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Tuesday, February 9, 2010

To avoid or not to avoid?

The evidence is mounting. Early exposure to potential allergens is critical to the development of tolerance. In this blog, we talk about 3 articles that have appeared recently that basically deliver the same message: when it comes to infant feeding to avoid atopy, the jury is still out.

The leading allergy journal in Europe, Allergy, published an article by the EuroPrevall research consortium (a European Union funded project). Their literature review paper found that there is no overall evidence that supports European infant-feeding guidelines for allergy prevention. There was consensus that breastfeeding for 6 months is best for the infant, but its effect on allergy prevention is unknown.

Two Finnish research groups have come up with similar findings about the timing of introduction of solid foods. One article, in the US journal Pediatrics, shows that introduction of eggs, oats, and wheat after the age of 5 months is associated with food allergies later, and late introduction of potatoes and fish is associated with inhalant allergies.

The other article by Finnish researchers, published in the British Journal of Nutrition, reports on the results of a study of asthma risk, and oatmeal. The researchers followed a large cohort of children and parents for 5 years, and report that children introduced to porridge before 5 months of age were 64% less likely to have wheezing as toddlers compared to children who never ate it or ate it at an older age. It was also shown that infants that were fed fish at an early age had significantly lower incidence of allergic rhinitis by 5 years of age.

These findings stand in sharp contradiction to US and European infant-feeding guidelines that emphasize the introduction of solid foods at discrete developmental stages that begin at 6 months of age. Are we creating – unintentionally – our immune-impaired populations by being too avoidant of allergens?

What do you think? Please feel free to post your own comments below. Topics and articles that you think would be of interest in our NBOP section and/or this blog can be sent to the JACI Editorial Office at jaci@njhealth.org.

2 comments:

  1. Brings to mind the not so distant paper published in JACI which raised the question of whether delaying introduction of peanut has been counter productive. J Allergy Clin Immunol. 2008 Nov;122(5):984-91

    In light of this, and other evidence suggesting that American hyper-avoidance of allergens has not had the desired protective effect, I no longer advise parents to delay introduction of solids, or other common allergens (unless there is a family history of severe food allergy). This change in my practice occurred approximately 1 year ago- so far, so good!

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  2. I agree with you. Thank you for sharing the update. It is interesting to have it discussed widely so that we can gain more objective opinions.

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