Does Breastfeeding (BSACI) prevent food allergy in infants?

From the Guidelines

To prevent food allergies in your baby, introduce common allergenic foods early, starting around 4-6 months of age when your baby begins solid foods, as recommended by recent guidelines 1. This approach is supported by several studies, including the 2015 Learning Early About Peanut Allergy trial and the 2016 Enquiring About Tolerance study, which demonstrated the benefits of early introduction of peanut and egg in reducing the risk of allergy 1. The American Academy of Pediatrics also recommends introducing allergenic foods, including peanuts, eggs, and fish, at around 4 to 6 months of age, as there is no evidence that delaying introduction prevents food allergies 1. Some key points to consider when introducing allergenic foods include:

• Introduce common allergenic foods, such as peanut, egg, dairy, tree nuts, fish, shellfish, wheat, and soy, in age-appropriate forms 1
• Start with small tastes and gradually increase portions over several feedings 1
• Continue offering these foods regularly, about 2-3 times per week, to maintain tolerance 1
• Breastfeeding for at least 4-6 months may provide additional protection 1
• When introducing allergenic foods, do so at home during the day, one new food at a time, waiting 2-3 days between new foods to monitor for reactions 1 It is essential to consult with your pediatrician before introducing allergenic foods if your baby has severe eczema, an existing food allergy, or a family history of allergies, as they may recommend specific timing or supervision 1.

From the Research

Preventing Food Allergy in Infants

• The European Academy of Allergy and Clinical Immunology (EAACI) recommends introducing well-cooked egg and peanuts into an infant's diet as part of complementary feeding to prevent food allergy 2.
• The EAACI suggests avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first week of life 2.
• Introducing allergenic foods early, around 6 months, but not before 4 months of age, can prevent common food allergies, including peanut and egg allergies 3, 4.
• Regular ingestion of allergenic foods, such as a few times a week, is important to maintain tolerance 3.

Dietary Exposures and Allergy Prevention

• Breastfeeding should be promoted and supported, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies 3.
• There is no recommendation for or against the use of vitamin supplements, fish oil, prebiotics, probiotics, or synbiotics in pregnancy, when breastfeeding, or in infancy 2, 3.
• Maternal dietary modification during pregnancy or lactation has not been shown to prevent food allergy 3, 5.

Introduction of Allergenic Foods

• Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low 3.
• Infants at high risk for peanut allergy should be evaluated by an allergy specialist prior to introduction of peanuts and work with providers to create an individualized plan for introduction of peanuts and other allergenic foods as needed 4.
• Exclusive breastfeeding for three to four months reduces the likelihood of developing eczema and asthma but does not reduce development of food allergies 6.