A pragmatic approach to infant feeding for food allergy prevention

McWilliam, Vicki; Venter, Carina; Greenhawt, Matthew; Perrett, Kirsten P.; Tang, Mimi L. K.; Koplin, Jennifer J.; Peters, Rachel L.

doi:10.1111/pai.13849

Cited by 15 publications

(12 citation statements)

References 58 publications

(140 reference statements)

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“…We evaluated several factors that have been proposed to be related to the achievement of tolerance in FPIAP in two groups of infants, taking 6 months of age as a cut-off point for early tolerance. Current infant feeding guidelines, including those of WHO and UNICEF, recommend the introduction of complementary foods at 6 months of age, with continued breastfeeding for up to 2 years of age [ 28 , 29 , 30 ]. In breastfed infants, differences in breast milk composition, such as the levels of cytokines or the presence of immunoglobulins, could promote the development of tolerance to antigens present in breast milk [ 31 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

et al. 2023

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Background: Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. Methods: Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. Results: Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow’s milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, “ready-to-eat” meals and pastries during breastfeeding were correlated with longer duration of symptoms. Conclusions: Mothers of children with FPIAP to cow’s milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled food, “ready-to-eat” meals, pastries, meat and alcohol during breastfeeding, to reduce the duration of FPIAP presenting in future infants.

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Section: Discussionmentioning

confidence: 99%

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

et al. 2023

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“…As one of the most important sources providing the initial bacterial community, human breast milk is the optimal food for infants, while the feeding guidelines vary in different regions 177–179. Previous studies have confirmed the benefits of breast feeding for both mothers and infants 11 178 180 181.…”

Section: Microbial Transmission During and After Deliverymentioning

confidence: 99%

“…Additionally, breast feeding is suggested to alter the maternal metabolic process, greatly decreasing the risk of hypertension, hyperlipidaemia and cardiovascular diseases 186. Although many studies have associated breast milk with a decreased risk of allergies in infants, some of them have indicated that the effectiveness of breast milk in allergy prevention is insufficient and is highly related to the timing and type of introduction of solid food 179 187–189. Such conflicting evidence remains to be further explored.…”

Section: Microbial Transmission During and After Deliverymentioning

confidence: 99%

“… 186 Although many studies have associated breast milk with a decreased risk of allergies in infants, some of them have indicated that the effectiveness of breast milk in allergy prevention is insufficient and is highly related to the timing and type of introduction of solid food. 179 187–189 Such conflicting evidence remains to be further explored.…”

Section: Microbial Transmission During and After Deliverymentioning

confidence: 99%

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Microbial transmission, colonisation and succession: from pregnancy to infancy

Xiao

Zhao

2023

Gut

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The microbiome has been proven to be associated with many diseases and has been used as a biomarker and target in disease prevention and intervention. Currently, the vital role of the microbiome in pregnant women and newborns is increasingly emphasised. In this review, we discuss the interplay of the microbiome and the corresponding immune mechanism between mothers and their offspring during the perinatal period. We aim to present a comprehensive picture of microbial transmission and potential immune imprinting before and after delivery. In addition, we discuss the possibility of in utero microbial colonisation during pregnancy, which has been highly debated in recent studies, and highlight the importance of the microbiome in infant development during the first 3 years of life. This holistic view of the role of the microbial interplay between mothers and infants will refine our current understanding of pregnancy complications as well as diseases in early life and will greatly facilitate the microbiome-based prenatal diagnosis and treatment of mother-infant-related diseases.

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“…This paradigm shift in allergy prevention—away from allergen avoidance toward a tolerance-induction approach [ 8 - 10 ]—challenges both parents and health care professionals (HCPs) as they have to deal with changing information and new evidence that often contradicts previous assumptions. Thus, different knowledge of (changing) guidelines, attitudes, and beliefs about FA may result in heterogeneous counseling practices [ 11 ] and prevention strategies [ 12 ] in pediatricians.…”

Section: Introductionmentioning

confidence: 99%

Parents’ and Health Care Professionals’ Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

Hörold¹,

Apfelbacher²,

Gerhardinger³

et al. 2023

JMIR Res Protoc

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Background Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade—away from allergen avoidance toward a tolerance induction approach—challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information–seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. Objective The aim of the study is to explore and understand parents’ and health care professionals’ perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families’ experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. Methods This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals’ predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents’ experiences, interactions, and social processes in families in daily life. Results Recruitment and data collection started in February 2022 and is still ongoing. Conclusions The qualitative study will provide insight into parents’ information-seeking behavior and needs regarding the prevention of food allergy in children, parents’ use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user’s perspective and inform the development of the NAMIBIO apps. International Registered Report Identifier (IRRID) DERR1-10.2196/41436

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A pragmatic approach to infant feeding for food allergy prevention

Cited by 15 publications

References 58 publications

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

Microbial transmission, colonisation and succession: from pregnancy to infancy

Parents’ and Health Care Professionals’ Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

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