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ASCIA Guideline: Infant Feeding for Food Allergy Prevention
S L Vale1,2, M J Netting1,3, C J Hornung4,5,6,7
1National Allergy Council, Sydney, New South Wales, Australia.
Insights
Introduce infants to solids around 6 months, including well-cooked egg and peanut soon after. Offer common allergens weekly to prevent food allergies, with no need for maternal dietary changes or hydrolyzed formulas.
Area of Science:
- Allergy and Immunology
- Pediatric Nutrition
- Public Health Guidelines
Background:
- The Australasian Society of Clinical Immunology and Allergy (ASCIA) updated its 2016 infant feeding guideline for food allergy prevention.
- The guideline provides specific recommendations for infant feeding practices aimed at preventing food allergies.
Purpose of the Study:
- To provide updated recommendations for infant feeding to prevent food allergies.
- To incorporate new evidence and expert consensus into clinical practice guidelines.
Main Methods:
- Systematic evidence review using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework.
- Delphi process for recommendations where evidence was lacking, based on expert consensus.
- Formation of an Expert Writing Group with representation from key allergy organizations and research centers.
Main Results:
- 16 recommendations were developed: 8 based on published evidence, 8 on expert consensus.
- Infants should start solids around 6 months (not before 4 months) when developmentally ready.
- Introduce well-cooked egg and peanut soon after solids begin; offer other allergens weekly. Breastfeeding is encouraged; hydrolyzed formulas are not recommended for prevention.
- Mild perioral rashes may not indicate allergy and the food can be offered again.
Conclusions:
- Key updates include specific timing for peanut and egg introduction and guidance on perioral rashes.
- These guidelines aim to support primary healthcare providers in advising families on infant feeding for allergy prevention.
- The guidelines necessitate ongoing review and updates as new scientific evidence emerges.
Background:
The Australasian Society of Clinical Immunology and Allergy (ASCIA) Guideline: Infant Feeding for Food Allergy Prevention is an update of the 2016 ASCIA guideline. This updated guideline provides recommendations specifically in relation to infant feeding for food allergy prevention.
Methods:
A review of the guideline began in 2024, informed by a systematic evidence review process and using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework. Where evidence was lacking, a formal Delphi process was used to develop recommendations based on expert consensus. An Expert Writing Group comprising representation from ASCIA, the National Allergy Council, Allergy & Anaphylaxis Australia the National Allergy Centre of Excellence and the Centre for Food Allergy Research was established. Key stakeholder meetings were held.
Results:
A systematic review of evidence resulted in 16 recommendations: eight based on published evidence; eight based on expert consensus. ASCIA recommends: In Australia and New Zealand, infants should be introduced to solid foods when they are showing signs of developmental readiness. This is usually around 6 months and not before 4 months of age. Soon after infants have started solid foods, well cooked egg and appropriate forms of peanut are included in the infant's diet. Other common food allergens included in the family diet should be offered to the infant. Once introduced, common food allergens should be offered around once a week. Breastfeeding is encouraged, with no maternal dietary modifications. Breastmilk substitutes based on hydrolysed milk protein, soy or other proteins are not recommended for allergy prevention. Mild perioral rashes which appear around food consumption (redness or contact urticaria with no other symptoms of allergy) may not be a sign of an allergic reaction, and the food should be offered again.
Conclusion:
Key changes from the 2016 ASCIA guideline include specific recommendations regarding the timing of peanut and egg introduction, alongside a recommendation regarding perioral rashes to support primary healthcare providers. These guidelines require ongoing review and updating as new evidence emerges.
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