Food Avoidance Doesn\'t Prevent Allergy

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Food Avoidance Doesn't Prevent Allergy Mon Mar 22, 4:16 PM ET

SAN FRANCISCO (Reuters Health) - Asking pregnant and breastfeeding women to avoid foods associated with allergies such as milk, eggs and nuts was not an effective strategy in preventing the development of allergy to those foods in their children, according to new research presented here at the annual meeting of the American Academy of Allergy, Asthma & Immunology. "Partial food avoidance strategies are not effective to preventing sensitization," lead author Dr. Greg K. Appelt, of the Pediatric Allergy and Clinical Immunology Department at the University of Manitoba, told attendees at the meeting.

Previous evidence of avoiding certain foods to prevent allergy have been mixed, he noted, with some studies finding decreases in dermatitis at one year. Other studies have found a decrease in allergy one year, but no difference at age seven.

Appelt's group conducted a study that enrolled mothers from the Canadian Asthma and Allergy Primary Prevention study. The children were considered high risk, defined as having either one first-degree relative with asthma or two first-degree relatives with IgE-mediated allergic disease.

The researchers counseled the mothers to avoid peanuts, nuts, fish, and decrease milk and egg consumption in the third trimester and during the first year of breastfeeding. The women were also asked to delay the introduction of solids for six months and only introduce milk after one year, eggs after two years and nuts after three years.

The researchers had parents fill out a food questionnaire before birth, and at 2 weeks, and then at 2, 4, 8, 12 and 24 months.

At one, two, and seven years old, the child was given a skin test for sensitization to milk, egg, nut, soy and wheat. Data were collected from 545 families--251 randomly assigned to the intervention group and 246 were assigned to the "control" group in which no allergy avoidance measures were taken

The researchers found that at one year of age, there was no statistically significant difference between the groups. For example, about 4 percent of children in each group were allergic to milk. As many as 20 percent of the children in the intervention group and 14 percent of the control children were allergic to egg, but the differences were not significant.

At two years of age, there was a significant difference between the two groups in allergy to eggs, with 12 percent of the children in the intervention group allergic to eggs but only 6 percent of controls. Four percent in the intervention group were allergic to milk, compared with only 1 percent of the control group. About 9 percent of both groups were allergic to nuts at this age.

By age seven, only about 1 percent were sensitive to milk, and 1 percent to 4 percent were sensitive to eggs. At that age, 11 percent of the intervention group and 7 percent of the control group were sensitive to nuts.

"Overall, sensitization declined from ages one to seven," Appelt said. At one year of age, 102 children showed sensitization, while at age seven, only 47 did so.

"Children with a strong family history of asthma sensitize to common foods, but this wanes over time (for) milk and eggs," he said.

The researchers concluded that partial food avoidance strategies in the third trimester and during breastfeeding were not effective in preventing sensitization to food among these high-risk children.

On the contrary, the strategies seemed to worsen the outcome, for unknown reasons.

"We have concerns that these avoidances may enhance sensitization to foods in high-risk children," Appelt said.

These findings contradict the current recommendation by medical groups for mothers to limit their children's contact with these foods if their children are at risk for developing allergies, noted Dr. Wesley Burks, a professor of pediatrics at Duke University in Chapel Hill, North Carolina.

"To not find that is surprising," Burks said. However, he added, the data set was relatively small. "It's a relatively small number of patients to make any conclusions."

On Mar 22, 2004

Quote:

Originally posted by michelle0123: [b] "To not find that is surprising," Burks said.[/b]

[i]noting[/i]. No surprises here.

[i]Is there an echo in here?[/i] [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

Quote:

Originally posted by michelle0123: [b]However, he added, the data set was relatively small. "It's a relatively small number of patients to make any conclusions."

[/b]

[i]noting.[/i]

On Mar 22, 2004

Now I have a Doris Day song going through my head. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

On Mar 23, 2004

Is there a link? Love this site Synthia

On Mar 23, 2004

Well...now I have less to feel guilty about, if this study is to be believed. I lived on Pb for both pregnancies and early postnatal period.

On Mar 23, 2004

I don't see where they said if the children with allergies to milk and egg continued total avoidance as they grew. Would love to hear about that experience.

T.

On Mar 23, 2004

Quote:

Originally posted by michelle0123: [b] On the contrary, the strategies seemed to worsen the outcome, for unknown reasons.

"We have concerns that these avoidances may enhance sensitization to foods in high-risk children," Appelt said. [/b]

So my eldest is PA because I didn't eat *enough* peanut butter? [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img]

And by not eating peanuts, nuts, shellfish, etc., I've made it *more* likely that my youngest son will have food allergies? Gee, I'm so glad I've been making the sacrifice for the past 2 years. Not!

It's so frustrating to realize that medical science doesn't know its, um, bottom, from its elbow in terms of food allergies.

Okay, just shoot me now.

Debbie

On Mar 31, 2004

DRobbins, great post! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

I didn't eat pb when I was pregnant with Jesse and if I ate any peanut products, it certainly wasn't a significant amount.

I found out Jesse was PA when I was 7 months pregnant with Ember (non-PA).

So, DUH. For me, at least, I thought it was re-affirming that I didn't *cause* Jess' allergy because I had eaten pb and peanut products because I knew that wasn't the case in our own personal situation and that's why I always hate it when Mothers beat themselves up about what they ate during pregnancy. That's why I even went so far, at one point, to raise a thread asking what the Fathers were eating at the time of conception. Why is it always the Mother's fault when the child was, in fact, MADE by two people and shares what I believe are half the genes from each person.

In all honesty, I can't remember what Jesse's Father ate around the time I became pregnant with Jesse, but I don't think he was eating pb or a lot of peanut products either.

What I do think is important for people to be told, although I'm not sure if it's just not like saying to people that they shouldn't pro-create, is that if you do have a family history of certain things like asthma, environmental allergies, and certainly food allergies, than your child is more at risk.

But, as I posted in the Nestle Baby Magazine thread, if I read what they are putting out, which is current, and how a lot of new Mothers feed their babies (I went to the Gerber school myself [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] ), even in looking at myself, I wouldn't have considered my children to be "high risk" at developing food allergies. Environmental allergies, certainly, because of me (not their Father), asthma (certainly, because of me, again, not their Father) but not food allergies.

But I guess, because I had one asthma attack as a child and have had environmental allergies since time began, perhaps my children were to be considered "high risk", no matter who their Father was. I really don't know.

When I think of the question about whether or not our children are atopic (another thread), I can't even say that about myself as far as presenting a risk to my children (or as another Mom posted to-day, which I found endearing, my monsters [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] ). I had one asthma attack. I have environmental allergies. I have never had ezcema.

So, no, don't join the Mother Guilt bandwagon now because of this Debbie, 'cus I'm not. I don't believe in it, not unless there is an equal amount of Father Guilt as well. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

------------------

On Apr 7, 2004

reraisng.

On Apr 27, 2004

reraising.

On Apr 27, 2004

So does anyone else think that this study will eventually be discounted? Perhaps because it wasn't large enough to be statistically meaningful, or something like that?

Even now that I've had time to digest this, it peeves me. I'm trying so hard to avoid likely allergens in my own diet while I'm breastfeeding, and if it turns out that I've sabotaged my baby through my efforts...

--Debbie

On Jul 18, 2004

[i]reraising.[/i]

(?)

On Jan 4, 2006

reraising.

On Mar 12, 2006

reraising.

On Oct 14, 2006

Re-raising. I'm breastfeeding and avoiding peanut...anyone know the current research-based opinion about whether avoiding peanut helps or hurts my child in the long run?

Thanks

April

On Oct 14, 2006

Something to think about during pregnancy...

[url="http://www.docguide.com/news/content.nsf/news/852571020057CCF68525718D00696BEE"]http://www.docguide.com/news/content.nsf/news/852571020057CCF68525718D00696BEE[/url] By Norra MacReady VIENNA, AUSTRIA -- June 14, 2006 -- Perinatal and environmental factors affect the occurrence of specific IgE antibodies in cord blood and may influence the development of allergies to those items, according to a poster presentation here at the 25th Congress of the European Academy of Allergology and Clinical Immunology (EAACI).

In a study of 173 healthy, full-term infants, prenatal exposure to cats and tobacco smoke had a significant impact on allergen-specific IgE levels in cord blood, said investigator Adam J. Sybilksi, MD, Medical University of Warsaw, Poland. Male sex in the infant and complications during pregnancy were other influential factors.

Allergies require both a genetic predisposition and environmental factors that provoke the response. In the fetus, allergen-induced responses have been reported as early as 22 weeks' gestation, but the second and third trimesters are considered the crucial times for the initiation of an immune reaction to environmental allergens.

The researchers analyzed IgE levels in cord blood for 3 classes of allergens: children's food, including eggs, milk, wheat meal, peanuts, and soy; the most common strains of grasses and wheat found in Poland; and house dust mites.

Just after delivery, the mothers completed questionnaires on type of delivery, pregnancy complications, and parents' lifestyle and medical and atopic histories.

For all infants, the mean cord blood IgE level was 0.549 IU/mL. Boys had a mean total IgE level of 0.816 IU/mL and girls had a mean level of 0.389 IU/mL (P = .007). Newborns with a complicated pregnancy had a mean of 0.749 IU/mL, while the mean level was 0.167 IU/mL for those with no complications (P = .003).

Specific IgE tests were positive in 34 newborns. The mother's contact with cat dander was associated with a higher IgE level for wheat and grass (odds ratio [OR] 3.24, P < .07) and children's food (OR 4.98, P < .04). Exposure to tobacco smoke was correlated with higher levels of IgE specific to house dust mites (OR 4.7, P = .005). Household contact with dogs was associated with a lower level of IgE specific to grass and wheat (OR 0.28, P < .05).

The researchers found no correlation with a family history of atopy.

While genetic predisposition for allergic disease is important, prenatal as well as postpartum exposure to environmental factors clearly play a role in their development, the investigators concluded.

On Oct 14, 2006

Quote:

Originally posted by 2BusyBoys: [b]Specific IgE tests were positive in 34 newborns. The mother's contact with cat dander was associated with a higher IgE level for wheat and grass (odds ratio [OR] 3.24, P < .07) and children's food (OR 4.98, P < .04). Exposure to tobacco smoke was correlated with higher levels of IgE specific to house dust mites (OR 4.7, P = .005). Household contact with dogs was associated with a lower level of IgE specific to grass and wheat (OR 0.28, P < .05).

[/b]

[b]DOGS RULE!!![/b]

As if the dangers of toxoplasmosis weren't enough, (let alone the whole idea of a [i]litterbox[/i]) looks like there might be one more reason to give kitty their walking papers related to pregnancy! (just kidding....sorta.)

And I'm assuming any informed, concerned pregnant woman would avoid cigarette smoke in any shape or form.

On Oct 15, 2006

I'm no medical expert...This is just my personal opinion... My personal advise to anyone pregnant or breastfeeding is strictly avoid all nuts during both periods. You should, however, discuss your diet restrictions with your doc. before doing so.

I have five children. My oldest child has life-threatening peanut/tree-nut allergies...Has had airborne reactions, also. She is off-the-charts allergic. During pregnancy & breastfeeding I consumed lots of peanut butter. Was told by the docs. it was a good source of protein. I was trying to avoid chocolate because of the caffine so satisfied my sweet tooth by eating peanut butter. I waited til 6 months to introduce solids to her...Nursed her til 18 months. Felt I was doing everything humanly possible to avoid allergies even though there was no history of food allergies in either my family nor my dh's. She had atopic dermatitis soon after birth. Docs. at the time didn't tell me it was usually a sign of allergies. Within a few days of weaning her at 18 months, she had her first taste of p.b...A Reese's peanut butter cup. Her skin was so inflammed I took her to the doc. who brushed off my concerns. So suspecting allergies, took her to an allergy doc. He said she was milk, egg, & nut allergic. She has outgrown the milk & egg...but not the nuts. She has had RAST testing every 3 years and it is still off-the-charts allergic to nuts. No improvement at all.

With my 2nd & 3rd dc I strictly avoided all nuts during preg. & breastfeeding...nursed them even longer than my first dc..The only allergies they have is #2 has hayfever in the summer & can't eat cantaloupe (has compound in it similar to ragweed)...and 3rd child has no allergies.

With my 4th child I relaxed my guard and ate "may contain traces of nuts" candy during pregnancy ocassionally. When he was about 1 month old, I ate a "bunch" of left-over Halloween candy with nuts..A one time binge! He has life-threating nut allergies (especially to almonds & peanuts) and mild egg allergy.

I went back to strict avoidance of nuts with the preg. & nursing of my 5th child...and he shows no signs of allergies. I delayed all solids the same amount of time with each child...Waited til 6 months. Nursed each one longer than the child before (under the allergy doc. advise.). I personally feel breastfeeding does help prevent allergies..but it seems logic to me that exposure of high allergen items (like nuts) during preg. & breastfeeding (especially overexposure) may trigger sensitivity to them. I did not limit milk or egg intake during either stage. Again, always discuss with your doc. before any diet restrictions.

On Oct 15, 2006

FromtheSouth,

your post definitely drove home the value of [i]double blind placebo studies[/i] for me. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Oct 15, 2006

Quote:

Originally posted by 2BusyBoys: [b] In a study of 173 healthy, full-term infants, prenatal exposure to cats and tobacco smoke had a significant impact on allergen-specific IgE levels in cord blood, said investigator Adam J. Sybilksi, MD, Medical University of Warsaw, Poland. [/b]

[i]no kidding[/i]. My mom smoked all through her pregnancy with me. She also ate PB&J every day for lunch for the protein, per a doc's advice.

On Oct 15, 2006

Just wanted to add...Most of us don't know details about our genetic family tree beyond our own parents. As a matter of fact, my father is in his mid 70's and I just discovered a few years ago that he has some allergies. Our allergy doc. told me years ago that a genetic predisposition to food allergies may be a reason why some children become allergic while others don't. That even though I also know some people who profess they ate p.b. regularly during pregnancy and/or breastfeeding but don't have food allergic kids...and yet I indulge one time...and my dc develop them and my friends don't... may just mean the genes linked to this condition may not be on their family tree....or at least skipped a generation. Our family tree, however, very likely had a great-grandparent, for example, that had the same allergies my dc have.

Therefore, he highly suspects the overindulgence of very strong allergens (like nuts...There are more peanut products out there than every before) combined with a genetic tendency may be the reason nut allergies keep rising among children.

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