Time to revise infant eating guidelines to tackle rise in allergies, Hong Kong experts say

Health guidelines that still recommend infants avoid solid foods at an early age should be revaluated as science now suggests earlier exposure could be a good way to prevent allergy developments in later life, experts say.

The advice by the Hong Kong Institute of Allergy comes as global prevalence of allergic diseases has increased three- to four-fold over the past few decades, with most of this uptick across Asia attributed to changing diets, lifestyles and hygiene levels.

“International consensus guidelines are already being revised to cease recommending avoidance of common food allergens, but rather, an early consumption strategy to prevent the development of allergy,” the institute said in a press release on Sunday.

The institute, which promotes awareness of allergic diseases, said it had recently altered its guidelines on peanut allergies to take into account recent breakthroughs in research.

It cited recent findings by the British Enquiring About Tolerance (EAT) research project, involving the Food Standards Agency, King’s College London and the Medical Research Council.

The study found that introducing six potentially allergenic foods, including eggs, peanut and cow’s milk, to breastfed infants from four to six months of age decreased the rate of allergic development compared with those who avoided them.

“This challenges conventional thinking. Even the World Health Organisation recommends parents to exclusively breastfeed in the first six months,” institute council member Dr Marco Ho Hok-kung, a paediatrician, said.

Paediatric allergist Dr George Du Toit of Guy’s and St Thomas’ Hospital London, who helped conduct a related study on the early introduction of peanuts, said introduction at four to six months of age provided a narrow opportunity to expose children safely to foods containing peanut.

“As children approach the milestone of sitting, usually at six months, many are well on their way to becoming allergic. By the time they reach the milestone of walking, at one year, it’s usually set,” he said. “We’ve just shown that it reduces allergy if you eat it early.”

The researchers conducted randomised clinical trials on 600 infants in Britain at high risk of allergy – those with moderate to severe eczema and/or egg allergies. Some ate about six grams of peanut-containing food a week from four months to five years old, while the rest avoided such food.

For infants in the “avoidance” group, 18 per cent developed peanut allergies compared with just 3.6 per cent in the “consume” group, an 81 per cent relative difference. A follow-up study found that tolerance was sustained after the child avoided peanuts for a year and then resumed consumption.