Could the days of avoiding eggs, peanuts, fish and other potential allergens until a child is at least one year old be coming to an end?
Canadian pediatricians and allergy specialists now say that babies can be fed these foods as early as six months of age.
In fact, waiting much longer might even increase the risk of an allergy, doctors suggest.
In a joint statement by the Canadian Pediatric Society and the Canadian Society of Allergy and Clinical Immunology, and also endorsed by Dietitians of Canada, the doctors say there appears to be no benefits to delaying the introduction of these foods.
"There is no evidence to support the theory that avoiding certain foods during this time will prevent allergies in children," Dr. Carl Cummings, co-author of the statement and chair of the CPS Community Paediatrics Committee said in a statement.
The advice is a bit of an about-face for parents, who have long been told that it's best to wait until a child's immune system matures before introducing foods that are notorious allergens. But the doctors say the latest research say that approach may be doing more harm than good.
Like many mothers, Farah Meghji-Habib avoided giving her baby any foods that might spark a lifelong allergy.
“I was actually avoiding fish and peanut butter and eggs,” Meghji-Habib said. “I was sticking mostly right now to fruits and vegetables and a little bit of rice and oats cereal.”
But the doctors write: "There is increasing speculation that a later introduction of peanut has increased the prevalence of peanut allergy.”
"There is increasing speculation that a later introduction of peanut has increased the prevalence of peanut allergy," the doctors write.
"One study in the United Kingdom showed that the prevalence of peanut allergy tripled during the period when public health practitioners were advising parents to delay peanut introduction."
The groups also don't recommend that pregnant or breastfeeding mothers avoid milk, egg, peanut or other foods. They say the evidence that avoiding certain foods helps prevent allergies is "weak" and might even raise the risk of maternal undernutrition.
Babies who have a parent or sibling with a food allergy, such as atopic dermatitis or food allergy asthma are considered at high risk of developing a food allergy. The statement says that while these foods can be introduced to high-risk babies, the decision about when should really be based on the parents' comfort level.
The Canadian Pediatric Society advises parents who are nervous about introducing new foods to talk to their physician.
Once parents introduce a new food, it is also important to continue to offer that food regularly to the child – preferably, several times a week -- to maintain his or her tolerance, the groups' statement adds.
They say that the current understanding of immunological tolerance suggests that regularly eating a new food may be just as important as when that food is first introduced in determining whether a child will develop an allergy.
And Joelene Huber, pediatrician at St. Michael’s and Sick Kids hospitals in Toronto, suggests introducing new foods in the morning, so that parents can watch the infant’s reaction to the food during the day.
“We’re starting to understand that there is no evidence (avoiding foods) will actually prevent an allergy, and in some cases, we may be promoting allergy by delaying the exposure,” Huber said.
The doctors' groups also recommend:
- Mothers breastfeed exclusively for the first six months of life. While it's still not clear whether breastfeeding prevents food allergies, it is clear that it provides "optimal infant nutrition."
- If using baby formula, choose a hydrolyzed cow’s milk-based formula, which may have a preventive effect against atopic dermatitis compared with whole cow’s milk formula.
- Do not delay the introduction of any specific solid food beyond six months of age. Later introduction of peanut, fish or egg does not prevent, and may even increase, the risk of developing food allergy.
- Attempting to induce tolerance by introducing solid foods at four months of age is currently under investigation and cannot be recommended at this time.
- Routine skin or specific blood testing before introducing a new food is discouraged because of the high risk of false-positive results, which can be confusing.
