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