Expert advice changes for preventing allergies in infants and children

CHICAGO -- Breast-feeding helps prevent babies' allergies, but there's no good evidence for avoiding certain foods during pregnancy, using soy formula or delaying introduction of solid foods beyond six months.

That's the word from the American Academy of Pediatrics, which is updating earlier suggestions that may have made some parents feel like they weren't doing enough to prevent food allergies, asthma and allergic rashes.

In August 2000, the doctors group advised mothers of infants with a family history of allergies to avoid cow's milk, eggs, fish, peanuts and tree nuts while breast-feeding.

That advice, along with a recommended schedule for introducing certain risky foods, left some moms and dads blaming themselves if their children went on to develop allergies.

"They say, 'I shouldn't have had milk in my coffee,"' said Dr. Scott Sicherer of the Mount Sinai School of Medicine's Jaffe Food Allergy Institute in New York. "I've been saying, 'We don't really have evidence that it causes a problem. Don't be on a guilt trip about it."'

Sicherer helped write the new guidance report for pediatricians, published in the January issue of the journal Pediatrics. Earlier advice about restricting certain foods from moms' and babies' diets has been tossed out and the only surefire advice remaining is to breast-feed.

The report says:

• There is no convincing evidence that women who avoid peanuts or other foods during pregnancy or breast-feeding lower their child's risk of allergies.
• For infants with a family history of allergies, exclusive breast-feeding for at least four months can lessen the risk of rashes and allergy to cow's milk.
• Exclusive breast-feeding for at least three months protects against wheezing in babies, but whether it prevents asthma in older children is unclear.
• There is modest evidence for feeding hypoallergenic formulas to susceptible babies if they are not solely breast-fed.
• There is no good evidence that soy-based formulas prevent allergies.
• There is no convincing evidence that delaying the introduction of foods such as eggs, fish or peanut butter to children prevents allergies. Babies should not get solid food before 4 to 6 months of age, however.

The evidence for the earlier recommendations was weak and hasn't been strengthened by new research, Sicherer said.

"You never know what's going to come around the corner, but in the past seven years there hasn't been enough evidence to support the old recommendations," Sicherer said.

Dr. Peter Vadas of the University of Toronto conducted prior research that found peanut protein in breast milk. His work has been cited as a reason for nursing mothers to avoid eating peanuts.

Vadas said he advises breast-feeding mothers to avoid peanuts, but only if there is a family history of peanut allergy, and he makes it clear the advice is arguable.

"There's really no reason to engage in a lot of dietary manipulation except in very specific instances," Vadas said.

On the Net

• Pediatrics: www.aap.org