Current international breastfeeding guidelines recommend exclusive breastfeeding for 6 months, followed by the appropriate and adequate introduction of complementary foods at 6 months, with continued breastfeeding for 2 years and beyond. This guideline is based on evidence to support exclusive and extended breastfeeding as the optimal method of feeding infants and young children. Not only do these breastfeeding practices meet the nutrition needs of infants and children for optimal growth and development, but they also offer a host of other health and socio-economic benefits at all levels of society. The poor breastfeeding rates and increase in infant and child morbidity and mortality in South Africa have led to increased prioritized attention towards the promotion, protection and support of breastfeeding. In 2000, the National Department of Health formally adopted the international breastfeeding guidelines for exclusive and extended breastfeeding practices. Therefore, it remains a priority to implement these guidelines in all current and future breastfeeding programmes and interventions, including the South African paediatric food-based dietary guidelines.

True food allergy is less prevalent than common ly perceived. Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because the food may possibly contain an allergen. However, only 1 6% of persons test positive on full evaluation, which may include doubleblind placebocontrolled food challenges. [14] Epidemiology of IgEmediated food allergyThe prevalence of food allergy varies significantly based on geographical region, allergens tested, diagnostic criteria, population age and concurrent atopic conditions.[5] Variations in food allergy definitions and inconsistencies in study design make studies on food allergy prevalence difficult to compare. Self reporting significantly overestimates food allergy prevalence up to 10fold; [4] hence, objective measurements are necessary to establish a true food allergy diagnosis. Similarly, sensitisation to foods is much higher than clinically relevant allergies; therefore, sensitisation should always be combined with more objective information to prove allergies. Food challenge testing is the optimal way of proving food allergy, albeit labour and cost intensive. Recent large populationbased studies, such as the EuroPrevall study in Europe [6] and HealthNuts study in Australia, [7] have used food challenge testing and can be considered flagship studies of food allergy prevalence. Prevalence of food allergyDespite the large number of foods that can cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. [8] Food allergy peaks during the first two years of life, and then diminishes towards late childhood as tolerance to several foods develops over time. Based on metaanalyses and large populationbased studies, the true prevalence of food allergy varies from 1% to >10%, depending on the geographical area and age of the patient.[919] Allergy prevalence to the most common allergenic foods is summarised in Table 1. The prevalence of food allergy in South Africa (SA) is currently being studied. An unselected population of 211 Xhosa highschool students showed an overall sensitisation to foods of 5%. [20,21] Preliminary data from the South African Food Sensitisation and Food Allergy (SAFFA) study, [22] which is investigating food allergy in an unselected cohort of 1 3yearolds, show a prevalence of skin prick tests of ≥1 mm (11.6%), ≥3 mm (9.9%) and ≥7 mm (4.2%) to all foods tested. Challengeproven food allergy to any food is 1.8% after the preliminary analysis; recruitment is ongoing. Correspondence to : C Gray (claudiagray.paediatrics@gmail.com) Despite the large number of foods that may cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. ARTICLE Epidemiology of IgEFood allergy peaks during the first two years of life, and then dim...

Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because of the mere possibility that the food may contain an allergen, when in fact only between 1% and 6% test positive on full evaluation. [1] A working group was constituted of medical professionals with interest and expertise in food allergy in South Africa (SA) with representation from the Allergy Society of South Africa (ALLSA), the South African Gastroenterology Society (SAGES) and the Association for Dietetics in South Africa (ADSA). The structure and content of the document was networked, individuals were allocated sections to write and a draft document was compiled. A meeting was then held to discuss the draft document, resolve controversial issues and achieve a consensus document. The document is endorsed by ALLSA, SAGES and ADSA. Definitions Adverse reactions to food can be divided into psychological reactions (food aversion), organic reactions (e.g. peptic ulcer disease), anatomical reactions (e.g. strictures), toxic reactions (e.g. food poisoning) and nontoxic reactions (Fig. 1). [2] Non-toxic reactions imply an individual hypersensitivity to the food, either immune-mediated (food allergy) or not immunemediated [3] (food intolerance) (Fig. 2). Non-REVIEW South African food allergy consensus document 2014

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