New paediatric guidelines say to start risky foods early and often
The Canadian Paediatric Society is now recommending the introduction of foods such as peanuts and eggs for at-risk children as young as six months – provided a healthcare practitioner capable of diagnosing and treating an allergic reaction is accessible.
Dr. Elissa M. Abrams one of the authors of a new study – Timing of Introduction of Allergenic Solids for Infants at High Risk – that the Canadian Paediatric Society has put forward as a recommendation for all Canadians, including those in the far north.
Abrams said research into early introduction of allergens has been happening internationally for a very long time.
“There was a study that looked at introducing peanuts early in populations,” she told the Nation. “It compared feeding early in Israel versus late in the UK and it showed that feeding early was protective and also safe. There has never been a fatality on the first introduction of a food.”
Still, there can be a reaction, she warned. That’s why facilities should be available to treat an allergic reaction. Parents should also be very attentive the first time a baby is introduced to these foods at home.
A baby is considered to be of higher risk of these allergies if they have a family member who already suffers from them – or if the child has eczema.
A skin reaction is the most common, occurring 80% to 90% of the time, producing hives, welts or swelling of the skin. Anaphylaxis is also a possibility, Abrams noted, as are stomach upsets. If any of these problems occur, she said the infant must get medical assistance for treatment with epinephrine.
For remote communities, however, Dr. Elaine Innes of the Weeneebayko General Hospital in Moose Factory said it is better to err on the side of caution. Her department serves the Cree communities of Ontario’s James Bay coast, and she urges waiting for periods when medical personnel is available.
“The communities we service have nursing stations that are staffed with RNs who should be able to treat an allergic reaction,” Innes noted. “We have physicians who do site visits and are in the community for three-to-four days each visit. Perhaps this would be the best time for the introduction of allergenic foods.”
If a child does suffer an allergic reaction, Abrams says the family will need to follow up with an allergist. The specialist will then recommend a course of treatment.
“That is the balance – the higher-risk children eating early might be protective against these food allergies in general, but to some degree some clinical judgement will obviously be required individually because these things don’t apply to every single family,” explained Abrams.
Breastfeeding for up to two years or more is also recommended. If the child doesn’t react to the trial, one should keep that food in the child’s diet continually. If it is removed, an allergic reaction may still happen when they consume the same food months later.