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Published by Australasian Society of Clinical Immunology and Allergy (ASCIA) · GRADE
This clinical practice guideline from the Australasian Society of Clinical Immunology and Allergy (ASCIA) provides 16 updated recommendations on infant feeding for the prevention of IgE-mediated food allergies. Key recommendations include introducing solid foods around 6 months of age (and not before 4 months) when developmentally ready, followed shortly by introducing well-cooked egg and age-appropriate peanut. Other common food allergens in the family diet should be introduced in the first year of life and offered weekly once introduced. Standard cow's milk-based formulas are preferred if breastfeeding is not possible, while hydrolyzed, soy-based, or alternative protein formulas are not recommended for allergy prevention. Additionally, mild perioral rashes should not be misidentified as allergic reactions, and testing food on the skin is discouraged.
Key Takeaways
Key changes from the 2016 ASCIA guideline include: specific recommendations regarding the timing of peanut and egg introduction soon after solids start; a new recommendation regarding perioral rashes to prevent unnecessary food elimination and support primary healthcare providers; updated guidance on the frequency of offering common food allergens (at least once a week); and clarification that infant formulas (hydrolyzed, soy, alternative proteins) are not recommended for allergy prevention.
Solid food introduction is recommended when the infant is showing signs of developmental readiness. This is usually around 6 months of age and not before 4 months of age.
When introducing new common food allergens, only introduce one new allergen at the same meal. This allows the trigger food to be more easily identified if there is an allergic reaction.
Well cooked egg should be included in the infant's diet soon after the infant has started solid foods.
Peanut, in an age-appropriate form such as smooth peanut butter, finely ground peanut or peanut flour, should be included in the infant's diet soon after the infant has started solid foods.
Parents or carers should introduce other common food allergens in the first year of life, prioritising foods included in the family's usual diet. This includes cow's milk, wheat, tree nuts (such as cashew and walnut), sesame, soy, fish and shellfish.
If there is an allergy to a specific food, other common food allergens should still be introduced into the infant's diet.
A mild perioral rash (redness or contact urticaria) which appears during or immediately after food consumption, without any other symptoms of allergy, may not be a sign of an allergic reaction. Parents and carers should be encouraged to try the food again. If more generalised symptoms develop upon subsequent consumption, parents or carers should seek specialist medical advice before re-trialling that food.
Food should not be smeared onto the skin to test if an infant is allergic, as food can cause irritation and/or redness/contact reactions, which does not indicate an allergy to the food. Furthermore, frequent skin contact to food allergens without consumption may be a risk factor for allergic sensitisation.
Once a common food allergen has been introduced, unless the infant has an allergic reaction to the food, the food should continue to be offered to the infant at least once a week.
Once introduced, if there are no signs of an allergic reaction, egg should continue to be offered to the infant at least once a week.
Once introduced, if there are no signs of an allergic reaction, peanut should continue to be offered to the infant at least once a week.
It is not necessary to remove common food allergens from the diet of breastfeeding mothers to prevent food allergy.
Hydrolysed (partially and extensively) infant formula is not recommended for the prevention of food allergy.
Soy-based infant formula is not recommended for the prevention of food allergy.
Due to a lack of evidence, infant formula based on alternative proteins is not recommended for food allergy prevention. This includes infant formula based on goat milk, sheep milk, rice, oat, pea or coconut protein.
In healthy breastfed infants, transient supplementary feeding in the first week of life with cow's milk-based formula should be avoided, unless it is required for a medical reason or regular use is anticipated.
Clinical Topic
Infant Feeding for Food Allergy Prevention
Objectives
To provide updated recommendations specifically in relation to infant feeding for food allergy prevention, specifically addressing the use of infant formulas, timing of complementary feeding, timing of introduction of common food allergens, and frequency of inclusion of common food allergens.
Target Patient Population
All infants, including those considered at increased risk of developing a food allergy, such as infants with allergic conditions (e.g., atopic dermatitis or pre-existing food allergies), infants with siblings or parents with allergic conditions and infants born in Australia to recently migrated parents, especially from Asian countries.
Target Providers
Therapeutic Area
Allergy and ImmunologyGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: GRADE
Evidence Distribution
Evidence Levels
Recommendation Strength
Contraindications
Monitoring Guidance
Monitor the adherence to infant feeding practices, the timing of introduction of allergenic foods, and the prevalence of food allergy in the population. Parents should monitor for signs of systemic allergic reactions upon food introduction, while distinguishing them from local perioral rashes.
Difficulty
intermediate
Learning Paths