Dietary diversification: Preventing eczema and allergies in babies

The incidence of allergic diseases, such as eczema, food sensitivities and allergies, continues to rise, significantly affecting the quality of life of individuals and their families, and imposing a heavy economic burden on society. Early prevention of atopic diseases is therefore crucial. One promising strategy is to increase dietary diversity among infants, a method that could reduce the risk of atopic diseases later in life.

What is atopy?

Atopic diseases include eczema, food allergies, asthma and allergic rhinitis. Professionals often diagnose these diseases in childhood, and they can persist into adulthood.

With limited treatment options, prevention through early intervention is essential. Dietary diversification is one approach being studied for its potential to induce oral tolerance to allergens.

What is the purpose of dietary diversification?

Food diversification refers to the introduction of a wide range of solid foods during the weaning period in infants. Studies show that the early and varied introduction of foods may play a protective role against the development of atopic diseases. The Learning Early About Peanut (LEAP) and the Enquiring About Tolerance (EAT) studies have shown that early introduction of peanut reduces the risk of peanut allergy in high-risk children.

Dietary diversification and atopy: what are the recommendations?

To reap the potential benefits of dietary diversification, it is recommended that a variety of solid foods be introduced between 4 and 6 months of age. This period, often referred to as the “tolerance window”, is crucial for developing babies’ immunological tolerance. Starting with vegetables, fruit, cereals, animal proteins and dairy products allows exposure to a diverse range of foods, promoting food tolerance and reducing the risk of allergies.

How should solid foods be introduced?

Step	Food	Details
Start with vegetables	Carrots, courgettes, sweet potatoes	Vegetables are generally well tolerated and can be introduced as a smooth purée.
Introduce fruit	Bananas, apples, pears	Fruit can be added gradually in puréed form.
Introducing cereals	Rice, oats	Iron-enriched cereals are important for preventing iron deficiency.
Add animal proteins	Meat, fish, eggs	Meat, fish and eggs can be introduced from 6 months to provide protein and essential fatty acids.
Introduce dairy products	Yoghurts, cheese	Yoghurts and cheeses can be introduced to provide calcium and beneficial probiotics.

How can I prevent a peanut allergy?

Guidelines from leading health organisations have evolved to encourage the early introduction of certain food allergens, such as peanuts, to reduce the risk of developing allergies. According to guidelines from the National Institute of Allergy and Infectious Disease (NIAID), it is recommended that peanuts be introduced between 4 and 6 months of age to children at high risk of allergy, particularly those with severe atopic dermatitis, egg allergy, or both.

It is important to mention that recent studies have highlighted the importance of early introduction of certain allergens such as peanuts and eggs, not only for high-risk children, but also for the general infant population. A follow-up study to the LEAP study showed that early introduction of peanuts can reduce the risk of developing allergies in adolescence by 71%.

TheAustralasian Society of Clinical Immunology and Allergy (ASCIA) also advocates the early introduction of peanuts and other common allergens, stressing that this approach can help induce oral tolerance and prevent later food allergies. In addition, theEuropean Academy of Allergy and Clinical Immunology (EAACI) recommends increasing dietary diversity to prevent allergies.

These health organisations base their position on moderate evidence showing that dietary diversity can reduce the risk of asthma, atopic dermatitis and food sensitisation. The EAACI also stresses the importance of not delaying the introduction of potentially allergenic foods such as peanuts, eggs, fish and milk.

All the questions about food diversification :

When should I start introducing solid foods to my baby?

The recommended time to start is between 4 and 6 months, when your baby is showing signs of readiness, such as being able to hold his head upright and showing an interest in solid foods.

What foods should I avoid introducing first?

It is generally advisable to avoid highly processed foods and sweets. In addition, don’t introduce certain foods such as honey before the age of 1 because of the risk of infant botulism.

How can I tell if my baby is having an allergic reaction?

Signs of an allergic reaction may include skin rashes, swelling, breathing difficulties or vomiting. If you suspect an allergic reaction, consult a healthcare professional immediately.

Can I introduce several new foods at the same time?

It is best to introduce one new food at a time and wait 3 to 5 days before introducing another. This makes it easier to monitor any allergic reactions and to identify the food responsible.

Source:

1. Clinical trials investigating how to best prevent Peanut Allergy
2. European Academy of Allergy & Clinical Immunology. EAACI
3. Nurturing Infants to Prevent Atopic Dermatitis and Food Allergies: A Longitudinal Study
4. The Australasian Society of Clinical Immunology and Allergy (ASCIA)
5. Associations between diet diversity during infancy and atopic disease in later life: Systematic review