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Work Under Way

Question

What is the relationship between complementary feeding and food allergies and atopic allergic diseases?

Approach to Answering the Question
Existing NESR Systematic Review

Subcommittee
Birth to 24 Months Subcommittee

Existing Systematic Review Protocol
Developed for each scientific question being examined, the protocol describes the plan for how the systematic review will be conducted. For this question, the existing NESR systematic reviews were conducted during the Pregnancy and Birth to 24 Months Project, and captured evidence published from January 1980 to February 2017. The Complementary Feeding Technical Expert Collaborative conducted the systematic reviews in collaboration with staff from USDA’s Nutrition Evidence Systematic Review (NESR). Complete documentation of the existing systematic reviews and the related publication in the American Journal of Clinical Nutrition is available on the NESR website:

For additional details, see the full protocol for the question, what is the relationship between complementary feeding and food allergies and atopic allergic diseases?

View Full Protocol

Draft Conclusion Statement

The draft conclusion statements listed below describe the state of the science related to the specific question examined. Draft conclusions are not considered final until they have been deliberated with and decided upon by the full Committee and published in the Committee’s final advisory report. Individual conclusion statements should not be interpreted as dietary guidance or the Committee’s overarching advice to the Departments. 

Timing of Introduction of Complementary Foods or Beverages

Moderate evidence suggests that there is no relationship between the age at which complementary feeding first begins and risk of developing food allergy, atopic dermatitis/eczema, or asthma during childhood. Grade: Moderate

There is insufficient evidence to determine the relationship between the age at which complementary foods or beverages are first introduced and risk of developing allergic rhinitis during childhood. Grade: Grade Not Assignable

Types and Amounts of Complementary Foods or Beverages

Peanut, tree nuts, seeds

Strong evidence suggests that introducing peanut in the first year of life (after 4 months of age) may reduce risk of food allergy to peanuts. This evidence is strongest for introducing peanut in infants at the highest risk (with severe atopic dermatitis and/or egg allergy) to prevent peanut allergy, but is also applicable to infants at lower risk. However, the evidence for tree nuts and sesame seeds is limited. Limited evidence also suggests that there is no relationship between consumption of peanut, tree nuts, or sesame seeds during the complementary feeding period and risk of atopic dermatitis/eczema and asthma. There is not enough evidence to determine the relationship between consuming peanut, tree nuts, or seeds as complementary foods and allergic rhinitis. Grade: Strong (peanuts), Limited (tree nuts or seeds)

Egg

Moderate evidence suggests that introducing egg in the first year of life (after 4 months of age) may reduce risk of food allergy to egg. Limited evidence suggests that there is no relationship between the age of introduction to egg and risk of atopic dermatitis/eczema and asthma. There is not enough evidence to determine if there is a relationship between consuming egg as a complementary food and allergic rhinitis. Grade: Moderate

Fish

Limited evidence suggests that introducing fish in the first year of life (after 4 months of age) may reduce risk of atopic dermatitis/eczema. There is not enough evidence to determine if there is a relationship between consuming fish as a complementary food and risk of allergy to fish or other foods, asthma, or allergic rhinitis. There is also not enough evidence to determine if there is a relationship between consuming shellfish as a complementary food and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis. Grade: Limited

Cow milk products

Limited evidence suggests there is no relationship between age of introduction of cow’s milk products, such as cheese and yogurt, and risk of food allergy and atopic dermatitis/eczema. There is not enough evidence to determine if there is a relationship between consuming milk products during the complementary feeding period and risk of asthma or allergic rhinitis. Grade: Limited

Other foods

Wheat: There is not enough evidence to determine if there is a relationship between wheat consumption during the complementary feeding period and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis. Grade: Grade Not Assignable

Soy: There is not enough evidence to determine if there is a relationship between soybean consumption during the complementary feeding period and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis. Grade: Grade Not Assignable

Foods and beverages that are not common allergens: Limited evidence from observational studies suggests that introducing foods not commonly considered to be allergens, such as fruits, vegetables, and meat, in the first year of life (after 4 months of age) is not associated with risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis. Grade: Limited

Diet diversity and dietary patterns: There is not enough evidence to determine a relationship between diet diversity or dietary patterns and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis. Grade: Grade Not Assignable