Clinical Questions List
The Role of the Maternal Diet and Supplements in the Prevention of Infant Food Allergies

CQ #275 - May 16, 2023

by Anne Eglash MD, IBCLC, FABM

#LactFact

Exclusive breastfeeding, timing of infant food protein introduction, and maternal ingestion of allergens during lactation all likely play a role in decreasing the risk of childhood food allergies, but we don’t have clear guidelines yet.

Prevention of food allergy in infancy: the role of maternal interventions and exposures during pregnancy and lactation
Lancet Child Adolesc Health 2023;7:358-66
Can diet and/or supplements during pregnancy and lactation prevent infant food allergies?

Childhood food allergies have increased in the last few decades and according to the authors of this week’s study, several of these allergies are life long, including fish, tree nut, sesame, and peanut. It has been found that earlier exposure to food allergens in the infant diet helps to prevent allergies, such as introducing peanut protein and hen eggs to infants before rather than after 12 months of age. Conversely, avoidance of allergenic food proteins in the infant diet combined with early skin exposure to the allergens increases the risk of food allergy.

The authors for this week’s study review evidence on the role of vitamin D, prebiotics, probiotics, maternal diet elimination, maternal allergen ingestion, exclusive breastfeeding, and timing of infant allergen introduction in the prevention of infant food allergies.

Check out the question to check your knowledge!

What do you think are accurate statements regarding infant food allergies and maternal diet/supplements during pregnancy and/or lactation? Choose 1 or more:
  1. Vitamin D supplementation during pregnancy and lactation is now routinely recommended to decrease the risk of infant food allergies.
  2. Omega 3 supplementation during pregnancy is recommended to prevent infant egg allergy.
  3. The American Academy of Allergy, Asthma and Immunology recommends against food elimination diets during pregnancy and lactation to prevent infant food allergies.
  4. Maternal probiotic ingestion during pregnancy and lactation has been found to decrease the risk of infantile eczema but not infant food allergies.
  5. Exclusive breastfeeding with no exposure to cow’s milk protein formula decreases the risk of cow’s milk allergy.
  6. Routine maternal ingestion of peanuts during breastfeeding protects from peanut allergy, even if the infant does not ingest peanut until after 12 months of age.

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Comments (5)
    Kristi Cortina

    There are parents who do not use formula at all and babies have CMPA. Parents who consume dairy also increase their risk of their baby having CMPA, not just early formula use.

    IABLE

    Hi, Cows milk protein allergy, also known as food protein induced allergic proctocolitis (FPIAP) is a non-IgE food allergy. These kids are not at increased risk of hives, wheezing, anaphylaxis from exposure of cows milk in the parental diet. This study is discussing some different- IgE related food allergies, that cause severe, possibly life threatening reactions.

    B Lichy

    Is the continuing low exposure to cow’s milk mean it is recommended for formula to continue? Or does it mean low level exposure through a breastfeeding mother ingesting milk? So many newborns are supplemented in hospital and the pedis are not talking about risks.

    IABLE

    Unfortunately there are now guidelines out there recommending that if a breastfed infant is given cows milk based formula in the first few days after birth, that continued daily formula supplementation of about 10-30 ml will decrease the risk of cows milk allergy by age 2. There is no evidence that the dairy in the parental diet reduces the risk of cows milk protein allergy in these situations.
    However, this is all so frustrating and disrespectful of families. We should be recognizing that newborns of parents who intend to exclusively breastfeed or provide exclusive breastmilk should be given either donor milk or elemental formula when supplementation is indicated to reduce the risk of cows milk allergy. They should NOT be given cows milk based formula.

    MRE Lite

    The findings of this study highlight the crucial role of the maternal diet and supplements in preventing infant food allergies. It is alarming to witness the rising cases of childhood food allergies, with many becoming lifelong burdens. Early exposure to allergens through the infant diet, particularly with foods like peanut protein and hen eggs, has been shown to reduce allergy risks. On the other hand, avoiding allergenic foods in infancy combined with early skin exposure to allergens can increase the likelihood of allergies. This research emphasizes the significance of factors such as vitamin D, prebiotics, probiotics, maternal diet elimination, and timing of allergen introduction. Implementing these recommendations can be a vital step towards safeguarding our children’s health and wellbeing.

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