Thursday, May 01, 2008

Myths about Diets in Preventing Children's Allergies

From Medscape Pediatrics

New Guidelines Downplay Role of Diet in Preventing Pediatric Allergies: An Expert Interview With Frank Greer, MD
Posted 04/21/2008
Kathleen Louden

Medscape: What was the impetus for developing this new clinical report?

Dr. Greer: There was a lot of folklore built around this idea that something the mother eats during pregnancy or lactation or something she feeds her baby has long-term impact for allergy disease. Traditionally a lot of pediatricians have recommended not to give infants eggs, fish, peanuts, or any nuts in the first year of life.

Medscape: Were there new research findings?

Dr. Greer: Yes. It makes absolutely no difference. For instance, if you're going to have a peanut allergy, it has nothing to do with when you were introduced to peanuts. If a mother eats peanuts during pregnancy or lactation or if she feeds her 6-month-old peanut butter, it has no effect on whether you get peanut allergy. If you're going to get it, you're going to get it. There's even evidence from one study that if you don't introduce egg into the infant's diet until after 6 months, the baby is more likely to develop an egg allergy. And European recommendations came out the same month that ours did that if you introduce wheat between 4 and 6 months of age, your baby will be less likely to have a gluten allergy.[1] We didn't go that far. This is one of the very few areas where ESPGHAN [European Society for Paediatric Gastroenterology, Hepatology and Nutrition] policy differed from the AAP's January statement.

Medscape: So expecting and breastfeeding mothers don't have to restrict their diet by avoiding common food allergens?

Dr. Greer: Correct. The evidence is just not there that pregnant and lactating women restricting their diet in any way affects whether their baby gets allergic disease.

Medscape: This is a major change from the recommendations the AAP made in 2000, isn't it?

Dr. Greer: We've never had a statement this strong. The statement that this replaced said that it's probably not a good idea to introduce these [potentially allergenic] foods until after the infant is of age. [The former recommendation was to delay giving dairy products until 1 year; eggs until 2 years; and peanuts, tree nuts, and fish until 3 years of age.] These recommendations were not based on evidence but on expert opinion. The new statement is evidence based. There have been a number of recent studies, particularly looking at the effect on allergy of nutritional interventions during pregnancy and lactation.

read interview

read journal article
Published online December 31, 2007 PEDIATRICS Vol. 121 No. 1 January 2008, pp. 183-191
Full Text (PDF)

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
Frank R. Greer, MD, Scott H. Sicherer, MD, A. Wesley Burks, MD and the Committee on Nutrition and Section on Allergy and Immunology

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