New moms should breastfeed exclusively for six months to help protect their babies against developing food allergies later on, one of the nation’s leading allergy and asthma groups says.
Solid foods of all types should be avoided for the first six months, and certain items -- like cow’s milk, eggs, fish, and nuts -- should not be introduced until even later, according to a consensus statement on infant feeding released this week by the American College of Allergy, Asthma and Immunology (ACAAI).
“It is important to understand that we are talking about exclusive breastfeeding, with no formula, soy or anything else,” researcher Amal Assa’ad, MD, tells WebMD. “This appears to be important for protecting against allergies.”
The ACAAI committee came up with its recommendations after reviewing the available clinical evidence. The consensus statement is published in July’s Annals of Allergy, Asthma & Immunology -- the journal of the ACAAI.
Foods Should Be Introduced Gradually
The American Academy of Pediatrics (AAP) also recommends exclusive breastfeeding for six months, followed by gradual introduction of solid foods.
Some infants and mothers with certain medical conditions or who are undergoing certain medical treatments should not breastfeed.
AAP guidelines also include detailed suggestions about when infants at risk for developing allergies should first be given certain foods, which the ACAAI committee endorsed.
The ACAAI food allergy committee also specifically recommends that -- when there is evidence of an increased risk for food allergies -- cow’s milk and other dairy products should be avoided for the first year of life; eggs should not be given until at least age 2; and peanuts, tree nuts, fish, and other seafood should be avoided until at least age 3.
Although the foods above are the most likely to trigger allergies, other foods may also pose a risk if introduced too early, the group noted.
In addition to exclusive breastfeeding and avoidance of solid foods for six months, the ACAAI committee recommended that:
Staple foods, such as fruits, vegetables, meats, soy, and cereal be introduced “individually and gradually” to lessen allergy risk. Mixed foods containing a variety of potentially allergenic foods should be avoided until the baby’s tolerance to each ingredient is known. Beef, vegetables, and fruits should initially be given in the form of prepared baby foods that are cooked and homogenized. Studies suggest these processed foods are less likely to cause allergies than their fresh counterparts.
The committee made no specific recommendations regarding introduction of wheat and cereals into the diets of babies older than six months. “In many people’s minds, wheat is a highly allergenic food, but the clinical evidence does not support this,” Assa’ad says.
“The timing after age 6 months at which specific foods should be introduced depends on a number of factors, including the individual infant’s nutritional needs and risk for allergies,” committee chairman Alessandro Fiocchi, MD, said.
Evidence Compelling but Not Conclusive
Assa’ad says breast milk contains many of the same food allergens as individual foods, but instead of promoting allergies, it appears to help babies become tolerant as their immune systems develop.
Assa’ad acknowledged there is still debate about the impact of food introduction timing on allergy risk.
Even so, the committee wrote in its consensus state, “There seems to be no reason why delayed exposure to solid foods should not prove similarly useful (as the delay of cow’s milk) in the prevention of food allergies,” the committee wrote in its consensus statement.
By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Fiocchi, A. Annals of Allergy, Asthma, and Immunology, July 2006; vol 97: pp.10-21. Alessandro Fiocchi, MD, University of Milan Medical School; chairman, ACAAI Adverse Reactions to Foods Committee. Amal Assa’ad, MD, associate director, division of allergy and immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati.