The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines

Joshi, Preeti A; Smith, Jill; Vale, Sandra; Campbell, Dianne E

doi:10.5694/mja2.12102

Topics

Immune system diseases

Skin and connective tissue diseases

Environment and public health

Pediatric medicine

Abstract

Introduction: The Australasian Society of Clinical Immunology and Allergy, the peak professional body for clinical immunology and allergy in Australia and New Zealand, develops and provides information on a wide range of immune‐mediated disorders, including advice about infant feeding and allergy prevention for health professionals and families. Guidelines for infant feeding and early onset allergy prevention were published in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence.

Main recommendations:

When the infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods. (This is not a strict window of introduction but rather a recommendation not to delay the introduction of solid foods beyond 12 months.)
Introduce peanut and egg in the first year of life in all infants, regardless of their allergy risk factors.
Hydrolysed (partially and extensively) formula is no longer recommended for the prevention of allergic disease.

Changes in management a result of the guidelines: The guidelines specifically recommend introducing solid foods at around 6 months of age and introducing peanut and egg in the first year of life in all infants to prevent allergy development. Hydrolysed formula is no longer recommended for prevention of allergic disease. A new document outlining the reasons for and the method of peanut introduction to high risk infants is available for health professionals.

1 Australasian Society of Clinical Immunology and Allergy, Sydney, NSW
2 The Children's Hospital at Westmead, Sydney, NSW
3 University of Sydney, Sydney, NSW

Correspondence: preeti.joshi@health.nsw.gov.au

Competing interests:

Preeti Joshi is currently the chair of the ASCIA paediatric committee and the deputy chair of the National Allergy Strategy allergy prevention project. Sandra Vale is coordinator of the National Allergy Strategy. Jill Smith is the ASCIA CEO and company secretary. Dianne Campbell was chair of the ASCIA paediatric committee from 2011 to 2017, has received funding for unrelated research from the NHMRC, the Allergy and Immunology Foundation of Australasia and the Australian Food Allergy Foundation, and has received travel expenses to attend investigator meetings from DBV Technologies.

1. Odhiambo JA, Williams HC, Clayton TO, et al. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009; 124: 1251–1258.e23.
2. Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J 2013; 6: 21.
3. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge‐proven IgE‐mediated food allergy using population‐based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol 2011; 127: 668–676.e2.
4. Mullins RJ, Dear KB, Tang ML. Time trends in Australian hospital anaphylaxis admissions in 1998‐1999 to 2011‐2012. J Allergy Clin Immunol 2015; 136: 367–375.
5. Mullins RJ, Wainstein BK, Barnes EH, et al. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46: 1099–1110.
6. Australasian Society of Clinical Immunology and Allergy. ASCIA guidelines – infant feeding and allergy prevention. Sydney: ASCIA, 2016. https://www.allergy.org.au/health-professionals/papers/infant-feeding-and-allergy-prevention (viewed Nov 2018).
7. National Asthma Council Australia. Australian asthma handbook. Infant feeding and asthma prevention. http://www.asthmahandbook.org.au/prevention/primary/infant-feeding (viewed Nov 2018).
8. BI Nwaru ME, S. Ahonen, M. Kaila, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics 2010; 125: 50–59.
9. Netting MJ, Campbell DE, Koplin JJ, et al. An Australian consensus on infant feeding guidelines to prevent food allergy: outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 2017; 5: 1617–1624.
10. Grade Working Group. What is GRADE? http://www.gradeworkinggroup.org/ (viewed Nov 2018).
11. Australasian Society of Clinical Immunology and Allergy. ASCIA guide for introduction of peanut to infants with severe eczema and/or food allergy. https://www.allergy.org.au/health-professionals/papers/ascia-guide-peanut-introduction (viewed Nov 2018).
12. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372: 803–813.
13. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008; 122: 984–991.
14. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2012; (9): CD000133.
15. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Evid Based Child Health 2014; 9: 447–483.
16. Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n‐3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database Syst Rev 2015; (7): CD010085.
17. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Vitamin and mineral supplementation and pregnancy. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27sHealth/Statementandguidelines/Clinical-Obstetrics/Vitamin-andmineral-supplementation-in-pregnancy-(C-Obs-25)-Review-Nov-2014,-Amended-May-2015.pdf?ext=.pdf (viewed Nov 2018).
18. United States Food and Drug Administration. Eating fish: what pregnant women and parents should know. https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm (viewed Nov 2018).
19. Fiocchi A, Pawankar R, Cuello‐Garcia C, et al. World Allergy Organization‐McMaster University Guidelines for Allergic Disease Prevention (GLAD‐P): probiotics. World Allergy Organ J 2015; 8: 4.
20. Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol 2013; 149: 350–355.
21. Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev 2007; (4): CD006475.
22. National Health and Medical Research Council. Infant feeding guidelines: information for health workers. Canberra: NHMRC, 2012. https://www.nhmrc.gov.au/guidelines-publications/n56 (viewed Nov 2018).
23. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–490.
24. Grimshaw K, Logan K, O'Donovan S, et al. Modifying the infant's diet to prevent food allergy. Arch Dis Child 2017; 102: 179–186.
25. Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; (4): CD003741.
26. Boyle RJ, Ierodiakonou D, Khan T, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta‐analysis. BMJ 2016; 352: i974.
27. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2006; (4): CD003664.
28. Osborn DA, Sinn JK, Jones LJ. WITHDRAWN: Infant formulas containing hydrolysed protein for prevention of allergic disease and food allergy. Cochrane Database Syst Rev 2017; (5): CD003664.
29. von Berg A, Filipiak‐Pittroff B, Schulz H, et al. Allergic manifestation 15 years after early intervention with hydrolyzed formulas–the GINI Study. Allergy 2016; 71: 210–219.
30. Australasian Society of Clinical Immunology and Allergy. ASCIA information on how to introduce solid foods to babies for allergy prevention. https://www.allergy.org.au/patients/allergy-prevention/ascia-how-to-introduce-solid-foods-to-babies (viewed Nov 2018).
31. Perkin MR, Logan K, Tseng A, et al. Randomized trial of introduction of allergenic foods in breast‐fed infants. N Engl J Med 2016; 374: 1733–1743.
32. Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract 2013; 1: 29–36.
33. FR Greer SHS, A. W Burks. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas Pediatrics 2008; 121: 183–191.
34. Muraro A, Halken S, Arshad SH, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69: 590–601.
35. World Health Organization. Global strategy on infant and young child feeding. Geneva: WHO, 2003. https://www.who.int/nutrition/topics/infantfeeding_recommendation/en/ (viewed Nov 2018).
36. Palmer DJ, Sullivan TR, Gold MS, et al. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2017; 139:1600–1607.e2.
37. Perkin MR, Lack G. Introducing allergenic foods in infants. N Engl J Med 2016; 375: e16.
38. Du Toit G, Roberts G, Sayre PH, et al. Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study. J Allergy Clin Immunol 2013; 131: 135–143.e12.
39. Du Toit G, Sayre PH, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med 2016; 374: 1435–1443.
40. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases‐sponsored expert panel. J Allergy Clin Immunol 2017; 139: 29–44.
41. Turner PJ, Campbell DE, Boyle RJ, Levin ME. Primary prevention of food allergy: translating evidence from clinical trials to population‐based recommendations. J Allergy Clin Immunol Pract 2018; 6: 367–375.
42. Turner PJ CD. Implementing primary prevention for peanut allergy at a population level. JAMA 2017; 317: 1111–1112.
43. Levin M, Goga A, Doherty T, et al. Allergy and infant feeding guidelines in the context of resource‐constrained settings. J Allergy Clin Immunol 2017; 139: 455–458.

Online responses are no longer available. Please refer to our instructions for authors page for more information.