Time to Start Potentially Allergic Foods in Complementary Feeding and Food Allergies

Öz

Early exposure to potentially allergenic foods during the complementary feeding period, when the infant begins to consume foods other than breast milk, may reduce the risk of food allergy by inducing oral tolerance. Cow's milk, egg, peanut and fish are among the potentially allergenic foods included in guidelines and recommendations. There is also a recommendation for the introduction of gluten in complementary feeding. Nowadays, the timing of the introduction of potentially allergenic foods has changed in parallel with the increasing prevalence of food allergy. There are various guidelines regarding the timing of introduction of these foods, especially in infants at high risk of allergy. According to these guidelines, the introduction of egg and peanut in complementary feeding at 6 months of age reduces the risk of food allergy. However, cow's milk and fish have no significant effect on the risk of allergy. Among cereals, foods made from wheat are most commonly consumed. Early or late introduction of gluten protein in wheat does not affect the prevalence of celiac disease in childhood. Recommendations on this subject should be made taking into account the negative consequences that may be caused by the food recommended for later consumption in the complementary feeding.

Anahtar Kelimeler

• Infant food
• Allergens
• Food Hypersensitivity
• Atopic
• Growth & development

Tamamlayıcı Beslenmede Potansiyel Alerjik Besinlere Başlama Zamanı ve Besin Alerjileri

Öz

İnfantın anne sütü dışındaki besinleri tüketmeye başladığı tamamlayıcı beslenme döneminde potansiyel alerjik besinlerin erken tüketimi oral toleransı indükleyerek besin alerjisi riskini azaltabilir. İnek sütü, yumurta, yer fıstığı ve balık kılavuzlarda yer alan ve öneri geliştirilen potansiyel olarak alerjik besinlerdendir. Ayrıca tamamlayıcı beslenmede glutene başlanması konusunda da öneri mevcuttur. Günümüzde potansiyel olarak alerjiye neden olabilecek besinlerin başlanma zamanı, artan besin alerjisi prevalanslarına paralel olarak değişiklik göstermiştir. Özellikle alerji riski yüksek olan infantlarda, bu besinlere başlama zamanı ile ilgili çeşitli kılavuz önerileri mevcuttur. Bu kılavuzlara göre tamamlayıcı beslenmede yumurta ve yer fıstığına 6. ayda başlanması besin alerjisi riskini azaltmaktadır. Ancak erken dönemde inek sütü ve balık tüketiminin alerji riski üzerinde anlamlı etkisi yoktur. Tahılların içerisinde en fazla buğdaydan üretilen besinler tüketilmektedir. Buğdayda bulunan gluten proteinine erken ya da geç başlanması ise çocukluk çağındaki çölyak prevalansını etkilememektedir. Bu konuda tamamlayıcı beslenmede daha geç tüketilmesi önerilen besinin neden olabileceği olumsuz sonuçlar dikkate alınarak öneri verilmelidir.

Anahtar Kelimeler

• Bebek gıdası
• Alerjenler
• Besin aşırı duyarlılığı
• Atopik
• Büyüme ve gelişme

Kaynakça

1. Agostoi C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, et al; ESPGHAN Committee on Nutrition. Complementary feeding: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46(1):99-110.
2. World Health Organization. Infant and young child feeding. Avaible at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed November 7, 2022.
3. American Academy Of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106: 346-9.
4. Høst A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P, et al. Dietary products used in infants for treatment and prevention of food allergy: Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999;81(1):80-4.
5. Sicherer Sh, Muñoz-Furlong A, Godbold Jh, Sampson Ha. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010;125(6):1322-6.
6. Caffarelli C, Valeriani L, Agostoni C. Recommendations on complementary feeding for healthy, full-term infants. Ital J Pediatr 2015;41(1):1-9.
7. Anvari S, Chokshi NY, Davis CM. Evolution of guidelines on peanut allergy and peanut introduction in infants: A review. JAMA Pediatrics 2017;171(1):77-82.
8. Grueger B, Canadian Paediatric Society; Community Paediatrics Committee. Weaning from the breast. Paediatrics & Child Health 2013;18(4):210-1.

9. Muraro A, Halken S, Arshad SH, Beyer K, Dubois AEJ, Du Toit G, et al; EAACI Food Allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014;69(5):590-601.
10. Burgess JA, Dharmage SC, Allen K, Koplin J, Garcia‐Larsen V, Boyle R, et al. Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta‐analysis. Clin Exp Allergy 2019; 49(6):754-69.
11. World Health Organization. Risk Assessment of Food Allergens. Part 1: Review and validation of Codex Alimentarius priority allergen list through risk assessment: Meeting Report. 2022.
12. Nwaru BI, Hickstein L, Panesar Ss, Roberts G, Muraro A, Sheikh A; EAACI Food Allergy and Anaphylaxis Guidelines Group. Prevalence of common food allergies in Europe: a systematic review and meta‐analysis. Allergy 2014; 69(8): 992-1007.
13. Grabenhenrich L, Trendelenburg V, Bellach J, Yürek S, Reich A, Fiandor A, et al. Frequency of food allergy in school‐aged children in eight European countries—The EuroPrevall‐iFAAM birth cohort. Allergy 2020;75(9): 2294-308.
14. Savage J, Johns CB. Food allergy: epidemiology and natural history. Immunol Allergy Clin North A 2015; 35(1):45-59.
15. Schoemaker AA, Sprikkelman AB, Grİmshaw Ke, Roberts G, Grabenhenrıch L, Rosenfeld L, et al. Incidence and natural history of challenge‐proven cow's milk allergy in European children–EuroPrevall birth cohort. Allergy 2015;70(8):963-72.
16. Elmas B, Özdemir Ö. Sensitization Prevalence of children with allergic rhinitis for inhalant and food allergens in the province of Sakarya, Turkey. JAREM 2017;7:63-9.
17. Akarsu A, Ocak M, Köken G, Şahiner ÜM, Soyer Ö, Şekerel BE. IgE mediated food allergy in Turkey: Different spectrum, similar outcome. Turk J Pediatr 2021;63(4):554-63.
18. Warren CM, Jıang J, Gupta RS. Epidemiology and burden of food allergy. Curr Allergy Asthma Rep 2020;20(2):1-9.
19. Shrimpton R, Victora CG, DE Onis M, Lima RC, Blossner M, Clugston G. Worldwide timing of growth faltering: Implications for nutritional interventions. Pediatrics 2001;107(5):75.
20. Skypala IJ, MCkenzie R. Nutritional issues in food allergy. Clin Rev Allergy Immunol 2019;57:166-78.
21. Fewtrell M, Bronsky J, Campoy C, Domellof M, Embleton N, Mis NF, et al. Complementary feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017;64(1):119-32.
22. EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Castenmiller J, De Henauw S, Hirsch‐Ernst Ki, Kearney J, Knutsen HK, Macıuk A, Mangelsdorf I, Mcardle HJ, Naska A, Pelaez C, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA Journal 2019;17(9):e05780.
23. Dona DW, Suphioglu C. Egg allergy: Diagnosis and immunotherapy. Int J Mol Sci 2020;21(14):5010.
24. Al-saud B, Sigurdardottir ST. Early introduction of egg and the development of egg allergy in children: A systematic review and meta-analysis. Int Arch Allergy Immunol 2018; 177(4):350-9.
25. Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge, J, Robinson Z, Geoghegan N, Jarrold K, Reeves T,Tagiyeva-Milne N, Nurmatov U, Jo Leonardı-Bee M, Boyle RJ. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: A systematic review and meta-analysis. JAMA 2016;316(11):1181-92.
26. Natsume O, Kabashima S, Nakazato J, Yamamoto-Hanada K, Narita M, Kondo M, et al & PETIT Study Team. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): A randomised, double-blind, placebo-controlled trial. The Lancet 2017;389(10066):276-86.
27. Palmer DJ, Sullivan TR, Gold MS, Prescott SL, Makrides M. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2017;139(5):1600-7.
28. Wal JM. Bovine milk allergenicity. Ann Allergy Asthma Immunol 2004;93(5):2-11.
29. Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med 2016;374:1733-43.
30. Zhuang Y, Dreskin SC. Redefining the major peanut allergens Immunol Res 2013;55(1):125-34.
31. Greenhawt M, Shake M, Wang J, Oppenheimer JJ, Sicherer S, Keet C, et al. Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis. J Allergy Clin Immunol 2020;146(6):1302-34.
32. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372:803-13.
33. Dewey KG. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr. 2013;143(12):2050–54.
34. Counter S, Buchanan LH. Mercury exposure in children: a review. Toxicol Appl Pharmacol 2004; 198(2): 209-30.
35. Mercury Concentrations in Fish from the FDA Monitoring Program (1990-2010) Avaible at: https://www.fda.gov/food/environmental-contaminants-food/mercury-concentrations-fish-fda-monitoring-program-1990-2010. Accessed July 23, 2023
36. Shewry P. What is gluten—Why is it special? Front. Nutr. 2019;6:101.
37. Schalk K, Lexhaller B, Koehler P, Scherf KA. Isolation and characterization of gluten protein types from wheat, rye, barley and oats for use as reference materials. PLoS ONE 2017; 12(2): e0172819
38. Szajewska H, Shamir R, Mearin L, Ribes-Koninckx C, Catassi C, Domellöf M, et al. Gluten introduction and the risk of coeliac disease: a position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2016;62(3):507-13.
39. Prescott SL, Smith P, Tang M, Palmer DJ, Sinn J, Huntley SJ, et al. The importance of early complementary feeding in the development of oral tolerance: concerns and controversies. Pediatr Allergy Immunol 2008;19(5):375-80.
40. Foong RX, Santos AF. Oral tolerance induction—opportunities and mechanisms. Foods 2022;11(21):3386.