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Developing allergies and high risk babies
There is a lot of conflicting advice about how to reduce the risk of your baby developing allergies.
In this section consultant in paediatric allergy, Gary Stiefel, shares the latest advice and how to know if your baby is in the high risk category for developing a food allergy
Can I prevent my baby from developing food allergies whilst pregnant?
There is a lot of conflicting information around what advice to follow when trying to prevent your baby from developing allergies, even before they are born. The latest advice for expectant mums to follow when pregnant is:
Avoiding foods: Unless you are allergic to any particular food there is no need to avoid any foods (ie, peanut, fish etc) as this has not been shown to prevent allergy.
Oily fish: Omega-3-fatty acids (found in oily fish such as salmon, trout and mackerel may help reduce the risk of eczema and allergic sensitisation (development of allergy antibodies) in early life. Try to include some of these in your diet but remember that pregnant women should not eat more than two portions of oily fish a week.
Probiotics: There is not enough evidence to recommend that routine probiotics prevent food allergy.
Supplements: General health advice is to take folic acid and vitamin D supplements during pregnancy.
Your diet: There is no evidence that any particular diets or foods can prevent allergy either when pregnant or when weaning your baby. Advice is therefore to eat a healthy well balanced diet including plenty of vegetables and fruit to provide vitamins and minerals as well as fibre
Can I prevent my newborn from developing food allergies?
It is recommended that babies should be exclusively breastfed for the first six months of life, however this is not always possible as some mum’s find this too difficult (eg when baby has ‘tounge tie’ etc) and others choose not to. Many settle for a combined approach to feed their infants, that suits both mother and baby. However you choose to feed your baby it is important to understand the following information with regards to allergy.
Breastfeeding is most important in the first days of life as research is showing that early exposure to cow’s milk may be associated with a higher risk of cow’s milk allergy. How you choose to feed your newborn baby/infant is absolutely your decision, but make it relaxed and enjoyable for both of you.
Breast feeding: The World Health Organisation and all UK Health Departments recommend exclusive breast feeding for around the first six months of life. Breast feeding alone does not prevent allergies, but has many other important benefits to the mother and child. Breastfeeding should continue throughout the first year of life. Don’t avoid eating any particular foods (such as peanut or dairy) while breastfeeding as it has not been shown to prevent allergies.
Formula feeding: Infant formula is the only suitable alternative to breast milk when your baby is under 12 months of age. Infant formulas made from cow’s and goat’s milk are suitable, however soyabased infant formula should not be used unless prescribed/recommended by a healthcare professional.
Hypoallergenic formula: If your baby is formula fed and is diagnosed with a cow’s milk allergy a non-cow’s milk-based formula (eg soya) or a specialist “low allergy” or hypoallergenic formula will be recommended by a healthcare professional. However, please note that none of these alternatives have consistently been shown to prevent food allergy or other allergic disease.
How do I know if my baby is in the high risk category when it comes to developing allergies?
Advice differs when introducing solids to your baby’s diet, based on whether they fall into a high risk or low risk category for developing food allergies. Below, we explain the criteria for both groups and the advice for each:
Which babies are considered high risk?
- Babies with eczema, particularly babies with more severe eczema (eg needs daily steroid creams)
- Babies who already have a food allergy
Which babies are considered low risk?
- All other babies
What is the advice for introducing solids to high risk babies?
When you and your baby are ready (from around six, but not before four months of age), you may start to offer them solid foods including vegetables, fruit, protein and starchy foods. At this stage you do not need to add salt or sugar to any foods/recipes.
Early introduction: If your baby is considered high risk, research shows that they may benefit from the earlier introduction (around four months old) of complimentary foods (solids), including food containing egg and peanut. If you choose to go down this route, it is advised that you start with puréed foods as the baby led weaning approach is safer for babies aged six months plus.
Allergic reactions: Introducing your baby to solid foods if you think they are at risk of a food allergy can be really frightening. Whilst babies in the higher risk group are more likely to have a reaction, they can benefit more where the food does not cause a reaction. Introducing allergenic foods to your baby’s diet earlier and on a regular basis can help to significantly reduce the risk of them developing food allergies.
Also, to help put your mind at ease, it is estimated that 998-999 out of 1000 babies will NOT have a severe reaction. Also, reassuringly, no life-threatening reactions have been reported as a result of early introduction of allergenic foods in an infant’s diet.
If you are not happy to introduce allergenic foods (especially egg and peanut) then please discuss this further with a healthcare professional.
The advice for introducing solids to low risk babies is if your baby is low risk, introduce solid foods from around six months of age including allergenic foods such as egg and peanut. From six months, you can follow the baby led weaning approach, purées or a combination of both.
Can I get my baby tested before we start weaning?
Allergy testing can be helpful in identifying individual babies at higher risk of food allergy. If you want your baby to be tested for allergy before introducing them to foods like egg and peanut, you need to consider whether the delayed introduction to these foods (eg due to waiting for an appointments) could increase the risk of allergy developing. If you think your baby has a higher risk of developing an allergic reaction then talk to your health visitor or GP.
What else should I be aware of?
The impact of eczema: In babies with moderate to severe eczema up to three in every 10 could develop an egg allergy and up to one in every 10 could develop a peanut allergy. That means at least seven out of 10 do not have egg allergy and nine out of 10 do not have peanut allergy. The risk is higher if your baby has eczema (especially moderate/severe eczema) or a diagnosis of another food allergy.
It is very important to control eczema and use any prescribed creams/emollients. If you notice your baby has patches of dry skin that become red and inflamed, you should ask your health visitor or GP for advice on how to manage and treat this. However, recent research has shown that using emollients from birth to enhance the barrier of the skin has not been shown to prevent allergy, so this is not necessary, only use this to treat eczema.
Siblings with allergies: If your baby has a sibling with peanut allergy, they have a slightly increased risk of peanut allergy (approximately one in 12 risk rather than one in 50 risk. There is less than a 10% chance that they will have a peanut allergy.