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Allergies

How does a family history of allergy affect weaning?

About Allergies
Allergy affects 1 in 4 people within their lifetimes, and around half of those currently affected by allergies are thought to be children (Allergy UK 2011). This is defined as an adverse immunological response which the body has to the proteins found in certain foods. It is different to intolerances where the immune system isn’t involved, although the symptoms for both can be similar.

Food allergies, alongside the other ‘allergic conditions’ have a genetic link, with the risk of getting one 20-40% higher if a parent or sibling has one, rising to 40-60% if both parents have one (Bjorksten 2005). However it is important to recognise that children from parents with no known allergies can still have up to a 20% risk of developing one (Source: Blossom and Allergy UK).

But what happens when there is a history of allergy in the family – how should this knowledge change a parent’s approach to weaning?

Allergies and Weaning
From birth, the advice for a child born into a family with a history of allergy is the same as that for any other child – ideally six months of exclusive breastfeeding as recommended by the Department of Health in the UK.

Specifically, for babies with a family history of allergies exclusive breastfeeding may offer some protection, due to the transfer of some of the mother’s natural immunity to her baby as well as other compounds such as Omega 3 fatty acids and prebiotics – which can promote development of healthy immune and digestive systems and delay incidence of allergic conditions (Greer et al 2008, van Odijk et al 2003)

Weaning should begin ideally at six months. Some babies may be ready for weaning earlier than this; if this is the case weaning should not start before 17 weeks (BDA, DoH 2007). Again this is the same recommendation for all babies. If weaning is started before 6 months then care should be taken to avoid ‘high allergy risk’ foods (such as egg, wheat, mustard, sesame, celery, fish and shellfish) until the baby is at least six months old and after consultation with a health professional. In contrast, delaying weaning beyond the age of six months is not recommended either, as babies’ natural iron stores start to run low and they need more ‘energy dense’ foods.

Appropriate food choices for first weaning include potatoes, starchy vegetables, rice and soft fruits, all well cooked and blended to a smooth puree. A good piece of advice for parents with a family history of allergy is to introduce each new food one at a time, every other day, including all of the high allergy foods after six months of age. That way they can watch carefully for signs of an allergy, and if they see any symptoms they can be fairly sure which food has caused it. It also helps to provide a sense of control around the situation and alleviate some anxiety. A food diary can be useful for this. Once foods have been well accepted singly these can then be consumed together.

If an allergy is suspected
If a parent has a good reason to suspect their child may be allergic to a particular ingredient (for example, if all other siblings are allergic to egg) then this food should not be fed to the child without first seeking medical advice.

Similarly, if symptoms are noticed with a particular food type, no matter how small, this food should not be fed to the child again without speaking to a GP or being referred to an allergist.

References

Allergy UK, ‘What is Allergy?’ article, available at: http://www.allergyuk.org/allergy_whatis.aspx [Accessed 05/10/11]

Austin, J.B., Kaur, B., Anderson, H.R., Burr, M. (1999) Hay fever, eczema and wheeze: a nationwide UK study (International Study of Asthma and Allergies in Childhood – ISAAC), Archives of Disease in Children, Vol 81 pages 225-230.

Bjorksten, B. (2005) Genetic and environmental risk factors for the development of food allergy, Current Opinion in Allergy and Clinical Immunology, Vol 5 pages 249-253.

British Dietetic Association Specialist Paediatric Group, Weaning infants onto solid foods; a position statement, available online at: http://www.bda.uk.com/publications/statements/PositionStatementWeaning.pdf [Accessed 17/10/11]

Department of Health (2007) ‘Weaning – starting solid food’ – a leaflet produced by the Department of Health and NHS, available online at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_084164.pdf [Accessed 17/10/11]

Greer, et al (2008) Effects of early nutritional interventions on the development of atopic disease in infants and children, Paediatrics, Vol 121 (1), pages 183-191.

Van Odijk, J., Kull, I., Borres, M.P., Brandtzaeg, P, Edberg, U., Hanson, L.A., Host, A., Kuitunen, M., Olsen, S.F., Skerfving, S., Sundell, J., Willie, S. (2003) Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations, Allergy, Vol 58 (9) pages 833-843.