Dr Janice Joneja charts the change in approach to infant food allergy from avoidance to induced tolerance.

Abstract

For many years, the prevailing maxim for prevention of food allergy in at-risk infants was to reduce allergic sensitization by avoiding exposure to highly allergenic foods until the baby's immune and digestive systems were sufficiently developed to cope with the allergen. Current thinking is completely different: exposure to food in the early stages of development may be the way to induce tolerance. Exclusive breastfeeding until 4-6 months, followed by introduction of complementary foods individually, is recommended. Any restrictions on mother's diet, other than avoidance of her own allergens during pregnancy and breastfeeding, are contraindicated. If a baby at high risk for allergy (defined as having 1 first-degree relative with diagnosed allergy) cannot be exclusively breastfed to 4-6 months of age, the preferred method of feeding for the prevention of atopic disease is an extensively hydrolyzed formula. There appears to be no value in delaying the introduction of any food beyond 6 months of age. Most food allergy is outgrown in childhood, but allergy to some foods tends to persist. Induction of tolerance to foods to which a child is allergic may be achieved by low-dose exposure in a process known as specific oral tolerance induction (SOTI). Early results indicate that some probiotic strains of bacteria, such as Lactobacillus rhamnosus GG or Lactobacillus F19, may reduce allergic sensitization.

JPEN J Parenter Enteral Nutr. 2012 Jan;36(1 Suppl):49S-55S.

First Published Janury 2012

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