COMMENTARY

Delay Food Introduction to Prevent Food Allergy? It Doesn't Work

Jonathan M. Spergel, MD, PhD

Disclosures

May 18, 2015

Editorial Collaboration

Medscape &

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I am Jonathan Spergel, chief of the Allergy Section at the Children's Hospital of Philadelphia. I will be talking today about the changing recommendations for food introduction in infants and toddlers.

Ten or 15 years ago, we all said, "Avoid, avoid, avoid." The idea was that if you didn't ingest the allergen, the body would never see it as foreign and would accept it as normal. However, the prevalence of food allergies has risen, almost doubling in the past 20 years. So we began to look hard at the scientific evidence from observational studies and randomized trials to determine the right time to introduce foods.

These studies have very consistently shown that early introduction is the right way to go. It has been shown that if you introduce milk early, a child is much less likely to develop milk allergy. By introducing cow's milk early in yogurt or cheese, children will be much less likely to develop milk allergy. The same is true for peanuts and eggs. A study just published by Gideon Lack and colleagues[1] shows that when peanuts are introduced in the first 8 months of life, children are much less likely to develop peanut allergies.

So, early is better, which is the complete opposite of what we said 10 years ago. Our recommendations now are different. We still say breastfeed for 4-6 months if you can. If you can't, use an infant formula. It is unclear which is the best infant formula for prevention of food allergies. But breastfeeding is best if possible, for 4-6 months.

When foods are introduced, we typically recommend starting with a food that the child will tolerate easily—usually fruits and vegetables. After that, the foods that we used to say are more allergenic—milk, egg, peanut—are gradually introduced. These foods are given early so that the body will think they are normal and not develop allergies to them. The reason that straight cow's milk is not given isn't because of allergy; it's because of the risk for anemia.

Our recommendations have "done a 180" over the past 10 years. Instead of recommending avoidance, now we say, "Give foods early." This is a true reversal, and hopefully these changes will slow the rate of increase in food allergies that we have seen in the past 20 years.

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