‘Succinct’ guidance on preventing infant allergy

During antenatal and postnatal care, GPs provide a breadth of health advice.
 
One of those is around preventing allergies in babies and whether avoiding certain foods during pregnancy and breastfeeding is beneficial – which is what was previously recommended.
 
But following strong evidence indicating the contrary, recommendations on avoidance diets have since been amended, arguing that in fact, the risks outweigh the benefits.
 
The RACGP supports this position and recommends to not exclude allergenic foods from maternal and infant diets in an attempt to prevent allergies. Rather, consuming these foods during breastfeeding and introducing them as solids to an infant may enable better tolerance and reduce risk of developing a food allergy.
 
This guidance is outlined in the new resource ‘Excluding allergenic foods in maternal and infant diets’, which is among the latest GP and accompanying patient resources of the RACGP’s First do no harm: A guide to choosing wisely.
 
‘It is already complicated enough to provide or receive all the preventive advice during pregnancy and beyond,’ Professor of General Practice Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC) and First Do No Harm Expert Steering Group, told newsGP.
 
‘This succinct guide helps GPs and patients navigate dietary advice for people concerned their baby might develop food allergies, providing clear statements about maternal diet during pregnancy and breastfeeding.
 
‘It is now clear from research trials that trying to exclude potentially allergenic foods from a mother or infant’s diet does more harm than good.’
 
So how can GPs best support parents or carers who ask about avoiding certain foods to prevent infant allergies, for those who do not already have a food allergy diagnosis?
 
Naturally some caution around introducing certain foods, such as egg, peanuts and dairy products – the most common allergenic foods – may arise, but excluding them from a baby’s diet in the first 12 months of life increases the risk of developing an allergy.
 
According to the First do no harm guide, which aims to address over-treating and overdiagnosis, there are also associated harms from trying to avoid traces of common allergenic foods in a mother or infant’s diet.
 
Aside from increasing the risk of allergy, many of these foods are an important part of a healthy diet, so avoiding them may mean that mother and child are not getting adequate nutrients, potentially resulting in low birth weight, breastfeeding issues, slow growth and fussy eating.
 
‘It just makes life more difficult at an already demanding stage,’ Professor Morgan said.
 
‘GPs can instead inform parents that avoidance diets do not prevent allergies … and recommend that they offer their baby well-cooked egg and smooth peanut butter regularly [twice weekly], starting before age 12 months.
 
‘Similarly, for infants with a family history of egg allergy, cooked egg should be part of the diet before eight months of age.’
 
The guide also ‘clearly advises’ against using specific infant formulas to prevent the development of food allergies, Professor Morgan said, as well as recommendations to avoid using medicines such as ranitidine or proton pump inhibitors to treat uncomplicated reflux in infants.
 
While food allergy occurs in around 10% of infants in Australia and New Zealand, the RACGP says as most will not be severe or life-threatening and many babies outgrow the allergy, excluding foods to prevent allergies may cause harm, and not provide any benefit.
 
And it’s important to reiterate this message to pregnant people and families of young babies.
 
‘The patient guide that accompanies has been carefully worded to provide helpful and practical advice,’ Professor Morgan said.
 
‘It describes how to recognise an allergic reaction and talks through immediate actions to take.’
 
‘Additionally, the information mentions allergy testing but also lists some of the very low-value tests offered by complementary and alternative therapists that cost the patient a lot of money without providing usable information.’
As with all First do no harm topics, the ‘Excluding allergenic foods in maternal and infant diets’ GP resource has an accompanying patient resource.
 
Upcoming releases of First do no harm topics include:

• ‘Initiating opioids for chronic non-cancer pain’
• Associated topics for GPs – ‘Overdiagnosis’, ‘Over-testing’, ‘Managing uncertainty’.

first do no harm food allergy food avoidance infant allergy maternal health over-testing