What is critical for allergy prevention in early life?

Allergy rates including eczema and food allergy in Australia are amongst the highest in the world affecting those with or without a family history of allergy. Preventive strategies are paramount to lower the ever-rising statistics. However, previously recommended practices, such the avoidance of food allergens, do not seem to have reduced the burden of allergic disease and may have made the situation worse. We now see mounting evidence from randomised studies showing that early exposure is critical for allergy prevention and the recently updated Australasian Society of Clinical Immunology and Allergy guidelines for infant feeding and allergy prevention now aim to support the four to six months of age for commencing solids.

Strategies around the first 1,000 days from conception to early infancy are critical to support healthy immune development and breast feeding remains the gold standard for infant feeding. A healthy diet throughout pregnancy, the timing of the introduction of complementary foods along with adequate vitamin D status are also key.

Diversity of the microbiome is an important concept to consider as the clinical decisions we make can have consequences for the infant microbiome and hence immune development. The method of delivery, the use of maternal and neonatal antibiotics, if breast fed or formula fed, can modify the microbiome and affect the immune system long term. If the baby cannot breast feed, then the addition of pre and probiotics into infant formula or as a supplement is becoming more relevant with recent recommendations from the World Allergy Organisation.

Article submitted by Dr John Sinn, Paediatric Allergist and Neonatologist