New AAP Guidelines for Educating Your Child About Food Allergens
The American Academy of Pediatrics (AAP) has updated its guidelines for infant peanut administration, continuing a decades-long shift in practice from delaying the introduction of food allergens to early and frequent administration.
Chronology
According to board-certified allergist Katie Marks-Kogan, in 2000, based on only two observational studies that did not provide much hard data, the AAP recommended that parents refrain from injecting common allergens. At the time, parents were advised to wait until the child was one year old (for cow’s milk), 2 years old (for eggs), and 3 years old (for peanuts and tree nuts).
Over the next few years, more observational studies were conducted that showed that delaying allergen administration was not actually beneficial. In 2008, the AAP removed the 2000 guidelines, but has not yet gone as far as recommending early implementation.
“Since then, better tests have shown the opposite is true,” says Marks-Kogan, a medical practitioner in the Los Angeles area. “Delay can be potentially harmful, and early implementation can be preventative.”
Therefore, in March, the AAP updated its guidelines to focus on infants at risk of developing food allergies:
These recommendations are targeted at a high-risk group – infants with severe atopic dermatitis and / or egg allergies – who are advised to administer infant-safe forms of peanuts as early as 4-6 months in specific amounts, subject to prior testing. to rule out allergies. The guidelines recommend that infants with mild to moderate eczema be taught infant-safe foods containing peanuts as early as 6 months of age, and children without food allergies or risk factors, depending on age and family preference, i.e. after 6 months with exclusive breastfeeding.
But Marks-Kogan expects these guidelines to be updated even more in the coming years to include early administration of allergens to all infants.
“Currently (among allergy sufferers) it is thought … that these products should be administered before they reach the age of one year,” says Marks-Kogan. “We’re trying to find this window of great opportunity for the immune system, and we think it’s about 4-6 months.”
This means that for some babies – even those who are not at high risk – Marx-Kogan believes that waiting until they are one year old may be too late to effectively protect them from allergies.
How to introduce allergens
Introducing food allergens can be challenging for some parents trying to follow their pediatrician’s recommendations for including solid foods in their child’s diet.
“Many pediatricians disagree when they advise parents to teach their children to eat solid foods,” says Marks-Kogan. “So you get a lot of opinions on when to introduce solid food and the parents listen to what their pediatrician says.”
For the parents of her pediatric patients, Marks-Kogan says she creates a detailed nutritional schedule that focuses on three major food allergens: peanuts, eggs, and cow’s milk. She emphasizes that it is important to train children to eat non-allergenic foods for a few days or weeks before switching to allergens.
From there, she says, parents can add peanuts to bamba snacks or mix peanut butter with breast milk or formula. Likewise, parents can make scrambled eggs puree and mix with breast milk or formula and include yogurt in their baby’s diet.
“As soon as it appears in the diet, keep it in the diet,” says Marks-Kogan. “Make a schedule because it can be very tiring.”
She experienced this stress herself when her son was born in 2015. She had to make sure her son’s third-party caregivers adhered to the detailed feeding schedule she had outlined.
“I’m an allergist, I’m still nervous and it’s still hard for me,” she says. This experience led her to create Ready, Set, Food! , a system that allows parents to add a daily dose of peanuts, eggs, and milk to breast milk, formula, or food.
“We made sure it was evidence-based; it was very important to me when I started working, ”she says. “We also wanted to really simplify things and take away a little anxiety and that overwhelming feeling.”
Enter early AND often
Perhaps the most important thing parents need to know about food allergens, Marks-Kogan says, is that once you’ve introduced them, you have to withstand their exposure.
“It is important to emphasize that injecting your child with allergenic foods once or twice has not been shown to be protective and, in fact, can be harmful,” she says. “I see many such patients; they give it (once) every 6 months to make sure everything is okay, and then, at 10 months, they have an allergy. “
For early introduction to be protective and not harmful, she says, babies need regular contact with the allergen for many months.