Eat It or Avoid It?
by Todd D. Green, MD, FAAAAI
Once you have a child who has severe food allergies and have experienced how hard it can be to keep that child safe, you naturally want to do anything you can to keep your next child (or children) from getting food allergies, too. This concept of stopping an allergy before it starts is known as primary prevention. As a pediatric allergist/immunologist I get a lot of questions about this: Should Mom avoid highly allergenic foods while pregnant or breastfeeding? If and when should you try feeding these foods to the baby? Is it best for Mom to avoid these foods and also delay letting the baby try them until he or she is older, or will avoidance actually increase the chances that allergy will develop?
These are all great questions – and the responses have actually changed in the past few years as we have realized how complicated is the issue of primary prevention. Not that long ago, for example, it was recommended that families with a history of allergy delay introducing cow’s milk into the baby’s diet until age 1, hold off on egg until age 2, and wait to try peanuts and tree nuts until age 3. In 2008, however, new guidelines came out based on more recent research, and “wait until the child is older” is no longer the general advice. So should you eat it or avoid it? As of now, here’s what you need to know…
What to Eat When Pregnant
When you are pregnant good nutrition is extremely important, and you should continue to eat all of the nutritious foods that you usually eat. As a general rule, avoiding highly allergenic foods during pregnancy is not recommended at this time. In particular, whether a pregnant woman avoids cow’s milk or egg does not seem to make a difference in whether her child develops allergies.
With respect to peanut, however, more studies are needed before we can make a conclusive recommendation. While some studies have shown that eating peanuts during pregnancy increases the baby’s risk of developing peanut allergy or asthma, other studies have shown the opposite to be true. It is important to note that most of the studies on this issue have important limitations, such as relying on mothers’ memories of their diets during pregnancy months to years afterwards. Until there is clear evidence one way or the other, pregnant women who do not have food allergies themselves do not need to avoid highly allergenic foods.
What to Eat When Breastfeeding
Just like when you are pregnant, when you are breastfeeding you should continue to eat all of the nutritious foods that you usually eat. Avoiding cow’s milk and egg while breastfeeding is not recommended at this time. Similar to peanut in pregnancy, data are inconclusive about whether you should avoid peanuts while breastfeeding, and at this time no recommendation can be made. This does not mean that it should be avoided, just that the information is not clear enough to be able to recommend one way or the other.
Please note, however, that if your baby has severe eczema or is showing signs of possible food allergy (such as hives, excessive vomiting, failure to thrive, extreme fussiness during most nursing sessions, coughing/wheezing with feedings, or other similar issues), you should speak to your allergist about your concerns before possibly changing your diet.
When to Begin Feeding Babies Highly Allergenic Foods
You can begin to introduce solid foods into your baby’s diet when he or she is between 4 and 6 months old, can sit up with support, and has enough head and neck control to be able to eat without choking. In general, even in a family with a strong history of food allergy, there is no reason to wait until the baby is older before introducing highly allergenic foods, and some studies suggest that it may even be helpful to introduce these foods early. Some cautions, however:
How to Begin Feeding Babies Highly Allergenic Foods
Even if you do not need a personalized plan for food introduction, there are a few precautions that you should take:
Does it matter which allergenic food you try first? No. Unless your doctor has advised otherwise, the order is completely up to you.
For additional information, the American Academy of Allergy, Asthma and Immunology has a new patient brochure you can download: Preventing Allergies: What You Should Know About Your Baby’s Nutrition.
Todd Green, MD, FAAAI, is an allergist/immunologist in the Division of Pulmonary Medicine, Allergy and Immunology at Children’s Hospital of Pittsburgh, Director of the University of Pittsburgh Medical Center Allergy/Immunology Fellowship Program, and an Assistant Professor of Pediatrics at the University of Pittsburgh School of Medicine. In addition to serving on KFA’s Medical Advisory Board he is also on the Board of Regents of the Pennsylvania Allergy and Asthma Association.
Dr. Green attended medical school at the University of Pittsburgh School of Medicine. He completed his residency at The Barbara Bush Children’s Hospital at Maine Medical Center and his fellowship at Duke University Medical Center. He is Board Certified in Allergy/Immunology and Pediatrics.