Fredericksburg Parent

March 2020

Issue link:

Contents of this Issue


Page 20 of 35

www.FredericksburgParent.NET 21 Sponsored Material Join us for the live conversation on Stay tuned to the Fred Parent Facebook Page and subscribe to the Fred Parent YouTube channel for a video interview later this month with Dr. Klaiber about common allergy questions. Facebook: @fredericksburgparent • Twitter: @FredParent • Instagram: @fredparentmagazine a sk t h e e x p e rt Q: What is the latest advice to parents on how to introduce foods that are common allergens? We no longer advise parents to delay the introduction of the most common food allergens. This is due to the ground-breaking Learning Early About Peanut (LEAP) study, published in the New England Journal of Medicine during 2015. This study found that the early introduction of peanuts to infants between four and six months old decreased the rate of peanut allergy in children later in life. The results of this study triggered a change in the Ameri- can Academy of Pediatrics (AAP) recommendations for high risk infants (those with eczema or siblings with food allergies). We now know that delaying the introduction of certain foods actually makes a child more likely to develop an allergy, because their immune system doesn't get a chance to learn to recognize that food in the body. So today we are trying to encourage a broader diet early on. Of course, there are still foods that should never be fed to infants, including honey, undercooked meats and choking hazards. Pregnant women should also be encouraged to eat peanuts and peanut butter while pregnant and breastfeeding, as data indicate that this, combined with early introduction of peanuts, produced the lowest overall rates of peanut allergy in children. Remember that infants are not born sensitized to particular foods. With these practices, we are trying to get the body accustomed to these foods before it develops an allergy. Q: What about children with eczema, or a family history of food allergies? Eczema can be the first sign that someone is going to have a food allergy, and the LEAP study actually found that children with eczema benefited the most from early introduction of peanut. Subsequent research indicates that the concept of early introduction preventing food allergy likely extends to other hyper-allergenic foods like eggs and milk, however, this research is still ongoing. At Allergy Partners, we also specialize in treating patients with eczema, because it is an immunologic disease that is often linked to other allergies. We can screen young children with eczema for food allergies in our office and help parents introduce foods safely into the diets of these children, with the goal of reducing their chances of developing a food allergy as they get older. Q: How should parents safely introduce peanuts and other poten- tially allergenic foods to infants? We encourage parents to introduce peanuts to infants as early as six months, or when they have started solid food. Remember that peanuts and peanut butter are both choking hazards. We advise using smooth peanut butter mixed with a small amount of breastmilk or formula. A finger dipped in this mixture is generally the most common method for first introduction of peanut to infants. In the LEAP study infants were given peanut butter three times per week starting at age 4-6 months. When you do introduce a new food, if there is going to be an allergic reaction it will typically occur within 30 minutes of the child consuming that food, but a reaction could take as long as two hours to manifest. Often first reactions are not serious, but this is not always the case. An itchy skin rash (hives), vomiting, diarrhea and trouble breathing immediately after consuming a food are signs of an allergic reac- tion. If you suspect a food allergy, the diagnosis should be confirmed by a physician who is Board Certified by the American Board of Allergy and Immunology (ABIM). An oral food challenge is the gold standard for diagnosing food allergy, because there is a high rate of false positives with skin and blood tests for food allergies. In the absence of symptoms of food allergy, introduction of age-appropriate new foods should occur one at a time, with no more than one new food per day. Q: Do kids outgrow food allergies? Studies indicate that the potential for children to outgrow a food allergy depends upon which food they are allergic to. Milk and egg are among the most common food allergies in infants. Thankfully, the data indicate that up to 90 per- cent of infants with milk and egg allergy will eventually outgrow their food aller- gies. For nuts the situation is almost directly reversed. Eighty percent of children diagnosed with a nut allergy will have this food allergy for life. That is why we want to emphasize the early introduction of peanuts and tree nuts, because these are allergies are much more likely to stick with the child longer if they develop. The potential for food allergy status to change over time is why we suggest that chil- dren food allergies should follow up at least once yearly with an allergist until they reach adulthood. Q: What are the benefi ts of having a food allergy diagnosed early? We have a lot more options today than we used to in treating allergies. Studies indicate that starting therapy for food allergy at a younger age improves the likelihood that an allergy can be eliminated. For peanut allergies, an increasingly common treatment option is a process known as oral desensitization therapy. Desensitization can take the form of sublingual immunotherapy (SLIT) or oral immunotherapy (OIT). OIT and SLIT both work by introducing tiny amounts of the allergen in a controlled setting. For some patients we may start with doses as small as a hundred thousandth of a milligram. The dose is given every day and then increased every two weeks as tolerated. The ultimate goal of current therapies is risk reduction. They have been shown to decrease the chances of anaphylaxis with accidental exposure to food allergens. While some children may ultimately lose the allergy completely (we call these patients long-term non-responders) after OIT, many will simply gain an increased tolerance to their food allergens. We try to emphasize the fact that desensitization is a marathon and not a sprint. We also see other options on the horizon for food allergic patients. An FDA advi- sory panel recommended approval late last year of the first-ever pill to treat peanut allergies, called Palforzia, which uses peanut flour to treat allergies in children. This is a fast-developing field, so hopefully we will have even more options in the years to come. We have certainly moved far past the approach of just diagnosing allergies and telling the patient to avoid that food for good. ...the early introduction of peanuts to infants between four and six months old decreased the rate of peanut allergy in children later in life.

Articles in this issue

Links on this page

Archives of this issue

view archives of Fredericksburg Parent - March 2020