Central PA Medicine - Spring 2017 - 24

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But what about allergies other than peanuts? There have been a few recent studies
(from the U.K. and Australia) looking at
milk, eggs, fish and wheat. Introducing
egg or egg powder between 3-6 months,
especially in children with eczema (atopic
dermatitis), showed a lower risk of egg allergy
at age 1-3 years. Milk, fish and wheat did
not show an increase in allergy with delayed
introduction with comparable percentages
to the early introduction group.

The most common food allergens in chil- 6 months of age including dairy products
dren include peanuts, tree nuts, eggs, milk, until 1 year; eggs until 2 years; and peanuts,
soy, wheat, and shellfish. The prevalence of nuts, and fish until 3 years of age. In 2008,
food allergy in children (aged 0 to 17 years) the AAP revised their statement citing a
has slowly increased in the United States lack of evidence for delaying introduction
from 3.4% in 1997 to 5.1% in 2011. Peanut of allergenic foods.
allergy specifically has increased from 0.4%
in 1997 to more than 2% in 2010.
So, what may you hear from your child
or grandchild's doctor at the next checkup?
Parents have heard varying recommenda- New data has surfaced from studies done in
tions from their doctors over the past decade Israeli children where peanuts are routinely
about introduction of solids and allergenic introduced early and a paucity of peanut
foods. In 2000, the American Academy of allergies reported. The LEAP trial (Learning
Pediatrics (AAP) recommended mothers Early About Peanut allergy) studied children
eliminate peanuts and other allergenic foods 4-11 months old at high risk for allergies
from their diets while nursing, but in 2008 (severe eczema, egg allergy, or both) to constated there was minimal evidence to support sume or avoid peanuts until 5 years of age.
this. In 2012, a Danish study indicated that Children who regularly consumed peanut
children born to mothers who regularly products had decreased peanut allergy by
consumed peanuts and tree nuts during 12%-25% at 5 years. Subsequent studies
pregnancy were less likely to have asthma of this group of children showed ongoing
and allergic rhinitis. Similarly, in 2000, AAP benefit of early introduction continued even
suggested delayed introduction of solid after a full year of peanut avoidance.
foods into the diet of high-risk infants until

The most common food
allergens in children
include peanuts, tree
nuts, eggs, milk, soy,
wheat, and shellfish

24 Spring 2017 Central PA Medicine

Early introduction of
peanuts between 4 and
6 months for children at
higher risk for allergies
decreases peanut allergy
at age 5 by up to 25%

The above early introduction of solids
varies from the current recommendation
by AAP and World Health Organization
for exclusive breastfeeding until 6 months
of age, with continued breastfeeding for one
year or longer as mutually desired by mother
and infant. Despite increased awareness and
educational efforts in supporting breastfeeding, only approximately 20% of mothers
breastfeed exclusively until age 6 months.
So, the pendulum appears to be swinging
over the past decade toward early introduction of "allergenic" foods with recent data
supporting the notion of introducing at least
eggs and peanuts between 4 and 6 months for
children who may be at higher risk. Grandma
may have been right... "a little piece won't
hurt 'em." It's a great discussion to have with
your child's family physician or pediatrician,
who can advise you on the specific benefit
or risk of early introduction of solid food for
your child. Then you can worry a little less
about allergies and more on how to clean
sticky food out of their hair!

Early introduction of egg
protein between 3 and 6
months seems to decrease
risk for egg allergy
between ages 1 to 3 years

Early introduction of milk,
soy, wheat or fish did
not seem to decrease
allergies at 1 year

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Table of Contents for the Digital Edition of Central PA Medicine - Spring 2017