The American Academy of Pediatrics updates a clinical
report that explores how maternal and infant nutrition affect development of
The American Academy of Pediatrics (AAP), examining the
latest research on how to prevent allergies in children, confirms that a
growing body of evidence supports the early introduction of peanut-based foods
to infants to prevent peanut allergies.
The AAP, which endorsed a policy on early peanut
introduction in high-risk infants in 2015, bolsters the recommendation with
research cited within a clinical report published in the April issue of Pediatrics
(published online March 18). The clinical report updates and
replaces 2008 guidance on the roles of maternal and early infant diet in
preventing atopic diseases – or allergic responses – such as dermatitis, asthma
and food allergies.
The report is titled, “The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods.”
“We know that some children are predisposed to allergies
because of their family history,” said Frank Greer, MD, FAAP, co-author of the
clinical report. “It’s clear that sometimes nutrition can play a key role in
preventing or minimizing allergies that can be concerning – or even deadly –
for some children.”
Eight groups of foods account for about 90 percent of all
food allergies and must be declared on U.S. product labels. These include cow
milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean.
More than 170 additional foods are reported to cause allergic reactions, and
some, including sesame, are included in labeling laws in other countries.
The AAP discusses the evidence concerning whether maternal
diet, breastfeeding, hydrolyzed formulas and timing of introduction of
allergenic complementary foods prevent infant allergies.
“There is no reason to delay giving your baby foods that are
thought of as allergens like peanut products, eggs or fish,” said Dr. Scott
Sicherer, MD, FAAP, a coauthor of the report. “These foods can be added to the
diet early, just like foods that are not common allergens, like rice, fruits or
The AAP also finds:
for the first 3 to 4 months helps protect against eczema during a child’s
first two years of life. Any amount of breastfeeding (even if it is not
exclusive) beyond 3 to 4 months also protects against wheezing for the
first two years and offers even longer benefits in reducing asthma.
Evidence does not
support restricting a mother’s diet during pregnancy or breastfeeding as
methods to prevent allergies.
Hydrolyzed formula does
not prevent allergies in infants and children, even in those at high risk
for allergic disease, according to research. This finding marks a change
from the 2008 clinical report, which concluded there was modest evidence
that supported the use of hydrolyzed formula to prevent dermatitis in
Recommendations on the
prevention of peanut allergy are based primarily on the Learning Early
About Peanut Allergy (LEAP) trial. Ground peanuts and other specialized
formulations are advised, as whole peanuts are a choking hazard to
children under 4.
An expert panel convened by the National Institute of
Allergy and Infectious Diseases (NIAID) developed guidelines for early peanut
introduction endorsed by the AAP. This includes adding infant-safe forms
of peanut to the diet for most babies, as early as around 6 months, after other
solid foods are tolerated.
For high-risk infants who have severe eczema requiring
prescription treatments or have an egg allergy, testing for peanut allergy and
introduction of peanut-containing foods under supervision of a health care
provider is a consideration. These high-risk infants may have peanut products
introduced as early as 4-6 month of age. More information is available in the NIAID
parents to talk to their pediatrician or allergist about the symptoms of
allergies and whether their child should be tested,” said A. Wesley Burks,
M.D., FAAP, who coauthored the report.
can help track any changes in allergies, some of which may go away as a child
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds