Many are not aware that the American Academy of Pediatrics (AAP) recommendation to delay introduction of allergenic foods to infants and toddlers changed in 2008 from the prior guideline issued in 2000. Because the AAP determined there was no convincing evidence for delaying the introduction of allergenic, they reversed their recommendation but no specific advice on how to go about introducing these foods was given to parents or pediatricians. In 2015 a landmark trial called LEAP, Learning Early About Peanut Allergy was published. In this trial, infants at high risk for developing peanut allergy were introduced to peanut products starting between 4-11 months of age and the “treated” group had an 80% relative risk reduction in developing peanut allergy vs those infants who actively avoided introduction in the first 5 years of life. This information could very well reverse the peanut allergy epidemic that has emerged in the past 20+ years and led to dozens more studies on early feeding of other allergenic foods. One study in particular, EAT, looked at introduction of peanut, egg, cow’s milk, sesame, fish and wheat simultaneously in the first year of life and the results favored early introduction. Links to the LEAP and EAT trial published in the New England Journal of Medicine are listed below.
So, now that we know that “early and often” is the name of the game when it comes to feeding babies these foods, how are parents supposed to go about this? There are a variety of approaches and I prefer to discuss these in person with parents but short of that, I recommend the Inspired Start line of fruit/allergenic food pouches as an easy and practical option. They have an Apple/Peanut, Pear/Egg, Banana/Tree Nut, Mango/Soy, Apple/Wheat, Pear/Sesame, Banana/Shrimp, Mango/Cod. The only pouch that contains more than 1 allergen is the Tree nut with walnut, cashew and almond. In the LEAP trial parents were given the option to feed their infants Bamba (an easily dissolving corn-based snack with peanut powder) or smooth/honey-free peanut butter watered down with water, breastmilk or formula. The dose used in the trial was 1 teaspoon three times a week. Because other dosing regimens where not studied, it is not known if more or less or a different feeding frequency would also work. The general idea is that there is a “grace period” in the immune system during the first year of life such that introduction of these foods early and often during the first year is more likely to result in tolerance than allergy. Once infants are ready to start eating baby foods between 4-6 months of age, these allergenic foods can be introduced one by one and then rotated, “early and often” so the immune system is used to seeing these allergens and not reacting to them. If your baby has severe eczema or already has a food allergy, it is best to consult your Allergist or Pediatrician for specific advice.
Links:
https://www.nejm.org/doi/full/10.1056/NEJMoa1414850
https://inspired-start.com/