Preventing Allergies in Infants with a Family History
What to Feed Your Allergic Baby
Babies can develop food intolerance or food allergy especially if there is a family history of atopic disease e,g. asthma, eczema, auto-immune disease and food intolerance or allergy. Breastfed infants can develop allergy due to food proteins the mother eats passing through her body to her breast milk. Formula-fed infants can show allergy symptoms due to not tolerating the food proteins in infant formula.
Symptoms of infant food intolerance can vary and may include colic, reflux or more projectile vomiting and sleep and settling problems.
A food allergy occurs when the body’s immune system sees a certain food as harmful. Then reacting to the allergen by causing one or more symptoms. This is known as an allergic reaction.
Foods causing allergic reactions are called allergens. Even a tiny amount of an ingested allergen can cause a reaction.
Symptoms of an infant food allergy may include:
- bloody, mucousy poo
- body and facial rash
- severe allergic reaction (anaphylaxis)
Breast Milk is Optimal for Preventing Allergy
Breast milk provides optimal nutrition for a baby. Even babies with food allergies can benefit from breast milk. But, the mother may need some dietary restrictions, also known as an “elimination diet.” Many women can continue to breastfeed if they remove an allergen from their diet e.g. dairy or eggs.
Allergies and food reactions in babies and children are common and may be associated with a variety of foods including adapted cow’s milk infant formula. Parents may consider using special infant formulas for preventing or treating allergic disorders.
This includes amino acid-based formula, hydrolysed formula, soy formula and milk from other animal species e.g. goats. However, the evidence is mixed and the routine use of special formulas for preventing allergy is not recommended. An Australian expert panel has made recommendations on the use of soy, extensively hydrolysed and amino acid formulas for treating cow’s milk protein allergy.
Hydrolysed infant formula, which is cow’s milk-based formula, processed to break down the proteins into smaller particles, may modify the development of the allergic disease.
Infants with a strong history of atopy, there is limited evidence hydrolysed formula, in comparison with cow’s milk formula, is helpful in reducing infant and childhood allergy. Most studies on the use of hydrolysed formulas have involved infants at high risk of atopy. Rather than the general population and benefits have been modest.
Additional randomised studies are needed among infants from families with low risk of atopy. There is no evidence partially hydrolysed infant formula prevents allergic disease when used for supplementary feeds in hospitals. And widespread use for this purpose may undermine breastfeeding.
The Royal Australasian College of Physicians (RAcP) recommends the use of extensively hydrolysed infant formula in infants with proven cow’s milk allergy or cow’s milk protein intolerance who are not breastfed.
Despite what the research has uncovered anecdotally I have helped babies with cows milk protein intolerance or eczema become amazingly settled on a partially hydrolysed formula. Compared to a predominantly cows milk-based formula.
Examples of partially hydrolysed formulae include Aptamil Allerpro Syneo and NAN HA Gold. Extensively hydrolysed formulas include Neocate, Nutramigen, Pepti-Junior and Alimentum.
In the past soy formula was the preferred option. However, soy formula has not been shown to be effective in preventing the development of atopy in ‘at-risk’ children. And may actually worsen atopic illness with prolonged use. Examples of soy formulas include Isomil, Prosobee and Nestle Good Start Soy.
Consuming high levels of soy can have potential risks for babies. For example, the phytoestrogen compounds in soy formula might affect babies’ growing neuroendocrine systems and immune systems. But there’s no compelling research to say what effects these have on babies.
Soy-based formulas don’t prevent or reduce the risk of your child developing allergies.
A Cochrane review concluded that feeding with soy formula should not be recommended for preventing atopy in infants at high risk of developing an allergy.
Further research may be warranted to determine the role of soy formulas for preventing allergy or food intolerance in infants who are unable to be breastfed, who have a strong family history of allergy or cow’s milk protein intolerance.
The RAcP policy for the use of soy formula in infants recommends:
- infants under 12 months who are not breastfed should be fed infant formula, not a soy drink or dairy-based milk marketed for older children or adult consumption
- soy-based infant formula should not be used for preterm infants
- the possible interaction of soy-based formula with thyroxin replacement therapy should be considered for children with thyroid disorders.
- A number of concerns have been raised about soy-based infant formulas, on the basis of possible physiological effects of isoflavone compounds on the infant’s developing neuroendocrine system. There is no clear clinical or scientific evidence to support the position that these compounds are harmful, although no long-term studies have conclusively documented the product’s safety in infants. It is appropriate to use soy infant formula in the management of galactosaemia. Its use may also be appropriate for infants who cannot consume dairy-based products for cultural or religious reasons.
Goat’s milk formula
Compared to cow’s milk formulas, there have been fewer studies evaluating the safety and efficacy of goat’s milk formulas. Goat’s milk is not considered to have any role in preventing or treating allergic disease. many infants who are allergic to cow’s milk are also allergic to goat’s milk and soy drinks. The use of goat’s milk formula is not recommended.
Amino acid-based formula
Amino acid-based or elemental formula is “built” from component nutrients including individual amino acids. Its use in preventing atopic disease has not been studied. Examples of amino acid-based formulas are Neocate and Elecare.
Infant formulas with probiotics or prebiotics
The evidence on probiotics or prebiotics in infant formula to prevent atopic disease varies. two Cochrane reviews and a review by the European Society for Paediatric gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition concluded there was insufficient evidence to recommend their use.
Maternal dietary restriction
There is no evidence that avoiding any particular foods or food allergens during pregnancy, lactation or infancy provides any benefit in preventing allergy and this is no longer recommended.
However, once your baby has been diagnosed with cows milk protein intolerance or allergy An elimination diet is recommended to remove all dairy and usually soy from the mum’s diet.
Table 8.6: Minimising the risk of allergy in infants with a family history
• Do not smoke during pregnancy and provide a smoke-free environment for your child after birth
• Dietary elimination of potential allergens during pregnancy is not recommended for preventing childhood allergy
• If breastfeeding is discontinued for any reason, there is no advantage in using special formulas, except under medical supervision
• Soy-based formulas do not prevent or reduce the risk of developing allergies and are not a suitable alternative to cow’s milk-based formulas
- soy or goat’s milk-based formulas are not suitable alternatives for infants with allergies to cow’s milk-based formulas unless used under medical supervision.
- Avoiding any particular foods or food allergens during pregnancy, lactation or infancy does not prevent allergy development.
Advice for parents
Formulas for managing other infant conditions
A number of infant formulas marketed in Australia claim that they are suited for managing minor conditions and symptoms. An extensive literature review failed to find any evidence of their efficacy.
Special infant formulas for managing metabolic, renal, hepatic, immunological and malabsorptive conditions are available (standard 2.9.1 of the FsAnZ code). Inborn errors of metabolism are outside of the scope of these guidelines.