Nutrition in the first months and risk of eczema, asthma and food allergies: the recommendations of American pediatricians

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Food allergies, allergic rhinitis, asthma, atopic dermatitis: these are conditions that are part of the more general category of atopic diseases, characterized by the tendency to produce a certain type of antibodies (immunoglobulins E) in response to low doses of allergens. An important line of research has long been concerned the influence that nutrition can have on the possibility of developing these conditions, especially in children already at risk. And by nutrition we mean both that of the mother during pregnancy and that of the child in the first months of life, therefore the type and duration of breastfeeding, any type of formula used, the time of introduction of allergenic foods such as eggs, fish or dried fruit.

Now a new document from the American Association of Pediatricians (AAP) takes stock of the knowledge available on the subject, proposing a series of dietary recommendations to reduce the risk of atopic conditions whenever possible. Let's see them together, with the comment of , medical director in charge of the Food Allergy Outpatient Clinic of the Buzzi Children's Hospital in our city.

Maternal diet in pregnancy and lactation and the risk of atopic diseases

It has long been thought that avoiding potentially allergenic foods during pregnancy and breastfeeding could reduce the baby's risk of developing an atopic condition. In reality - say the American pediatricians - there is no evidence that this is the case, confirming what has already been stated in the previous recommendations, published in 2008.

"The mother's diet during expectation and breastfeeding must be varied and balanced because it has important effects on the pregnancy itself and on the health of the fetus and the child to be born, but it has no particular effect on the risk of atopic diseases"underlines D'auria." From this point of view the diet must be varied and no particular restrictions are required"And this applies to all mothers, even those of children at risk because they have at least one first degree relative (parent or sibling) already suffering from food allergies, eczema, allergic rhinitis or asthma.

Baby allergic to egg, but mom doesn't have to feel guilty
Paolo, Elena's baby, suffers from an early age with allergies to eggs, milk proteins, beef and the mother (as often happens to mothers) feels guilty: throughout her pregnancy she avoided strawberries because he knows I'm an allergenic fruit, but he continued to eat eggs and fish and now he thinks that's why Paolo is so allergic.

"In reality, Elena can rest assured - she reassures - her son's allergies have nothing to do with the fact that during pregnancy she ate foods capable of causing allergies. And the latest recommendations from American pediatricians confirm this". 10 PHOTOS

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Type and duration of breastfeeding and atopic diseases

If the mother's diet during pregnancy and breastfeeding does not influence the risk of developing atopic conditions, it is true that the type and duration of breastfeeding can have an effect. "In particular, it is breastfeeding that plays a positive role, but with different effects depending on the condition we take into consideration", he explains.

It is a fairly common symptom in the first years of children's life, characterized by a particular sound of the breath (as if there was a whistle) following exposure to some triggers. "Often - he explains - it is only transitory, and in these cases it is generally triggered by infectious agents. In some children, however, it can evolve in school age into real asthma, ready to manifest itself following exposure to airborne allergens such as pollen. It happens in particular in children at risk for atopic conditions (because they have a parent or sibling already affected) or already affected by another atopic condition such as a dermatitis or a food allergy. "

Well, according to the review of American pediatricians, the available data show that breastfeeding - not necessarily exclusive but also mixed - seems to protect the baby from the risk of wheezing in the first two years, as long as it is continued for at least three to four months of life. "This is good news for mothers who, for various reasons, are unable to breastfeed exclusively but rely on mixed breastfeeding," said the expert.

The data now available lead to the conclusion that breastfeeding - both exclusive and mixed - of long duration, i.e. beyond the first months of life, has a protective effect against asthma real even beyond the five years of the child.

Eczema atopico
In this case the protective effect is linked to exclusive breastfeeding only (not mixed), which if practiced for at least three to four months of life reduces the risk of atopic eczema for the first two years of a child's life.

Food allergy
In this case, however, the available data do not allow us to reach firm conclusions on the relationship between the type and duration of breastfeeding and the risk of food allergies.

"We remember, however, that, beyond the prevention of some atopic conditions, breastfeeding has an important preventive role against other conditions, such as infectious diseases of the infant, starting from otitis. World Health Organization recommends it exclusively for the first six months of a baby's life, "he concludes.

Read also: Obesity and children: WHO invites us to focus on breastfeeding to prevent it

Type of formula and atopic diseases

Le hydrolyzed formulas (i.e. with more or less fragmented milk proteins) can they prevent the onset of atopic conditions in infants at risk fed with formula milk? Unlike what was previously recommended, it seems so: according to the conclusions of American pediatricians, there is no definitive evidence that the use of these special formulas can have a preventive effect on the development of dermatitis, food allergies, rhinitis or asthma. Therefore, even if the child is at risk (and even more so if he is not) there is no reason to prefer these formulas.

The situation is different if the child has already manifested an atopic condition with early onset (for example a dermatitis or an allergy to cow's milk proteins): "Here we pass from the area of ​​prevention to that of treatment and then the hydrolyzed formulas remain indicated. , and in particular the extensive hydrolysed formulas, in which the milk proteins are completely fragmented, "he explains.

Weaning and risk of atopic diseases

Until a decade ago, the fundamental indication that was given to parents who were preparing to start their babies for weaning was to delay the introduction of allergenic foods such as eggs, fish and certain types of fruit (strawberries, dried fruit). The general recommendation was not to give them before the year of life and sometimes even later. Thanks to the results of numerous studies conducted in recent years, however, the indications have radically changed since 2008: it emerged in fact that delaying the introduction of allergenic foods does not prevent atopic diseases. The latest recommendations of American pediatricians read verbatim:

"There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs and fish, beyond the baby's four to six months of life prevents the onset of atopic conditions. There is some evidence that early introduction of peanuts - carried out in a safe way - can prevent allergy to this food in children who are particularly at risk ".

An important recommendation, with respect to which, however, some clarifications are needed. "The data says that it makes no sense to delay the introduction beyond 4-6 months (and remember that WHO continues to recommend breastfeeding for the first 6 months), but they do not indicate a precise time when it is appropriate. do it, "he points out. It means that these recommendations should not be interpreted in the sense of starting a tight program of complementary feeding with allergenic foods at four months, but in the sense of choosing the moment of their introduction based on the recommendations of the pediatrician on weaning, the traditions and habits of the family, whether the baby is ready for weaning or not, without having to wait for the first birthday or beyond.

Read also: Weaning and food allergies: when to introduce risky foods Beware of peanuts
According to the recommendations of American pediatricians, for i children at high risk of peanut allergy because they already have moderate or severe atopic dermatitis or a documented egg allergy it may make sense to introduce peanuts themselves early to reduce the risk of developing an allergy to this food as well.

"But be careful - he says - some precautions are needed. First: you must check with a Prick test that the child is not already sensitive to peanuts. Second, you must offer them safely: not whole or in pieces (due to the high risk of suffocation) , but in the form of flours or spreads (the famous peanut butter) ".

However, it must be said that a lot of attention to peanuts is the result of a particular context such as the English and American one, where allergy to peanuts is very widespread (in Italy it is rare, while the most frequent food allergy in children is egg allergy. and milk) and some peanut-based foods such as butter are also very popular. Here, this is certainly a less felt problem. 7 PHOTOS

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  • breastfeeding
  • pregnancy feeding
  • atopic diseases
  • artificial milk
  • allergies children
  • asthma
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