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Early Introduction of Complementary Foods Might Prevent Allergic Disease

Summary and Comment |
January 30, 2013

Early Introduction of Complementary Foods Might Prevent Allergic Disease

  1. David J. Amrol, MD

Duration of total breast-feeding is more important than exclusive breast-feeding for prevention of asthma and allergies.

  1. David J. Amrol, MD

The timing of the introduction of complementary foods in infants is confusing for parents and clinicians alike. Older guidelines recommended avoidance of dairy until age 1 year; eggs until age 2 years; and peanuts, nuts, and seafood until age 3 years. Currently, the American Academy of Pediatrics recommends exclusive breast-feeding until age 4 to 6 months, followed by introduction of complementary foods without providing a timeline for when to introduce specific foods. Investigators followed 3781 Finnish children for 5 years to examine the association between duration of breast-feeding and timing of introduction of complementary foods (based on parent report) and the development of allergic disease and specific IgE (sIgE) sensitization to foods and inhalants.

Introduction of wheat, rye, oats, and barley before age 5.5 months, fish before age 9 months, and egg before age 11 months was associated with lower rates of asthma, allergic rhinitis, and sIgE sensitization. Total breast-feeding duration of 9.5 months or more was associated with lower risk for nonatopic asthma, and the benefit seemed to correlate with the duration of total breast-feeding rather than exclusive breast-feeding.

Comment

By telling parents for years to delay the introduction of allergenic complementary foods, we might have caused more harm than good. On the basis of these results and recent guidelines (J Allergy Clin Immunol: In Practice 2013;1:29), I recommend exclusive breast-feeding for only 4 months followed by continued breast-feeding with complementary foods until age 12 months. Grains should be started at age 4 months, followed by all other foods during the first year. A recent randomized trial showed similar growth rates and better iron status in breast-fed infants when complementary grains were started at 4 versus 6 months of age. (JW Pediatr Adolesc Med Jan 9 2013)

Dr. Amrol is an Associate Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.

Citation(s):

Reader Comments (4)

Marc A. Tanenbaum

Dr. Amrol,

Could you comment on the pros & cons of starting individual puréed meats vs infant cereals as first foods between the age of 4-6 months in terms of iron deficiency anemia prevention? Also what are your recommendations for vitamin & iron supplementation in breast fed infants before and after the start of complementary foods? Thank you.

Competing interests: None declared

Neal Devitt

It is premature, reckless and possibly dangerous to recommend changes in the time to introduce solid foods on the basis of this single study. Follow these children to age 15 to see whether introduction of solids at 4 months affects the incidence of obesity and diabetes, then give me a safe recommendation!

Competing interests: My 4 children were exclusive breast fed for 6 months.

James Thompson

I was looking over some of my molecular allergy results and realized that toddlers and infants are far more likely to be sensitized to allergens presented to the GI tract whereas grade school school children through adults become sensitized by aeroallergens.

For example, ISAC data shows that a 2 y/o is more likely sensitized to peach PR-10 (food), a 10 y/o to birch PR-10 (pollen). As the immune system and GI tract mature de novo food sensitization becomes less likely.

Later introduction of serious allergens such as peanuts and tree nuts in children of highly atopic parents makes common sense, keeping in mind the amount and frequency of peanut needed to induce IgE to Ara h 2 is small enough to escape observation by even the most careful parents.

Often it is only when the dad gives kiddo a bite of his peanut butter on toast while mom is grocery shopping does the family experience the calamity of a serious allergic reaction. Even then, screening peanut IgE levels may give false reassurance, but there you have anaphylaxis.

It would be best to avoid blanket recommendations for food introduction without considering the patient's clinical status and the family history.

Competing interests: None declared

Lucio Piermarini

People keep blindly proposing an age of weaning or another, always with good reasons, and always never asking the infants if they agree to it, i.e. asking themselves if they will comply or not. Forcing, always with good reasons, a neurodevelopmentally immature infant to accept solids is the main cause of picky eating, so I think hat, before promoting this new crusade, it would be more sensible to take into account also this actual problem and weight it vs a still impredictable allergic risk.

Competing interests: None declared

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