Food Allergy Prevention by Diet


EAACI 2013
NIAID 2010
AAP 2008
AAP 2000
Maternal diet during pregnancy
No restrictions
No restrictions
No restrictions
Eliminate peanuts
Maternal diet while nursing
No restrictions
Not commented
No restrictions
Eliminate peanuts and tree nuts (eg, almonds, walnuts, etc) and consider eliminating eggs, cow’s milk, fish.
Infant diet <4-6 months
  • Exclusive breastfeeding is recommended for all infants for the first 4–6 mo
  • If breastfeeding is insufficient or not possible:
    • High-risk (at least one parent and/or sibling with a history of allergic disease)
      infants should receive a hypoallergenic formula with documented preventive effect for the first 4 mo
    • Other infants may receive a standard formula
  • Exclusively breastfeed until at least 4-6 months, unless it is contraindicated for medical reasons
  • Do not use soy instead of cow’s milk formula as a strategy for preventing the development of FA or modifying its clinical course in at-risk infants
  • Hydrolyzed infant formulas, as opposed to cow’s milk formula, may be considered as a strategy for preventing the development of FA in at-risk infants who are not exclusively breast-fed. Cost and availability of extensively hydrolyzed infant formulas may be weighed as prohibitive factors.
space
  • Breastfeed exclusively until at least 4-6 months
  • No solid foods
  • If not breastfeeding and infant at high risk for developing allergy (positive family history), using extensively hydrolyzed formula may delay or prevent atopic dermatitis.
  • Do not use soy formula
  • Ideally, breastfeed until at least 1 year old
  • No solid foods
  • If breastfeeding exclusively and child develops food allergy, exclude cow’s milk, egg, fish, peanuts, treenuts from mother’s diet. If child still symptomatic, switch to extensively hydrolyzed or amino acid formula.
  • If not breastfeeding and infant at high risk for developing allergy, should breastfeed or give extensively hydrolyzed formula.
Infant diet >4-6 months
  • After the age of 4 mo, a standard cow’s milk-based formula is recommended, irrespective of atopic heredity
  • Introduction of complementary foods (without dietary restrictions) after the age of 4 mo for all children irrespective of atopic heredity
  • No withholding or encouraging exposure to ‘highly allergenic’ foods such as cow’s milk, hen’s egg, and peanuts irrespective of atopic heredity
Introduction of solid foods should not be delayed beyond 4-6 months of age. Potentially allergenic foods may be introduced at this time as well.
Introduce solid foods after 4-6 months, no restrictions on type (except no honey <1 year old, no choking hazards)
  • Ideally, breastfeed until at least 1 year old
  • Introduce solid foods after 6 months of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, tree-nuts, and seafood until 3 years of age.



Possible Food Allergy Development Risk Factors

FA_risk_factors.png


References