Allergic disorders are often life long, and although treatable, there is currently no cure. It therefore makes sense to try to prevent allergic diseases in children, if possible.
Allergic disorders are very common in children
Up to 40% of children in Australia and New Zealand are affected by allergic disorders some time during life, with 20% having current symptoms. Allergic diseases have approximately doubled in western countries over the last 25 years. The most common allergic conditions in children are food allergies, eczema, asthma and hay fever (allergic rhinitis).
Symptoms range from mild to potentially life-threatening
Allergic diseases are caused by abnormal immune responses to otherwise harmless substances in the environment. For example, hay fever is commonly caused by an immune response in the nose and eyes to grass pollens and/or house dust mites. Some allergic conditions (such as mild allergic rhinitis) may cause only mild symptoms. For others (such as moderate/severe allergic rhinitis, asthma), symptoms can be debilitating, disturb sleep and impact on learning and behaviour. Poorly controlled bad asthma, stinging insect allergy or severe food allergies can even be life threatening.
Why and how should we prevent children from developing allergic disease?
Although effective treatments are available, there are currently no cures for allergic conditions. Therefore it makes sense to try to prevent these conditions, if possible, in infants and children.
Allergy prevention in infants and children is an active area of research but so far, we only have some answers. Recent research has identified some "risk factors" that appear to increase the risk of developing allergic disease. Other studies are examining whether avoiding these factors will reduce the risk.
At present the optimal approach to prevent children from developing allergies is to:
A. Identify infants that have an increased risk of developing allergic disease
Which infants are at risk of developing allergic disease?
A number of factors appear to increase the risk of developing allergic disorders. We have no control over some risk factors such as family history, whilst there are other environmental factors that we might be able to influence. Identified risk factors for developing allergic disease include:
- Family history of allergic disease in a parent or sibling (family history of allergic disease in both parents OR a parent and a sibling is associated with a further increased risk)
- Introduction of cow's milk or soy milk formula before 3 - 4 months of age (an increased risk for eczema and food allergy)
- Introduction of solid foods before 3-4 months of age (an increased risk for eczema and food allergy)
- Birth in Spring - a risk for hay fever (seasonal allergic rhinitis)
- Passive exposure to cigarette smoke (a risk for increased respiratory symptoms)
Practical suggestions for preventing allergic conditions in children
If your child is identified as being at increased risk of developing allergic disease, it is sensible to try to reduce the risk by following the recommendations outlined below.
It should be emphasised that even if you follow these suggestions, there is still a chance that a child at high risk may develop allergic disease, and that taking measures to reduce one type of allergy such as eczema, may have no effect on whether the child develops asthma or allergic rhinitis.
- Do not smoke during pregnancy
- Do not smoke in the presence of the child, or in enclosed spaces where the child sleeps or plays.
- Where possible, breast feed your child for at least 6 months. Breastfeeding provides a nutritious and balanced food source for your baby, reduces the risk of gastrointestinal tract infections and may also reduce the risk of developing allergic disease in early life.
WEANING AND INTRODUCTION OF SOLIDS
- Where possible, delay the introduction of formula feeds until the child is 4-6 months of age.
- If it is not possible to breast feed, use a partially hydrolysed (hypo-allergenic) cow's milk formula in the first 4-6 months of life, commonly referred to as ‘HA' formula. It is important to note that these formulae should not be used if your child already has cow's milk allergy (confirmed by a doctor). Ask your doctor for more information.
- Delay the introduction of solid foods until the child is 4-6 months of age. Thereafter, foods can be introduced, with a new food introduced every 2-3 days. Introduce one new food at a time so that any reactions can be readily identified.
- There is no evidence that delayed introduction of allergenic foods like egg, milk, peanut, tree nuts, or seafood beyond the first 4-6 months of life reduces the risk of food allergy and eczema. Some studies suggest that delayed introduction of foods beyond 6 months may even lead to an increased risk of food allergy, although further research is required to confirm this.
ASCIA Infant Feeding Advice is available on the ASCIA website.
Research into allergy prevention is important
Although allergy prevention in children is an active area of research, our understanding of why allergic diseases develop and why they are increasing in our society is incomplete. We therefore encourage you to support and participate in studies on the development and prevention of allergic disease.
Allergy prevention in children - summary
|Probiotics||No||Await further research studies.|
|Fish oil Supplements||No|
|Breast-Feeding||Yes||Exclusively for 4-6 months. Continue breastfeeding while introducing new foods if possible.|
|Partial breast-feeding||Supplement with a partially hydrolysed cow’s milk formula (commonly referred to as ‘HA’ formula) for the first 4-6 months (unless infant is already cow’s milk allergic).|
|Soy formula||For some forms of cow’s milk allergy (seek medical advice).|
|Weaning||Avoid introduction of solids until aged 4-6 months. Thereafter, introduce a new food every 2-3 days according to developmental readiness and what the family eats. Introduce one new food at a time so that any reactions can be readily identified.|
|Diet restrictions||No||Introduce foods from 4-6 months.|
|Removal of pets||No||Only if family member is already allergic to pets.|
|Dust mite avoidance||No||Await further research studies.|
Avoid environmental irritants
||Avoid exposure to tobacco smoke, unflued indoor gas heaters, remove sources of mould and dampness where possible.|
|Immunotherapy||No||Useful to treat established allergies - await further studies regarding its role in prevention.|
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Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and foodintolerance in infants. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003664.
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The Australasian Society of Clinical Immunology and Allergy Position Statement: summary of allergy prevention in children. MJA Practice Essentials. Australasian Medical Publishing Company, Sydney 2007.
Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity (Review). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006475. DOI: 10.1002/14651858.CD006475.pub2.
© ASCIA 2010
The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of Clinical Immunologists and Allergists in Australia and New Zealand
Postal address: PO Box 450 Balgowlah NSW 2093 Australia
This document has been developed and peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. The development of this document is not funded by any commercial sources and is not influenced by commercial organisations.
Content Updated May 2014