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

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Allergy / Immunology Neonatology Paediatrics Allergies & Immunity Nutrition & Disease Management
[Guideline Summary] Summary of American Academy of Allergy, Asthma & Immunology (AAAAI)

Nutritional Recommendations on Primary Prevention of Allergic Disease

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.

Link to Journal


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.