw egg, however there is moderate evidence for the introduction of cooked egg into the diet of infants with a family history of allergy before 8 months of age to try and reduced the risk of egg allergy.
ASCIA Infant Feeding Advice and Guidelines for Allergy Prevention in Infants were last updated in 2010 and aim to provide families in Australia and New Zealand with a summary of evidence based information on infant feeding. This includes an explanation as to why families may choose to introduce solid foods to their infants from 4-6 months (whilst breastfeeding) and not delay the introduction of potentially allergenic foods, to prevent allergy.
"As with previous advice, ASCIA still recommends introducing complementary foods from 4-6 months when the infant is ready. We also recommend that allergenic foods should not be avoided and that there is some benefit in introducing these foods in the first year of life, whilst the infant is still being breastfed", says Prof Campbell.
Prof Campbell states "Where we once suggested that partially hydrolysed infant formulas may provide some benefit, the combined weight of evidence no longer supports this."
Prof Campbell cautions that "If your infant already has an allergic disease, such as severe eczema or food allergy, you should discuss what specific measures might be useful with your doctor."
Other important issues addressed in the ASCIA advice and guidelines includes dietary advice for the mother whilst pregnant and breastfeeding and advice regarding the introduction of peanut and egg into the infant's diet.
Full versions of the ASCIA Infant Feeding Advice and Guidelines for Allergy Prevention in Children are available from the ASCIA website:
Allergic diseases include food allergy, drug allergy, insect allergy, asthma, eczema and allergic rhinitis (hay fever).
Allergic diseases are caused by abnormal immune responses to otherwise harmless substances in the environment. For example, allergic rhinitis (hay fever) is commonly caused by an immune response in the nose and eyes to grass pollens and/or house dust mites. Some allergic conditions (such as mild allergic rhinitis) may cause only mild symptoms. For others (such as moderate/severe allergic rhinitis, asthma), symptoms can be debilitating, disturb sleep and impact on learning and behaviour. Poorly controlled bad asthma, stinging insect allergy or severe food allergies can even be life threatening
A number of factors appear to increase the risk of developing allergic disorders. We have no control over some risk factors such as family history, whilst there are other environmental factors that we might be able to influence. Identified risk factors for developing allergic disease include:
- Family history of allergic disease in a parent or sibling (family history of allergic disease in both parents OR a parent and a sibling is associated with a further increased risk).
- Introduction of cow's milk or soy milk formula before 3-4 months of age (an increased risk for eczema and food allergy).
- Introduction of solid foods before 3-4 months of age (an increased risk for eczema and food allergy).
- Birth in spring - a risk for seasonal allergic rhinitis (hay fever).
- Passive exposure to cigarette smoke (a risk for increased respiratory symptoms).
Why the rise in food allergy?We currently do not have a clear explanation as to why food allergy seems to have increased so rapidly in recent years, particularly in young children. Proposed explanations include:
- Hygiene hypothesis, which proposes that less exposure to infections in early childhood is associated with an increased risk of allergy.
Changes in microbiome- a complex set of microogransisms which colonise the human body.
- Delayed compared to earlier introduction of allergenic foods (e.g. egg, peanut, tree nuts) where introduction later in life might reduce the development of oral tolerance.
- Methods of food processing (e.g. roasting makes peanuts more allergenic).
- Development of allergy to food by skin exposure (e.g. use of unrefined nut oil based moisturisers, goat's milk products).
- Vitamin D deficiency in first year of life.
- Medication to suppress gastric acid production.
Australasian Society of Clinical Immunology and Allergy (ASCIA)
ASCIA was established in 1990 as a not for profit, peak professional medical organisation for allergy and clinical immunology in Australia and New Zealand. ASCIA members include clinical immunology/allergy specialists, other medical practitioners, scientists and allied health professionals who work in the areas of allergy and immunology.
The mission of ASCIA is to advance the science and practice of allergy and clinical immunology, by promoting the highest standard of medical practice, education and research, to improve the health and quality of life of people with allergic diseases, immunodeficiencies and other immune diseases.
For further information go to www.allergy.org.au
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