Infant Feeding and Allergy Prevention Clinical Update

Background

ASCIA Guidelines for infant feeding and allergy prevention were developed in 2016 to outline practices that may help reduce the risk of infants developing allergies, particularly early onset allergic diseases such as eczema and food allergy1.

The reasons for the continued rise in allergic diseases such as food allergy and eczema are complex and not well understood.  Although infants with a family history of allergic disease are at increased risk of developing allergies, infants with no family history can also develop allergies.  

Therefore, ASCIA guidelines are relevant for all families, including those in which siblings or parents already have food allergies or other allergic conditions.

pdfASCIA HP Clinical Update Infant Feeding and Allergy Prevention July 2018149.22 KB

Risk factors for food allergy development

An infant with severe eczema or immediate family history (first degree relative) of allergies, is considered at increased risk of developing food allergy. 

Severe eczema is defined as persistent or frequently recurring eczema with typical morphology and distribution, assessed as severe by a healthcare professional and requiring frequent prescription-strength topical corticosteroids, calcineurin inhibitors or other anti-inflammatory agents, despite appropriate use of emollients2.

Infants with severe eczema and/or egg allergy are at increased risk of developing peanut allergy. Introduction of peanut before 12 months of age in these infants significantly reduces the risk of developing peanut allergy3,4.

Implementing ASCIA Guidelines in clinical practice

  1. Breastfeeding and infant formula 
  1. Key recommendations for infant feeding and allergy prevention 
  1. Maternal diet during pregnancy and breastfeeding 
  1. Introducing solid foods 

Practice point

  • Do not remove baked egg or baked milk from the infant’s diet if it is already tolerated – egg and/or milk in baked products can be continued if the infant has reacted to straight egg and/or milk but previously tolerated egg and/or milk in baked products.
  • An allergic reaction that progresses rapidly and causes respiratory or circulatory symptoms is anaphylaxis.
  1. Optimise eczema management
  1. Other measures

Further information

Health professional resources

ASCIA Guidelines for infant feeding and allergy prevention, ASCIA Guide for introduction of peanut to infants with severe eczema and/or food allergy and reference list:

https://www.allergy.org.au/hp/papers/infant-feeding-allergy-prevention

ASCIA Action Plans, Anaphylaxis Guidelines, Travel Plan, Checklists and adrenaline (epinephrine) autoinjector instructions: https://www.allergy.org.au/anaphylaxis

Dietary avoidance: https://www.allergy.org.au/patients/food-allergy/ascia-dietary-avoidance-for-food-allergy

Food Allergy Clinical Update: https://www.allergy.org.au/hp/papers/food-allergy

Influenza Vaccination of the Egg Allergic Individual:

https://www.allergy.org.au/hp/papers/vaccination-of-the-egg-allergic-individual

Free online training:

Patient resources

References

  1. ASCIA Guidelines for infant feeding and allergy prevention. Australasian Society of Clinical Immunology and Allergy (ASCIA). 2016. https://www.allergy.org.au/patients/allergy-prevention
  2. NIAID, niaid.nih.gov/diseases-conditions/eczema-atopic-dermatitis
  3. Du Toit G et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016. DOI: 10.1056/NEJMoa1514209
  4. Du Toit G et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13

Additional references

  1. Perkin MR et al. Randomised trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016. DOI: 10.1056/NEJMoa1514210
  2. Togias A et al Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases (NIAID) sponsored expert panel. WAO J 2017 10(1):1
    ncbi.nlm.nih.gov/pmc/articles/PMC5217343/
  3. Turner PJ, Campbell DE. Implementing primary prevention for peanut allergy at a population level. JAMA 2017 Feb 13. jamanetwork.com/journals/jama/fullarticle/2603418

© ASCIA 2018

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand

Website: www.allergy.org.au                 
Email: This email address is being protected from spambots. You need JavaScript enabled to view it. 
Postal address: PO Box 450 Balgowlah NSW 2093 Australia

Disclaimer:

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. Development of this document is not funded by any commercial sources and is not influenced by commercial organisations.

Content updated July 2018