Timing of food introduction and atopy prevention

The apparent increase in atopic disease, particularly food allergy, over the past 2 decades has resulted in reconsideration of prevention strategies aimed at the infant's diet. Early advice to have atopy-prone infants delay ingestion of potential food allergens, such as egg, cow's milk, and peanut, was rescinded, as new evidence emerged that did not support these approaches. More recently, randomized controlled trials have provided data to support an opposite strategy, promoting early ingestion of allergens as a means of food allergy prevention. Specifically, new guidelines suggest early ingestion of peanut as a means to prevent peanut allergy. Additional dietary approaches regarding breastfeeding, early introduction of other types of food allergens, formula feeding, dietary nutrients, and probiotics are also under scrutiny as potential preventative strategies. This review focuses on the timing of food introduction as a preventative strategy for food allergy and also discusses other aspects of the infant diet that may provide opportunities for prevention of atopic disease.