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New Food Allergy Guidelines

Wait no more – start babies on allergenic foods early

It’s Food Allergy Awareness Week, and most moms know that food allergies are being diagnosed more and more frequently. In the past, most advice given about avoiding these allergies ran along these lines: Let the baby mature a bit. Wait until he’s 2 years old. Don’t give him peanut butter yet.

Now, guidelines have changed – a lot. When babies begin to transition to solids (as early as 4-6 months), they should be fed a varied diet that should include foods like eggs and peanut butter. Why such a huge change? We talked to food allergy expert, Dr. Kari Nadeau, who walked us through the hows and whys of the updated guidelines.

How many children have food allergies?
Currently in the United States, there are about six million children under the age of 18 with a doctor’s diagnosis of a food allergy. Of those, up to 30 percent of them have two or more additional food allergies.

It seems like there are many more kids who are being diagnosed with allergies now than years ago.
Yes, right now, the rate of some food allergies is doubling approximately every ten years. These allergies aren’t just in the United States – they’re developing around the world. Even adults can get food allergies for the first time decades after their childhood. In a study done at Northwestern, at least 15 percent of adults with a food allergy were first diagnosed over age 18. Unfortunately, food allergies affect everyone across all ethnic and socioeconomic groups.

So why is that? Those numbers are alarmingly high.
As to the cause, there seems to be many factors involved. A study involving 5,200 infants, directed by Dr. Katie Allen of The Royal Children’s Hospital in Melbourne, Australia, found factors that could increase the risk of a child being diagnosed with a food allergy include: developing moderate eczema, having a Vitamin D deficiency, and lacking diversity of foods in a child’s diet.

What are the new guidelines?
There’s a strong body of evidence that shows that when babies are starting to add solid foods to their diet – as early as 4-6 months old – that they should start diversifying their diet. This includes giving them foods like eggs, milk, wheat, fish, peanut, and tree nut products early and often. Data has shown that doing this may reduce the risk of food allergies up to five-fold. When you consider that six million U.S. children under the age of 18 have food allergies, reducing the risk by that much is really substantial. It is also important to note that the recent studies (like this one and this one) in the New England Journal of Medicine also showed how safe it was to introduce all these foods.

So why the change from the old guidelines, which told parents to delay allergenic foods for at least a year or two?
For years, parents had been instructed to avoid certain foods when their infants started eating solids. That directive wasn’t based on any substantive data – it was a precautionary reflex. These new recommendations, which have been suggested by the National Institute of Allergy and Infectious Diseases, have been developed from independent worldwide research. These guidelines can be applied to children who have a minimal risk of developing food allergies, but also those children who have a high risk. Also, parents don’t have to introduce foods one at a time. Instead, they can do it all at once. There’s no need to wait. The safety and usefulness of this approach has been validated by the independent data as well.

How do I talk to my doctor about these new guidelines?
These findings can help doctors talk to parents about the outdated guidelines and instead introduce these foods early, as long as it’s done responsibly and safely.

If a child has already been diagnosed with a food allergy by a doctor, then please follow the doctor’s recommendations. If mom is feeding her baby any food item, and thinks she’s seeing hives, or the baby starts vomiting, please consult with a pediatrician.

Kari Nadeau, M.D., Ph.D. is the Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. Her center’s vision is to find the causes and cures of allergies. Her center’s mission is to transform the lives of patients and families through innovative science and compassionate care.