Preventing allergies in infancy is currently a major focus for allergy specialists and new information is emerging all the time. The following updated recommendations are based on the most recent ASCIA Guidelines on Infant feeding and allergy prevention (who based their guideline on a consensus agreement by participants in the Infant Feeding Summit hosted by the Centre for Food & Allergy Research (CFAR)) in May 2016. They are now widely accepted as sensible, prudent measures to take if you have any allergies in your family.
What is an allergy?
An allergy occurs when the body's immune system over-reacts to normally harmless substances, which may be in the air or water, or things we touch or eat. When an allergic person comes in contact with such a substance their immune system produces a special kind of antibody (IgE) and other cells release further chemicals (histamines). This causes the symptoms of an allergic reaction.
What makes a baby susceptible to allergies?
Although infants with a family history of allergic diseases are at higher risk of allergies, infants with no family history can also develop allergies.
Your baby may inherit the tendency to develop allergies, if you, your partner, or any of your family suffers from eczema, asthma, hayfever or hives, allergic rhinitis, persistent cough, constant runny nose, food allergies (especially allergy to dairy, eggs, wheat, soy, peanuts, nuts, fish and shellfish), or recurrent ear infections.
Even if neither parent is allergic, there is still a 5-15% chance of a child developing allergies. For a child with one allergic parent the risk goes up to 25%, and if both parents are affected, there is a 50-60% chance of developing allergies. When both parents have the same allergic disease the risk increases to as high as 80%. The first child in the family is more at risk.
What the child inherits is the tendency to develop an allergy or allergies, not the specific hypersensitivity of any family member to specific allergenic factors. For example, if a parent has an allergy to shellfish the child will inherit the chance of being allergic, but not the specific shellfish allergy. The infant is born with the capacity to become sensitised to some allergen at some time. The stronger the family history of allergy, the greater the risk and the earlier the infant is likely to show symptoms.
The likelihood that a child will develop an allergy depends on both genetic and environmental factors. Children must be exposed to a potential allergen to become sensitised. Once this sensitivity is established, it can take very little contact with the allergen to cause a reaction and the child is also at risk of becoming allergic to other allergens.
If your infant already has an allergic disease (such as severe eczema or food allergy) you should discuss what specific steps might be useful with you doctor. These guidelines are relevant for all families, including those in which siblings or parents already have food allergies or other allergic conditions. There are some simple but very important steps you can take to, either prevent the development of allergies or at least reduce the potential severity of reactions.
How can I prevent my child from developing allergies?
Genetic factors are givens and out of your control. However, you do have some control over the exposure your baby has to allergens that can set off allergies in a child who is more likely to suffer from these conditions because of his or her genetic programming.
ASCIA recommends a healthy balanced diet, rich in fibre, vegetables, and fruit, to provide the many health benefits to the mother and infant during pregnancy and breastfeeding.
Exclusion of any particular foods (including foods considered to be highly allergenic like peanut) from the maternal diet during pregnancy or breastfeeding is not recommended, as this has not been shown to prevent allergies.
Up to 3 servings of oily fish per week may be beneficial, as there is evidence that omega-3 fatty acids (found in oily fish) during pregnancy and breastfeeding may help to prevent eczema in early life.
The advice on probiotics supplements cannot be made currently, because the optimal species and dose of probiotic that might have an effect is unclear. However, some of the studies look promising that probiotics during pregnancy and breastfeeding may help prevent eczema in early life.
It is very clear that sensitisation continues during breastfeeding and that significant amounts of allergens pass through the breastmilk causing allergic symptoms in babies. Infants born into a family with a history of allergy should be breastfed exclusively, if possible, for a minimum of six months.
Several studies have shown that breastfeeding helps to reduce the odds of developing an allergy when compared to feeding with standard milk or soy based formulas. However, this advantage is dependent on your diet. The same issues and preventative measures apply as in pregnancy, but again it is important, that in avoiding allergens you don't compromise your own diet.
There is low evidence that breastfeeding during the period that solids are first introduced to infants from around 6 months may help reduce the risk of the infant developing allergies. If breastfeeding is not possible or if a supplement to breastmilk is desired, use a a standard cow’s milk based formula). There is no evidence that soy or goat's formula reduce the risk of allergic disease.
There is no consistent convincing evidence to support a protective role for partially hydrolysed formulas (usually labelled ‘HA’ or Hypoallergenic. Or extensively hydrolysed formula for the prevention of eczema, food allergy, asthma, or allergic rhinitis in infants or children.
Regular cow’s, goat’s milk, soy milk, nut and cereal beverages are not recommended for infants as the main source of milk before 12 months of age.
Foods should not be introduced before 4 months
· Infants differ in the age that they are developmentally ready for solid foods
· Signs that your infant may be ready to start solid foods include being able to sit relatively unaided and trying to reach out and grab food
ASCIA recommends the introduction of solid foods around 6 months, but not before 4 months, and preferably while breastfeeding
When the infant is ready, introduce solids according to what the family usually eats, regardless of whether the food is considered to be a common allergen.
· Common allergenic foods like peanut, nuts, wheat and fish should not be delayed
· Avoid raw eggs
Introduce one new food at a time, so that if a reaction occurs, the problem food can be easily identified.
Cow’s milk or soy milk and their products can be used in cooking if they are tolerated
There is good evidence that for infants with severe eczema and/or egg allergy, that regular peanut intake before 12 months of age can reduce the risk of developing peanut allergy
There is moderate evidence that introducing cooked egg into an infant diet before 8 months of age, where there is a family history of allergy, can reduce the risk of developing the risk of egg allergy.
Facial skin of babies is very sensitive and many irritant foods like citrus, tomatoes, berries, other fruits and vegemite can irritate the skin on contact, causing redness. However, this is not an allergy.
Some infants will develop food allergies regardless of what you do. If there is any allergic reaction to a food, that food should be stopped immediately, and you should seek advice from a doctor with experience in food allergy
If your baby is at risk of developing an allergy, avoid using massage oil or nipple cream containing peanut oil, and make sure that the nappy rash products you use are also free from this ingredient. Using these products can sensitise your baby.
Try to minimize the exposure to inhalant allergens as well, such as cigarette smoke, polluted air, strong odours, animal fur, feathers, and dust mites.
If you smoke, stop! There is strong scientific evidence that exposure to cigarette smoke can contribute to the development of asthma and allergic disease.
• If you smoke, stop! There is strong scientific evidence that exposure to cigarette smoke can contribute to the development of asthma and allergic disease
What are the early warning signs of allergy?
Parents should look for early signs of sensitivity such as:
• Colic (not exclusively caused by allergy but can be an allergic symptom), excessive vomiting, abdominal pain, diarrhoea or constipation
• Skin rashes and eczema
• Swelling or welts
• Persistent sniffling and wheezing, stuffy nose, frequent colds, recurring ear infections
An unexplained change of behaviour as well as difficulties in breastfeeding or refusal of food.
Other reasons why allergen immunotherapy is better than drug therapy for treating
If you suffer from severe hay fever, asthma, eczema or have had any reactions to
bee or wasp sting apart from local reactions, ask your doctor about immunotherapy.
Allergen immunotherapy is one of the oldest treatments for allergies. It has lasted
100 years and unlike other treatment for allergies it treats the cause of the problem
and not just the symptoms, and the effects persists long after the treatment is
discontinued. It has also been shown to prevent allergies in children and stop the
progression of allergies, the "allergic march". Also over the years the side effects,
including anaphylaxis are improving as the allergen extracts (vaccines) and the
methods for administering the vaccines have improved. Allergen immunotherapy is
an allergy treatment of the past, present and future.