New AAP Report on Prevention of Food Allergy

The American Academy of Pediatrics issued a Clinical Report on the effects of early nutritional intervention to prevent atopic disease (atopic dermatitis, asthma, food allergy) in early childhood.  This report replaces an earlier policy statement that addressed the use of hypoallergenic infant formulas and included some recommendations for the dietary management to prevent atopic disease.  According to the report, only infants with at least one first degree relative (parent or sibling) with allergic disease are considered at high risk for developing atopic disease.  The report concludes that there is not enough evidence to support maternal dietary restrictions of potentially allergenic foods (i.e. milk, eggs, and nuts) during pregnancy or lactation as a way to prevent atopic disease, with the possible exception of atopic eczema.  More data are needed to substantiate this. 

Other report conclusions:

• For high-risk infants, there is evidence that exclusive breastfeeding for at least 4 months vs. feeding cow milk formula decreases the incidence of atopic dermatitis and cow milk allergy in the first two years of life.  Breastfeeding for at least three months protects against wheezing in early life.
• For high-risk infants who are formula-fed, there is evidence that feeding an extensively or partially hydrolyzed formula may delay or prevent atopic dermatitis in early childhood compared to cow milk formula. 
• There is no convincing evidence that soy-based infant formula will prevent allergy.
• Whether an infant is breastfed or formula fed, solid foods should not be introduced before 4 to 6 months of age.  There is no convincing evidence that delaying their introduction longer than this will prevent atopic disease.  This applies to the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein. 

[Greer FR, Sicherer SH, and Burks AW and the Committee on Nutrition and Section on Allergy and Immunology, Pediatrics, 121: 183-191, 2008]