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Early Dietary Exposures and Feeding Practices

Scott H. Sicherer, MD
Clinical Professor of Pediatrics, Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology
Mount Sinai School of Medicine
New York, New York, USA

Food allergy prevalence varies geographically and appears to be increasing in “westernized” areas.(1) This lecture focuses on the role of early dietary exposures (infant feeding) and feeding practices (timing and types of foods chosen) on food allergy. Recent Guidelines from the US have addressed diet as a means of allergy prevention.(2;3) Emphasis is placed upon encouraging breast feeding and considering the use of “hypoallergenic” infant formulas for infants “at risk” if the infant is not breast fed. New guidelines in the US rescind prior recommendations that suggested avoidance of potentially allergenic foods for prolonged periods in infants at risk; for example prior suggestions to  avoid milk until age 1, egg until age 2 and fish, peanut or nuts to age 3 years. The reversal substantially matches approaches that were in place in most countries outside of the US. Study after study appears to be substantiating the impression that waiting longer to introduce dietary “allergens” may be counterproductive for atopy outcomes (e.g., (4-7) and others). There are likely numerous dietary reasons, besides dietary allergen exposure per se, that can affect allergy outcomes.(8;9) We will explore how feeding practices themselves (using manufactured foods, cultural and regional differences) may have influenced allergy outcomes as well.

(1) Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011; 127(3):594-602.

(2) Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA et al. Guidelines for the Diagnosis and
Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J
Allergy Clin Immunol 2010; 126(6):1105-18.

(3) Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic
disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction
of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121(1):183-91.

(4) Katz Y, Rajuan N, Goldberg MR, Eisenberg E, Heyman E, Cohen A et al. Early exposure to cow’s milk protein
is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol 2010; 126(1):77-82.

(5) Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN et al. Can early introduction of egg prevent
egg allergy in infants? A population-based study. J Allergy Clin Immunol 2010; 126(4):807-13.

(6) 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(1):e115-e122.

(7) Joseph CL, Ownby DR, Havstad SL, Woodcroft KJ, Wegienka G, MacKechnie H et al. Early complementary
feeding and risk of food sensitization in a birth cohort. J Allergy Clin Immunol 2011; 127(5):1203-10.

(8) Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol 2008; 121(6):1331-6.

(9) Sicherer SH, Sampson HA. Peanut allergy: emerging concepts and approaches for an apparent epidemic. J
Allergy Clin Immunol 2007; 120(3):491-503.

Slide presentation