Food Introduction and the Development of Food Allergies in Infants

Bon Secours Memorial College of Nursing

Nursing Care of Children and Families
Kristina Knode
September 30, 2014

In the United States, food allergies affect one in every 13 children under the age of 18
and according to a 2013 Centers for Disease Control (CDC) study, food allergies among children
rose by approximately 50% between 1997 and 2011. In 2009-2010, the food allergy prevalence
in the United States was 8% (McHenry, 2014). With food allergies becoming a growing problem
in the United States, parents of infants are seeking more information about best practice in

Running head: FOOD INTRODUCTION AND ALLERGY DEVELOPMENT

introducing highly-allergenic foods to their infants' diet (Foodallergy.org, 2014). At least half the
time, parents of children with food allergies receive varying advice from healthcare professionals
as to how they should manage their child's diet, increasing parental anxiety while introducing
new potentially allergenic foods to their children. Parental anxiety may be reduced by healthcare
professionals adopting a consistent approach when providing advice regarding the introduction
of allergenic foods to high risk children's diet (McHenry, 2014). This research paper will explore
current international guidelines regarding introduction of allergenic foods to high-risk children in
order to determine how healthcare professionals should guide advice they give to parents
regarding food introduction in infancy and the development of food allergies.
Food allergies are an IgE mediated antibody response to allergenic food products. There
are eight major food allergens which include: milk, egg, peanut, tree nut, soy, wheat, fish and
shellfish (McHenry, 2014). Ingestion of these food products may lead to an anaphylactic
reaction. Signs and symptoms of an anaphylactic response include: oropharyngeal pruritus,
angioedema, laryngeal edema, stridor, dysphonia, cough, dyspnea, wheezing, nausea, vomiting,
diarrhea, flushing, uticaria, abdominal pain, feeling of impending doom, and cardiovascular
collapse (Sicherer, 2014). Primary prevention strategies for preventing food induced
anaphylaxis are currently debatable and are up for further discussion in this research paper.
Secondary screening measures for food allergies include specific IgE antibody testing. Methods
for such testing include: prick and puncture testing, intradermal testing, and patch testing.
Accuracy for these tests varies. The prick and puncture method is the most common form for
testing and has a negative predictive accuracy of 90%; however, its positive predictive accuracy
is only 50%. As for tertiary treatment of food allergies, there are no curative mechanisms for
allergies. Food allergies are managed with elimination diets. Emergency treatment of

Running head: FOOD INTRODUCTION AND ALLERGY DEVELOPMENT

anaphylaxis related to food allergy exposure includes: antihistamines,

bronchodilators, corticosteroids and IV fluids (Schrierer, 2014).
In 2000, the American Academy of Pediatrics (AAP) recommended to delay the
introduction of potentially allergenic foods for infants at high-risk of developing food allergies.
At the time, this recommendation was based on expert-opinion, as there was not much
supporting research to support this claim. Recommendations from the AAP have since changed;
however, best practice amongst healthcare professionals has not seemed to have caught up.
According to McHenry and Watson, 59% of children aged 10-13 avoided foods due to an adverse
reaction despite only 26% of these children having a specific IgE antibody mediated reaction.
Food avoidance to this degree creates a problem as it impacts nutrition, development, and
psychosocial well-being that may also result in vitamin and mineral deficiencies that may
negatively impact growth. Furthermore, delaying introduction of new foods may even increase
the risk of allergy development in children. Chin, Chan and Goldman site multiple international
studies that support introduction of allergenic foods before one year of age. One Swedish cohort
study suggested that a regular dietary intake of fish before 12 months of age reduced the risk of
allergic disease in the first four years of life. An Australian study supported that introduction of
eggs at four to six months of age reduced egg allergies in children when compared to introducing
eggs into the diet at 12 months (Chin, 2014). A study out of the United Kingdom suggested that
prevalence of peanut allergy tripled during the period of time when public health officials
recommended that parents delay introduction of allergenic foods to children until after three
years of age. Furthermore, an observational study in Israel amongst Jewish children showed that
the prevalence of peanut allergies in Jewish children in Israel was one-tenth that of Jewish
children living in the United Kingdom. Researchers believe this is because Jewish children in

Running head: FOOD INTRODUCTION AND ALLERGY DEVELOPMENT

Israel were regularly ingesting peanut protein during this time, compared to children in the
United Kingdom that were not consuming peanut protein at all (Chan, 2014).
Guidelines from the National Institute of Allergy and Infectious Disease (NIAID) state
that individuals with food allergies should avoid food related to specific antigens that trigger and
IgE mediated response and that physicians should help parents decide whether to introduce foods
that may be cross-reactive. The NIAID further recommends that patients at risk for developing a
food allergy (those with a first degree relative that suffers from contact dermatitis, asthma or
allergic rhinitis) do not need to limit exposure to foods that may cross-react with the eight major
food allergens. The problem with these guidelines is that physician advice to parents regarding
food introduction to their children greatly varied. Most physicians recommended delaying
introducing certain foods into the diet of children that suffer from other food allergies. Current
research is arguing that this may not be the best recommendation. Current recommendations
from the AAP state that "solid foods should not be introduced before four to six months of age"
and that there is "no convincing evidence that delaying food introduction beyond this point is
protective against food allergy." This recommendation supports NIAID guidelines. Furthermore,
a 2013 study by the Canadian Pediatric Society regarding allergy prevention recommends: no
restriction of maternal diet during pregnancy, exclusive breastfeeding for the first six months of
life, and not to delay the introduction of any specific food beyond six months of age.
Overall, current research lacks supporting evidence to confirm that delaying the
introduction of allergenic foods may later prevent the development of food allergies in children.
On the contrary, more research is beginning to support that introducing allergenic foods at four to
six months of age may have protective properties against the development of food allergies later
in life (Chin, 2014). Grimshaw, et al.'s cohort study that suggests that 17 weeks is a crucial timepoint where "solid food introduction before this time appear[s] to promote allergic disease

Running head: FOOD INTRODUCTION AND ALLERGY DEVELOPMENT

whereas solid food introduction beyond that time point tends to promote tolerance." Chin and
Cummings suggest that there has been a shift in evidence based practice to prevent the
development of food allergies in children by accepting the benefits of introducing allergenic
foods as early as four to six months of age. More research should be conducted on the early
introduction of specific foods to prevent food allergies as to whether regular ingestion of these
foods helps to maintain food tolerance. Until such research is conducted, it cannot be
recommended that guidelines set forth by the AAP should change. Currently established
guidelines should be used to guide physician advice to parents while discussing food
introduction to high-risk children.
I have neither given nor received aid, other than acknowledged, on this assignment or test, nor
have I seen anyone else do so.

References
AAP.org. (n.d.). Retrieved September 1, 2014.
Chan, E., & Cummings, C. (2014). Dietary exposures and allergy prevention in high-risk infants:
A joint statement with the Canadian Society of Allergy and Clinical Immunology.
Paediatrics & Child Health, 18(10), 545-554.
Chin, B., Chan, E., & Goldman, R. (2014). Early exposure to food and food allergy in children.
Canadian Family Physician, 60(4), 338-339.
Grimshaw, K., Maskell, J., Oliver, E., Morris, R., Foote, K., Mills, C., ... Margetts, B. (2013).
Introduction of complementary foods and the relationship to food allergy. Pediatrics,
132(6), 1529-1538.
Home - Food Allergy Research & Education. (n.d.). Retrieved September 1, 2014.

Running head: FOOD INTRODUCTION AND ALLERGY DEVELOPMENT

McHenry, M., & Watson, W. (2014). Impact of primary food allergies on the introduction of
other foods amongst Canadian children and their siblings. Official Journal of the
Canadian Society of Allergy and Clinical Immunology, 10(1).
National Institute of Allergy and Infectious Diseases (NIAID). (n.d.). Retrieved September 1,
2014.
Schrierer, S. (2014, January 1). Food Allergies . Retrieved September 1, 2014.