Implementing primary prevention of food allergy in infants: New BSACI guidance published

Abstract

The BSACI this month published guidance for UK Healthcare professionals on preventing food allergy in higher risk infants, including advice on the earlier introduction of potential allergenic foods into the infant diet, to reduce the risk of food allergy. 1 There is an accompanying information sheet for parents with practical advice on introducing allergenic foods during complementary feeding. 1 The guidance has been developed by the Paediatric Allergy Group of BSACI and the Food Allergy Specialist Group (FASG) of the British Dietetic Association (BDA), following consultation with both the BSACI and the BDA membership, a broad range of healthcare professionals including health visitors and general practitioners, parents and patient support groups.The guidance is designed to complement the recent review of scientific evidence published by a joint committee of the UK's Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT). 2 The SACN/COT statement recommended the following:• Exclusive breastfeeding for around the first 6 months of life.• The introduction of complementary foods in an age-appropriate form from around 6 months of age, alongside continued breastfeeding, at a time and in a manner to suit both the family and the individual child.

BSACI Annual Meeting, Harrogate, October 2019

“…In the randomized controlled trials, egg or peanut introduction into the diet from age 4 months, compared to the delayed introduction, was associated with reduced egg or peanut allergy, respectively. This does fit in with the current BSACI guidance . Of note, this group previously found no evidence for an association between age of introduction of complementary solids and eczema …”

Unmet needs of children with peanut allergy

“…More germane is the necessity for screening any infant, regardless of possible risk factors. Guidelines in Australia and New Zealand, Canada, and the United Kingdom do not recommend any assessment of preexisting peanut sensitization before undertaking early introduction to an infant, 22,27,28 a recommendation that is unique to the United States. Furthermore, the screening approach was found to not be cost-effective compared with not screening, with incremental costs of $641,000,000 to prevent approximately 3200 fewer cases of peanut allergy during a 20-year horizon, although screening was cost-effective and prevented more cases of peanut allergy development compared with delayed introduction.…”

Low allergen content of commercial baby foods

“…Resulting from this new evidence, many food allergy prevention guidelines globally have recently been updated to recommend the introduction of foods containing these allergens (especially peanut, egg, wheat and dairy) into the infant diet, including infants at high risk of food allergy. [6][7][8][9] On a background of rising food allergy incidence in many developed countries, 10 and the increasing recognition of burden on quality of life, 11 the implementation of these new food allergy prevention guidelines is an important public health issue. Infant feeding plays an important role in influencing future health and eating patterns.…”