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Guidelines for how to prevent food allergies in children are changing. Until very recently, it was avoid, avoid, avoid exposing babies or young children to any potential allergens. Remember parents being advised that if an allergy to X (whether pets or food) runs in the family, then absolutely avoid exposing the child to the potential allergen? Well, recent research (herehere, and here) found that the opposite is true - that in the first year of life the baby should be exposed to potential allergens (whether animals or food) which stimulates the child's developing immune system in beneficial ways.

Physicians at a recent conference of allergists said that evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life. The new 2017 medical guidelines will recommend introducing small amounts of peanuts (mixed in with other foods), when children are 4 to 6 months of age..

About two years ago a landmark study (LEAP study) found that when infants at a high risk of developing peanut allergy consumed peanuts on a regular basis, their risk of peanut allergy was dramatically reduced. And the opposite was also true: peanut avoidance in the first year of life was associated with a greater frequency of peanut allergy. Which made doctors start to rethink their strategies of how to avoid food allergies. From Medscape:

Allergenic Foods Should Be Introduced to Infants Early

Although the evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life, guidelines are lagging behind, said an allergist speaking here at the American College of Allergy, Asthma & Immunology (ACAAI) 2016 Annual Scientific Meeting. Official guidelines to be issued early in 2017 will address only peanuts, recommending introduction when children are 4 to 6 months of age.

"There is now a large body of observation and trial data for other foods, including egg, that show that delaying the introduction of allergenic solids increases the risk of those particular food allergies," said Katrina Allen, MBBS, PhD, from the Murdoch Childrens Research Institute in Melbourne, Australia. Policy changes are needed to help guide parents' decisions, she said. In fact, there is evidence showing that changes to policy — namely, infant-feeding guidelines — mirror the rise in the incidence of food allergies.

Not everyone agrees on exposure amount and timing in the case of egg allergy. In a recent trial, researchers looked at the early introduction of allergenic foods in breast-fed children (N Engl J Med. 2016;374:1733-1743). The prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group, as was the prevalence of peanut allergy and egg allergy. And a study Dr Allen was involved in, which introduced cooked egg in small amounts, showed that early introduction reduced allergy (J Allergy Clin Immunol. 2010;126:807-813).

However, in a German study, where greater amounts of egg were introduced at 4 to 6 months, early exposure increased the risk for life-threatening allergic reactions (J Allergy Clin Immunol. Published online August 12, 2016). And in the STEP study, there was no change in the number of food allergies in 1-year-old children when egg was introduced early (J Allergy Clin Immunol. Published online August 20, 2016). However, that did not take into account high-risk infants, particularly those with eczema, who are known to have a higher incidence of egg allergy and are likely to see a much greater benefit from the early introduction of egg.

The new peanut guidelines — coauthored by Amal Assa'ad, MD, from the Cincinnati Children's Hospital, who is chair of the ACAAI food allergy committee — will recommend that children with no eczema or egg allergy can be introduced to peanut-containing foods at home, according to the family's preference. And for children with mild to moderate eczema who have already started solid foods, the guidelines say that peanut-containing foods can be introduced at home at around 6 months of age, without the need for an evaluation. However, the guidelines caution, peanut-containing foods should not be the first solid food an infant tries, and an introduction should be made only when the child is healthy. The first feeding should not happen when the child has a cold, is vomiting, or has diarrhea or another illness.

For eggs, there is no official recommendation as of yet....The early introduction of allergenic foods is not the only policy that needs to be changed to lower the incidence of food allergies, Dr Allen told Medscape Medical News. Other factors, particularly environmental factors — mostly written up in observational studies — are contributing to an increasing intolerance to allergenic foods. Policies advocating that kids "get down and dirty," have more exposure to dogs, and bathe less are also warranted....Dr Allen and Dr Assa'ad agree that delaying the introduction of foods such cow's milk and egg until after 12 months is harmful. Guidelines should encourage families to introduce these foods in the first year of life, once solids have commenced at around 6 months, but not before 4 months.

Yikes! Another study showing effects from antibiotic use - this time a higher incidence of food allergies in children who took antibiotics in the first year of life. Especially multiple courses of antibiotics, with the strongest association among children receiving cephalosporin and sulfonamide antibiotics. Antibiotics can be life-saving, but there can also be unintended consequences.

As the researchers wrote: "Changes in the composition, richness, and abundance of microbiota that colonize the human gut during infancy has been theorized to play a role in development in atopic disease, including food allergen sensitization. " And what changes the gut microbes? Antibiotics. Other research suggests that alterations in microbes due to childhood antibiotic use may increase the risk of Crohn's disease, obesity, and asthma. From Science Daily:

Young children's antibiotic exposure associated with higher food allergy risk

Antibiotic treatment within the first year of life may wipe out more than an unwanted infection: exposure to the drugs is associated with an increase in food allergy diagnosis, new research from the University of South Carolina suggests.

Analyzing South Carolina Medicaid administrative data from 2007 to 2009, researchers from the College of Pharmacy, School of Medicine and Arnold School of Public Health identified 1,504 cases of children with food allergies and 5,995 controls without food allergies, adjusting for birth month and year, sex and race/ethnicity. Applying conditional logistic regression and adjusting for factors including birth, breastfeeding, asthma, eczema, maternal age and urban residence, the researchers found that children prescribed antibiotics within the first year of life were 1.21 times more likely to be diagnosed with food allergy than children who hadn't received an antibiotic prescription.

The association between antibiotic prescription and development of food allergy was statistically significant, and the odds of a food allergy diagnosis increased with the number of antibiotic prescriptions a child received, growing from 1.31 times greater risk with three prescriptions to 1.43 times with four prescriptions and 1.64 times with five or more prescriptions. The interdisciplinary research team, led by Bryan Love, Pharm.D., found the strongest association between children who were prescribed cephalosporin and sulfonamide antibiotics, which are broad-spectrum therapies (adjusted OR 1.50 and 1.54, respectively), compared with narrower spectrum agents such as penicillins and macrolides. .

This research builds upon previous studies finding that normal gut flora is critical for developing the body's tolerance to foreign proteins such as food. Antibiotics are known to alter the composition of gut flora, and U.S. children ages three months to three years are prescribed 2.2 antimicrobial prescriptions per year on average, according to the literature. The study's results suggest a potential link between the rise in antibiotic prescriptions for young children and the rise in diagnosis of food allergies in children.

If taking Clostridia as a probiotic for food allergies works, it would be amazing for food allergy sufferers. Very exciting research. From Time:

The Bacteria That May One Day Cure Food Allergies

Every round of antibiotics a person takes will wipe out strains of bacteria inside the body, some of which are eliminated forever. Considering how early and how often antibiotics are administered to kids—coupled with our increasingly antimicrobial lifestyles—we’ve become more prone to allergies and other ailments, the hygiene hypothesis goes. There’s no cure for food allergies, just lifestyle adjustments and abstention. But Nagler and her team may have the germ of an idea for treatment using gut bacteria, according to a new mice study published in the Proceedings of the National Academy of Sciences.

The team dosed two groups of mice with peanut allergens. One group of mice had been bred to be entirely without gut germs; the other group had sparsely populated gut bacteria due to treatment with antibiotics. Both groups of mice had higher levels of the allergen in their bloodstream compared to mice with healthy gut-bacteria populations.

After giving those same mice a mix that contained the bacteria strain Clostridia, their allergen levels plummeted. Infusing the mice with another group of intestinal bacteria, Bacteroides, didn’t help—so the researchers think the effect is special to Clostridia. “These bacteria are very abundant and they reside very close to the epithelial lining, so they’re in intimate contact with the immune system,” Nagler says.

Next, they’ll transfer gut bacteria from food-allergic infants and healthy infants into germ-free mice, Nagler says. “If we give back Clostridia to a mouse that has the bacteria of an allergic child, can we now reverse susceptibility in that mouse?”

This is a more in-depth article of the research. From Science Daily:

Gut bacteria that protect against food allergies identified

The presence of Clostridia, a common class of gut bacteria, protects against food allergies, a new study in mice finds. The discovery points toward probiotic therapies for this so-far untreatable condition. Food allergies affect 15 million Americans, including one in 13 children, who live with this potentially life-threatening disease that currently has no cure, researchers note.

Although the causes of food allergy -- a sometimes deadly immune response to certain foods -- are unknown, studies have hinted that modern hygienic or dietary practices may play a role by disturbing the body's natural bacterial composition. In recent years, food allergy rates among children have risen sharply -- increasing approximately 50 percent between 1997 and 2011 -- and studies have shown a correlation to antibiotic and antimicrobial use.

"Environmental stimuli such as antibiotic overuse, high fat diets, caesarean birth, removal of common pathogens and even formula feeding have affected the microbiota with which we've co-evolved," said study senior author Cathryn Nagler, PhD, Bunning Food Allergy Professor at the University of Chicago. "Our results suggest this could contribute to the increasing susceptibility to food allergies."

To test how gut bacteria affect food allergies, Nagler and her team investigated the response to food allergens in mice. ...This sensitization to food allergens could be reversed, however, by reintroducing a mix of Clostridia bacteria back into the mice. Reintroduction of another major group of intestinal bacteria, Bacteroides, failed to alleviate sensitization, indicating that Clostridia have a unique, protective role against food allergens.

To identify this protective mechanism, Nagler and her team studied cellular and molecular immune responses to bacteria in the gut. Genetic analysis revealed that Clostridia caused innate immune cells to produce high levels of interleukin-22 (IL-22), a signaling molecule known to decrease the permeability of the intestinal lining.

While complex and largely undetermined factors such as genetics greatly affect whether individuals develop food allergies and how they manifest, the identification of a bacteria-induced barrier-protective response represents a new paradigm for preventing sensitization to food. Clostridia bacteria are common in humans and represent a clear target for potential therapeutics that prevent or treat food allergies.