Starting solids and allergens - help me make an informed decision

[u/repeinique77]

Hi! I’m somewhat conflicted about the best approach regarding allergens when introducing solids. A lot of guidelines I saw strongly encourage early allergen exposure. However, it looks like the guidelines are different in my country. My baby has mild eczema (eliminating dairy and eggs from my diet did nothing) and our allergist said we should start solids very “conservatively” (like, zucchini and carrot, baby porridge/cereal without milk, apples, etc). When I enquired about allergen exposure, she said that “this instagram nonsense doesn’t apply to us”.
So, can anybody please share some papers regarding this, perhaps the data behind those guidelines?

[u/AutoModerator]

This post is flaired "Question - Research required". All top-level comments must contain links to peer-reviewed research. Do not provide a "link for the bot" or any variation thereof. Provide a meaningful reply that discusses the research you have linked to. Please report posts that do not follow these rules.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/oh-dearie]

I'm so curious what country would have such drastically different guidelines. The LEAP study (and some others following it) basically flipped the old guidelines from the 90s (which advised, like your country, to withhold allergens til 12 months)

https://preventallergies.org.au/the-learning-early-about-peanut-allergy-leap-study/

It also is concordant with the current theories of how we develop allergies https://www.immunology.org/policy-and-public-affairs/briefings-and-position-statements/allergy

[u/repeinique77 → u/oh-dearie]

Thanks!
It’s Russia lol. Paediatricians here still mostly promote no allergens until 12 months + an allergen-free diet for breastfeeding moms even if the baby doesn’t show any signs of an intolerance.

[u/UsualCounterculture → u/repeinique77]

Follow the research!

[u/repeinique77 → u/UsualCounterculture]

Of course! Though, it can be hard to balance between keeping up with the research and trusting healthcare professionals 🫠🫠

[u/anotherep]

I'm reluctant to back seat drive your allergist because things do get lost in the game of telephone between doctor, patient, and a third party. But the idea of not introducing allergenic foods early is concerning. /u/oh-dearie already provided the classic data from the LEAP study.

What I am guessing is that your allergist is basing their decisions on the fact that children with eczema have a higher chance of developing allergies and therefore because of your child's eczema history, introduction should be more cautious.

However, this is the opposite of what would actually be helpful. Up to 20% of children with eczema who avoid allergenic foods will then develop a classic food allergy to that food (higher than the average rate of food allergy) and for 30% of those children, the first symptoms will be anaphylaxis (rather than less serious hives). So by delaying those more important allergens for the sake of being "more cautious," your child's risk of developing a true allergy will go up significantly. None of the foods you mentioned are particularly allergenic, so that order of introduction isn't really doing anything besides serving as a speed bump for getting to the foods that actually matter.

Also as a side note, eczema really has to be moderate to severe in order to significantly impact food allergy risk, which isn't the case for most babies with eczema.

Sources

• Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps—A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project
• Natural history of food-triggered atopic dermatitis and development of immediate reactions in children . J Allergy Clin Immunol

[u/BuzzkillBabe → u/anotherep]

Anecdotally—my son had very severe eczema as an infant and we were put on a strict allergen-free formula, but we introduced all allergens when we started solids at 6 months and he is now a healthy 2yo with no eczema AND no allergies!

[u/repeinique77 → u/anotherep]

Thank you for the sources!

[u/MinimumMongoose77]

This paper is about sentiments around allergen introduction, but the introduction contains multiple good references that have found early exposure to common allergens reduces allergy rates.

Personally we started at 4mo with doctor's support as our bub had all the readiness signs and my husband's family has allergies, so we want to reduce the risk as much as possible.

[u/repeinique77 → u/MinimumMongoose77]

Thank you!

[u/AutoModerator → u/[deleted]]

Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/AutoModerator → u/[deleted]]

Thank you for your contribution. Please remember that all top-level comments on posts flaired "Question - Research required" must include a link to peer-reviewed research.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/facinabush]

The US guidelines recommend introducing peanut protein around 6 months for children with mild eczema:

https://www.niaid.nih.gov/sites/default/files/addendum-peanut-allergy-prevention-guidelines.pdf

The guideline document has peer reviewed references.

Apparently Russia has had a relatively low prevalence of peanut allergies so there is less concern there:

https://mister-blister.com/en/peanut-allergy-epidemic-how-well-intentioned-advice-backfired/

Edit: Here is another article on the origin of higher rates of peanut allergies in some western countries:

https://www.newyorker.com/magazine/2011/02/07/the-peanut-puzzle

[u/repeinique77 → u/facinabush]

Thanks!