As Head of Food Allergy at the FSA, I'd like to draw attention to an article published in the BMJ today, by researchers at UCL, that suggests babies might benefit from being given solids earlier than currently recommended – the research suggests that this is partly because weaning later may increase the risk of food allergies.
We welcome new developments in allergy research, and it is right to highlight to parents where there is scientific uncertainty, as the BMJ article does, so that parents can make informed decisions. But while the evidence base remains uncertain, suggestions to revise the current government recommendations are premature and are likely to only cause confusion to parents.
At present there is scientific uncertainty about whether young children should avoid foods that can cause allergic reactions to escape sensitisation or, instead, should eat them to induce tolerance and thus reduce the risk of developing food allergy. It's thought that there is a critical window of time during early life when the immune system is developing and this may be a key time for the development of allergies, but it's not clear how the route, timing and dose of exposure to food allergens during this period might influence whether the child develops an allergy or not.
The Agency is funding research to contribute to the evidence in this area and inform Government advice. For example, the EAT study is investigating whether the early introduction of allergenic foods to infant diets from the general population, alongside continued breastfeeding, could lead to a reduction in food allergies.
The Agency is also funding part of the ‘Learning Early About Peanuts study', which is a major clinical study being funded by the US National Institutes of Health. The LEAP study is investigating whether either eating high levels of peanuts from an early age or excluding them from diets of children at high risk of developing food allergies, is protective against the development of peanut and other food allergies. Any conclusions from this, or other Agency research on food allergy, will be published on our website: www.food.gov.uk
But in the meantime, the advice is clear: while the evidence as to why food allergies develop in infants is still uncertain, parents should continue to follow current government recommendations – which is to aim to exclusively breastfeed to around 6 months of age and not introduce any of the common allergenic foods (e.g. egg, wheat, peanuts and other nuts, sesame seeds, fish and shellfish) before six months of age.
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BA Festival of Science
Allergy studies need to examine in detail and control for, not only parental history of allergy, but parental and infant pre- and early post-natal exposure to, and dose of, milk. All milks contains multiple antigens and antibodies (from the animal's diet and environment, as well as bovine/caprine allergens per se, plus allergens from oils, perhaps especially the new protein-microencapsulated algal and fungal oils - and other formula ingredients- corn, potato, etc. The tiny traces inevitable in industrial food manufacture, once declared harmless, may now need to be identified by high-tech testing, as the infant immune system has proved so sensitive even to traces of proteins - which is why peanut oil is no longer used in formula.) Equally, all alien milk ingested by mothers presents those antigens and antibodies to the infant in utero, and postpartum via breastmilk. In utero, maternal anti-antibodies are added, amplifying the exposure.
Milk (and its mode of feeding) is the best candidate for an evolutionary mechanism that sculpts the vulnerable infant for its environment. Milk presents the young mammal with everything in its environment in tiny doses along with multiple regulatory and protective factors that should, and once did, lead to tolerance or rejection as appropriate. Intergenerational damage from artificial feeding seems to me to be a plausible candidate for amplifying the harms done by inevitable gut dysbiosis and allergy through the generations. Cross-nursing studies reveal that how the juvenile is fed determines growth. Milk influences gene expression and maternal and infant physiological regulation.
We all begin in our grandmother's womb. Looking at one generation in one country out of context will be interesting but not conclusive. Historical and cross-cultural studies are needed, with an awareness of how class differences in infant feeding have altered, over the last century of the largest in vivo experiment in human history: mass infant deprivation of normal nutrition and nurture, and its substitution by a series of mixtures ever changing in response to the harms revealed by succeeding generations of babies. Since every country has a different experience both of artificial feeding (timing, type, groups affected etc) and use of milk by pregnant women, results of studies are likely to be confused and confusing. But careful studies are a beginning. It is indeed a pity that we will find no population of infants breastfed exclusively by mothers themselves breastfed exclusively by grandmothers themselves breastfed exclusively, all on good diets that did not include an excess of alien proteins.....But identifying what our study population actually is, and has been exposed to over time, might be a start.
Posted by Maureen Minchin on January 19, 2011 at 09:21 AM GMT #
We carry with us a legacy of the (ongoing) journey of discovery that attempts to discover how our bodies work. it is understandable. Our forefathers began with 'us' and set about finding out how we work and what we are made of. So we see ourselves as being made of component parts. Our anatomy is comprised of an assembly of organs and we see our organs as an assembly of cells. Essentially and understandably, we see our selves as the 'host'.
We ought (now) to know enough to turn this thinking upon its head. The evident successionality demonstrated by the progress of evolution of life ought to teach us that things began with the small and simple and advanced and diversified to the complex. The complex only made possible by small and simple.
Our cells hold the key to life. The small and simple have simply found it an agreeable strategy for survival to form 'unions' that extend their functionality and increase their chances of proliferation and survival. Nature of course shows considerable instances of competition and rivalry, the survival of the fittest, but humans have hitherto overlooked the examples and lessons of cooperation, co-dependency, mutuality and 'egalitarianism' that are also prevalent in nature.
If cells had a representative institution, the equivalent of our Trades Union Congress say, they might have issued a statement many tens of thousands of years ago to the effect that some of their members had formed unions that had assembled themselves in homo sapiens - and they were especially pleased with the outcome. Now I believe that there is dissent within the congress. Some cells now see homo sapiens as a disruptive influence on the whole congress or the total ecology.
To resolve the premise laid down in the opening paragraph let me propose that progress would come easier if humans altered their thinking. Perhaps we should see things as they really are, that is that our cells and organs are truly host to us. We should not consider our needs to the exclusion of theirs. Likewise those countless and diverse buddies who populate our gut are host to our colon. Theirs is a demographic that should be respected and preserved.
When we neglect the needs of the buddies and systems that sustain us consequence is evident. we should simply have stuck with food sources and diets that were known to work.
[The astute (likely not many) will spot that there is something in this for economists too. We are host to the economy that sustains us yet we arrived at an unsustainable situation where the economy appears as host to us. It'll end in tears.]
My own cells took particular exception to the union that is Dr Rosemary Leonard speaking on BBC Breakfast News this morning. Dr Leonard responded to a news item on statins and cholesterol. A report criticises the extent of their use and Dr Leonard defended their use. From an evolutionary perspective what possible justification could their be that 6m in the UK, one in ten of the population, need to be prescribed statins? There isn't one .. well, not one on health grounds. The justification is predominately an economic consideration to line the pockets of the directors and shareholders of the pharmaceuticals companies.
The union of Dr Leonards' cells have so much more potential.
If you ski, venture off piste occasionally; it enriches the experience. Likewise when you think. God Bless.
Posted by Chris on January 19, 2011 at 04:03 PM GMT #
As a mother with a 4 year old who has multiple severe food allergies (exclusively breastfed until 6 months as per the advice) and a 16 week old baby, it is frustrating there is currently not enough evidence to indicate whether I should change my approach this time. As a scientist I understand the process of collecting evidence, but blindly following guidelines based on limited and out-dated evidence may not prevent my child from having food allergies - and indeed, may actually contribute to their development. The research currently being performed (eg the EAT study - which I could not take part in for geographical reasons - we don't all live in the South East!) will not produce decent data for some time to come, and this will leave parents in limbo (and confused limbo at that) for a number of years. Theory is all very well when it isn't YOUR child. I wonder what Sue Hattersley would do in my situation?
On a different note it is a shame that this response to the article in question wasn't given as much press coverage as the article itself. I've heard too many Mums responding to the coverage of the article in the media with no real understanding of the article in question - how many of them will deviate from the government recommendations as a result of this?
Posted by R. Monk on February 23, 2011 at 02:15 PM GMT #
I'd just like to add that it would be great if this response was included in the Allergy and food intolerance page of the Eatwell website - then more parents would have access to it.
Posted by R Monk on February 23, 2011 at 02:28 PM GMT #
I understand that it must be very frustrating that we do not have enough evidence at this time to know how to reduce the risk of your infant developing food allergies.
Unfortunately the evidence in this area is very uncertain at the moment and there are different theories about the best action to take. This is why studies such as EAT have been funded by the Food Standards Agency. It is very important that any changes to Government advice are based on robust evidence, without this it may be premature, confusing and even harmful to make changes. We do not have any evidence that shows that current advice puts babies at more risk of developing food allergy.
This was highlighted when the Committee on Toxicity and Scientific Advisory Committee on Nutrition published their scientific opinion on the best time to introduce gluten into an infant diet, to reduce the chance of them developing coeliac disease and type 1 diabetes. They have concluded that the evidence in this area is not strong enough to make specific recommendations about exactly when gluten should be introduced into the infant diet beyond three completed months. As there is no evidence that the current advice puts infants at more risk of developing coeliac disease or type 1 diabetes, it has been agreed not to change the current Government advice.
So the current advice relating to both food allergy and coeliac disease risks is that mothers should exclusively breast feed their infant until around six months. Solid foods should be introduced when an infant is around six months old, alongside continued breastfeeding. If parent choose to introduce solid foods before six months, they should avoid foods that commonly cause food allergies, including gluten-containing foods.
A much wider Government review of existing recommendations on infant and young child feeding, which will include the appropriate age for the introduction of solids including all of the common allergenic foods, is now underway.
Posted by Sue Hattersley on March 11, 2011 at 10:44 AM GMT #