Primary prevention of food allergy: beyond early introduction

Edmond S Chan; Elissa M Abrams; Douglas P Mack; Jennifer L P Protudjer; Wade Watson

doi:10.1186/s13223-024-00924-5

Primary prevention of food allergy: beyond early introduction

Allergy Asthma Clin Immunol. 2024 Dec 19;20(Suppl 3):71. doi: 10.1186/s13223-024-00924-5.

Authors

Edmond S Chan¹, Elissa M Abrams^{2

3}, Douglas P Mack^{4

5}, Jennifer L P Protudjer^{6

7

8

9

10}, Wade Watson¹¹

Affiliations

¹ Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada. EChan5@cw.bc.ca.
² Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
³ Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
⁵ Halton Pediatric Allergy, Burlington, Ontario, Canada.
⁶ Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁷ Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
⁸ Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁹ George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
¹⁰ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹¹ Department of Pediatrics, Division of Allergy, Dalhousie University, IWK Health Centre, Halifax, NS, Canada.

Abstract
in English, Spanish

Food allergy typically begins early in life and persists as a lifelong condition. Delayed introduction of allergenic foods followed by years of hesitancy to introduce these foods early may have contributed to the increase in food allergy prevalence in recent decades. Most infant feeding guidelines focus on the importance of early introduction of allergenic foods in infants at around age 4-6 months. However, regular, ongoing ingestion of allergenic foods is also critical for the primary prevention of food allergy. Similarly, intermittent exposure to cow's milk formula (CMF) in early infancy increases the risk of cow's milk allergy (CMA), while regular exposure (if it is introduced) prevents it. Families hesitant to introduce allergenic foods to their infant at home (despite education) should be offered introduction in a primary care clinic. Infants who have failed primary prevention should be referred to an allergist for consideration of early infant oral immunotherapy (OIT).

• To reduce the risk of cow’s milk allergy (CMA), intermittent supplementation of breastfeeding with cow’s milk formula (CMF) in the first few months of life should be avoided. If introduced, ongoing regular supplementation (e.g., one bottle per day to supplement breastfeeding) is recommended to maintain tolerance.

• Infants should have allergenic foods (e.g., cooked [not raw] egg, peanut) introduced at home, at approximately 4–6 months of age (but not before 4 months) in high-risk infants and 6 months of age in low-risk infants.

• Once introduced and tolerated, it is essential that allergenic foods be eaten regularly (multiple times per month and at least once per week) in amounts representative of age-appropriate servings.

• A single exposure or occasional/intermittent exposures to allergenic foods should be avoided as this could be detrimental and result in food allergy.

• Families who are hesitant to introduce allergenic foods at home and in a primary care clinic should be referred to an allergist. Also, infants who have failed primary prevention should be referred to an allergist as soon as possible for consideration of early infant oral immunotherapy (OIT; see Oral Immunotherapy article in this supplement).

Keywords: Early food introduction; Food allergy; Primary prevention.

Publication types

Review

Abstract in English, Spanish

Publication types

Abstract
in English, Spanish