Redefining the Role of Nutrition in Infant Food Allergy Prevention: A Narrative Review

Abstract

Pediatric food allergy remains commonplace, despite the advancement in our understanding of risk factors and prevention modalities for the condition. Early allergen introduction, a dietary intervention, has been endorsed by professional societies globally as an effective primary preventive measure, yet awareness among medical professionals and parents is lacking. Alongside food allergen introduction, overall nutrition, such as diet diversity, also plays an important role in allergy prevention. To address both food allergen introduction and overall nutrition, dietitians play a pivotal role in the dissemination and education of current guidelines to caregivers. This review addresses the particular role of the dietitian in food allergy prevention consultations, providing up-to-date information on food allergies, their development and prevalence, risk factors, dietary factors and an overview of the current guidelines in the United States. This has not been addressed in any of the current food allergy or nutrition guidelines.

Keywords: food allergy; nutrition; prevention.

Figure 1

Risk factors for the development of food allergies include family history of atopic conditions, the use of antibiotics and their effect on the microbiome, cutaneous exposure to allergens, the epithelial barrier hypothesis, various environmental influences, a previous diagnosis of atopic dermatitis, and caesarian birth.

Figure 2

The 2021 Guidance from the AAAAI and ACAAI for the primary prevention of food allergy through nutrition encourages the introduction of peanut and egg at around six months of age, but not before four months of age, to prevent food allergies. Other allergens should be introduced at the same age and after the initial introduction, allergens should be consumed consistently.