Early Intervention for Primary Tolerance to Allergens
Katrina Allen, MD PhD
Royal Children's Hospital
Parkville, VIC Australia
There have been dramatic changes in timing of first exposure to solid foods for children over the last 40 years, ranging from exposure prior to 4 months of age for most infants in the 1960s, to guidelines recommending delaying solids until after 6 months of age introduced in the 1990s. Infant diet, specifically age of weaning and age at introduction of allergenic foods, has long been thought to play a role food allergy. However, controversy surrounding the relationship between timing of introduction of foods and development of food allergy has led to a plethora of inconsistent infant feeding guidelines both between and within countries. This presentation will discuss the history of changing guidelines for optimal timing of introduction of solids in general and allergenic solids (such as cow’s milk, egg and peanut) in particular and the evidence (or lack thereof) underpinning recommendations at each of these time points. Future guideline modification about timing of introduction (both for high risk infants but also for the general population), and breastfeeding and weaning practices will require careful review of emerging literature to provide a true evidence base to inform public health practice such as infant feeding guidelines.
- Snijders BE, Thijs C, van Ree R, van den Brandt PA, Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA Birth Cohort Study. Pediatrics 2008;122: e115-122.
- Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, Tey D, Slaa M, Thiele L, Miles L, Anderson D, Tan T, Dang TD, Hill DJ, Lowe AJ, Matheson MC, Ponsonby AL, Tang ML, Dharmage SC, Allen KJ, Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol 2010;126: 807-813.
- Poole JA, Barriga K, Leung DY, Hoffman M, Eisenbarth GS, Rewers M, Norris JM, Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006;117: 2175-2182.
- Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, Fox AT, Turcanu V, Amir T, Zadik-Mnuhin G, Cohen A, Livne I, Lack G, Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122: 984-991.
- Lowe AJ, Hosking CS, Bennett CM, Allen KJ, Axelrad C, Carlin JB, Abramson MJ, Dharmage SC, Hill DJ. Effect of a partially hydrolysed whey infant formula at weaning on risk of allergic disease in high-risk children: A randomized controlled trial. Journal of Allergy and Clinical Immunology, 128(2): 360-365, 2011