Food allergies and pregnancy

To clarify...

From: Misconceptions and Misunderstandings About Food Allergy (Medscape)

Definition of Food Allergy

An "adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food."

Food Allergy vs Food Intolerance

The 50% to 90% of self-reported food allergies that are not really allergies are actually reactions to food that are not mediated by the immune system. Non-allergic food reactions, referred to as "food intolerances," typically occur 3-4 hours after ingesting a certain food or similar food and produce symptoms that vary depending on the nature of the intolerance.  [Milk intolerance is an example.]

Prevention of Food Allergy

"One common misconception," observed Dr. Fenton, "is that it is possible to prevent the development of food allergy by avoiding certain foods." Restricting maternal diet during pregnancy or lactation in the hope of preventing food allergy in the infant is not recommended. Feeding newborn infants soy formula does not prevent food allergy. Moreover, delaying the introduction of solid foods beyond 6 months of age, including potentially allergenic foods, does not prevent food allergy.

New Guidelines on Food Allergies

We have had question about whether or not a breastfeeding or pregnant woman should avoid certain foods that tend to be high on the allergy list. 

The first food allergy guidelines were issued today by the National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID).  These guidelines include the following information as it relates to pregnancy and breastfeeding.

The panel defines food allergy as "an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food."

Delaying of Foods Not Warranted
The guidelines do not recommend restricting maternal diet during pregnancy or lactation to prevent the development or clinical course of food allergies, but they do recommend exclusive breast-feeding of all infants until age 4 to 6 months, unless medical reasons contraindicate breast-feeding. 

According to Dr. Sampson, the guidelines concur with current American Academy of Pediatrics guidelines. "There is no evidence that delaying certain foods, even foods that are considered allergenic, (is) going to have any significant effect on the development of allergy," he said.

 Once more, exclusive breastfeeding is supported and allergies can be avoided by doing that.  It is worth investing in lactation services to be sure a new mom is successful in this effort and supplements should be avoided whenever possible.

Medical reasons not to breastfeed include a very few diseases, taking certain medications (also very few).  Unfortunately some mothers and babies miss out on this amazing opportunity without thoroughly checking this out.  The Pregnancy Risk Line is the best resource to learn what is likely safe or unsafe since testing by the FDA of drugs does not include pregnant and nursing mothers.  Therefore the Physician Desk Reference and package inserts routinely say, "not to be taken by pregnant or breastfeeding women without physician recommendation" or "inadequate information available to determine the safety in pregnant or breastfeeding mothers."  The PRL joins forces throughout the nation to gather evidence after thousands of women have used the drug and are able to give a more helpful recommendation for or against breastfeeding.  More often than not, the drug is safe.  Your physician may be very busy or not committed to successful breastfeeding and may not get this more updated info, relying only on the manufacturer's statement so a pro-active mom is a more informed mom.  Call them at (800) 822-2229 or (801) 328-2229.

Feeding your baby

Feed your baby right: Experts agree: breastmilk is best in the first year of life. Studies show that breastfed babies have fewer ear infections, lower respiratory infections, and urinary tract infections than children who receive formula. Breastfed babies are also less likely to become obese. “Breastmilk has all the basic nutrients your baby needs,” says Alan Fleischman, MD, medical director of the March of Dimes, a pediatrician and neonatologist. “The only supplement he’ll need is vitamin D.”

But some moms may be unable to breastfeed for health or other reasons. Formula is a perfectly suitable second-choice option, Fleischman says. Feed your baby whenever he’s hungry, which may be every two to four hours. Expect him to fall back to sleep after he eats. As long as your baby is gaining weight, has four wet diapers and one or two bowel movements every day, it’s okay to let your baby sleep a little longer. “These are very flexible recommendations,” Fleischman says. “Every baby is different.”

Babies are never allergic to breastmilk and they digest it easily. Rarely, a baby is so intolerant of cow's milk protein that he/she cannot handle even the mother drinking milk. These babies still do best on breastmilk but the mother may need to eliminate milk from her diet. If weaning occurs too soon, the baby may require expensive pre-digested formulas without milk or soy products.

Exclusive breastfeeding is recommended for the first six months. Around that that time your pediatrician will have you introduce solids, beginning with rice cereal. By then the baby is developmentally ready to eat from a spoon. Breastmilk should continue as the primary source of nutrition through the first year of life and as long thereafter as desired.

Pediatrician Jenny Thomas "...learned about the importance of breastmilk for preemies and the way breastmilk guarded babies from infectious diseases. “I was enthralled,” Thomas recalls. “It was the first time I’d heard anything of the sort.” Thomas began devouring information about breastfeeding and she went on to nurse her two younger sons. Nursing, she admits, was not
always easy, and she struggled when she first started nursing her second son. “But I knew if I quit, I wasn’t going to be much of a role model,” she says."

Preventing food allergies in babies

Click the post title to read Dr. Sears article.  Here are some things you can do now to help reduce the risk of food allergies in your baby.
 
* Breastfeed your baby as long as possible. The longer you breastfeed, the less chance your child has of developing allergic diseases, such as eczema and asthma. Breastmilk is rich in an immunoglobulin called secretory IGA, which acts as a protective paint, coating the intestines and keeping food allergens out of the bloodstream. Breastmilk keeps the intestinal lining healthy and better able to break down proteins into individual amino acids. The amino acids themselves are not likely to cause allergies when they get into the bloodstream. Intestines that are damaged due to infection or inflamed by foreign milk or formula may allow whole protein molecules to seep through, setting up an allergic reaction in the bloodstream. To further decrease the risk of developing food allergies, it would be wise for a breastfeeding mother to keep the most allergenic foods out of her diet until her baby is at least one year of age.

* Delay introduction of solid foods. Mature intestines are better able to screen out potential allergens and keep them from entering the bloodstream. If you feed your infant solid foods (especially those containing protein, such as wheat, soy, and dairy) before the intestinal lining is mature, food allergens can seep into the bloodstream, causing baby to build up antibodies to those allergens and later become allergic to those foods. When you do start solids, introduce the least allergic (lowest protein) foods first, such as fruits, vegetables, and rice. Wait until at least eighteen months before introducing potentially-allergic foods, such as egg whites, tomatoes, shellfish, and peanut butter . Make citrus fruits the last fruits you introduce. Also, if you're formula-feeding, discuss with your doctor the use of hypoallergenic formulas (a partial whey hydrolyzed formula), such as Alimentum or Nutramigen. Avoid soy formulas . Also, delay introducing cow's milk products until at least a year of age. By twelve months of age, your child's intestines are mature enough to screen out most of the food allergens.