Summary of American Academy of Allergy, Asthma & Immunology (AAAAI)

Thursday, Feb 01, 2018

Nutritional Recommendations on Primary Prevention of Allergic Disease


Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. Primary Prevention of Allergic Disease Through Nutritional Interventions. J Allergy Clin Immunol: In Practice. 2013; 1:29-36.Link to Journal

The Adverse Reactions to Food Committee of AAAAI based on available literatures and expert opinion, developed a set of nutritional recommendations for primary care physicians and specialists, on the primary prevention of allergic disease through nutritional interventions.

Summary of nutritional recommendations developed by AAAAI:

  • Maternal avoidance diets during pregnancy and lactation:
    • Avoidance of essential foods such as milk and egg is not recommended.
    • Dietary counseling is recommended for mothers who choose to avoid foods.
    • No recommendation regarding maternal avoidance of peanut can be made because of inconclusive data.
  • Exclusive breastfeeding is recommended for at least 4 months and up to 6 months of age to possibly reduce the below incidence:
    • Atopic dermatitis for children younger than 2 years of age.
    • Early onset of wheezing before 4 years of age.
    • Cow’s milk allergy (CMA), but not general food allergy, in the first 2 years of age.
  • Selection of infant formula for primary prevention of allergic disease:
    • Hydrolyzed formula appears to offer advantages for infants at increased risk of allergic disease1 that cannot be exclusively breastfed for the first 4 to 6 months of age.
    • Difference on beneficial effects between partially and extensively hydrolyzed (whey or casein) formulas are inconclusive.
    • There is no substantial evidence that soy formula prevents atopic disease.
    • More studies on using amino acid-based formula are needed.
  • Introduction of complementary foods regardless of allergic predisposition:
    • Single-ingredient complementary foods can be introduced between 4 and 6 months of age.
    • Highly allergenic foods2 are not recommended as one of the first complementary foods.
    • Highly allergenic foods are recommended to be introduced at home, when a few typical complementary foods3 are tolerated.
    • If no reactions occur, other new foods could be introduced at a rate of one new food every 3 to 5 days.


  1. Infants with at least 1 first-degree relative (parent or sibling) with a documented allergic condition.
  2. Cow’s milk , egg, soy, wheat, peanut, tree nuts, fish, shellfish, etc.
  3. Rice or oat cereal, vegetables, fruits, etc.


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