Published on Feb 21, 2011 with 0 comment
Ask anyone who was raising children 25 years ago if they ever heard of food allergies. The likely answer would be no. Yet today, who doesn’t know someone, if not several people, with severe food allergies? Allergists and pediatricians are observing first hand that the incidence of food allergies in infants and children has increased to “epidemic” proportions over the last few decades.
The good news is that we are now beginning to understand how food allergies are developed. But more importantly, new strategies are being recommended for food allergy prevention in the newborn and infant, and in the treatment of the severely food allergic individual.
Many theories have been presented to explain this disturbing trend. However, most research in the past has focused on breast feeding and its affect on the development of allergy. A close examination of the medical literature reveals that true scientific evidence about the timing of cows’ milk and solid food introduction into a child’s diet is scarce at best, and conflicting at worst. The time-honored and well established approach has been to delay the introduction of highly allergenic foods into the infant’s diet; solid foods until six months of age, cow’s milk until one year, eggs until two years, and peanuts, tree nuts and fish until three years. It is a generally accepted notion, although not necessarily valid, that breast feeding alone is the ideal diet for the first six months of life and that it can minimize or delay the onset of atopic dermatitis (eczema) and other allergic diseases, including asthma.
But, new medical evidence has shown that the recommendations to delay the introduction of foods to infants as a means of preventing food allergies may be the wrong approach altogether!
Recent studies have revealed very credible scientific evidence to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk for developing food allergies. And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food.
A landmark study published within the last year demonstrated that children in England were ten times more likely to be allergic to peanuts than children in Israel. One very strong hypothesis to explain this finding is the fact that most Israeli infants have been exposed to soft peanut snacks by six months of age. On the other hand, children in England are not introduced to peanuts in any form until approximately three years of age. This study is just one of many which strongly suggested that the decreased risk for the development of allergy by the early introduction of food is due to the induction of “oral tolerance”, i.e., the induction of a systemic immunologic hypo-responsiveness to a dietary protein.
Our entire approach to feeding newborns and infants may be “turned on its head” in the coming months to years. It is difficult to change one’s opinion and behavior about well accepted dogma; however, very exciting medical research may cause us to rethink the current approach which has resulted in an 18% increase in food allergies over the last 10 years.
There is also good reason to be very optimistic about the treatment of severe food allergies. Historically, the treatment of food allergies has consisted of avoiding exposure and ingestion of the allergenic food, and the immediate availability of antihistamines and epinephrine for the treatment of an allergic reaction. Avoidance of exposure is indeed difficult, as evidenced by the large number of accidental ingestions and allergic reactions with resulting emergency room visits. But even with strict avoidance measures, the potential for sudden and life-threatening reactions leads to extreme anxiety in both the allergic individual and his or her family. Fortunately, medical research has now proven that orally administered immunotherapy can result in a significant degree of desensitization, or tolerance, to a given food in most allergic patients.
Food Oral Immunotherapy is a process whereby a food allergic individual is given small amounts of the allergenic food daily and for long periods of time in order to induce a state of oral “tolerance”. It is often possible to increase the dose tolerated over time, leading to even greater protection. In the classic sense, this is not a cure. Rather, it is a method to desensitize the highly allergic individual to a given food in order to decrease, and sometimes eliminate, the likelihood of a severe allergic reaction upon ingestion. This method has been proven successful with milk, eggs, peanuts, and some tree nuts. But, do not try this at home! The desensitization process is associated with a small degree of risk and therefore should be performed only by an experienced allergist and in a controlled setting.
We are on the brink of some very exciting breakthroughs in both the prevention and treatment of food allergies. We are hopeful that one day soon, such treatment will significantly improve the quality of life for those individuals in whom avoidance of food either limits or controls their daily activities.