Childhood Food Allergy Prevention Q&A with Dr. Katie Marks-Cogan

 
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If you’re a dedicated Allergy Amulet follower, then you know we love to support individuals doing amazing things in the food allergy space! 

We recently had a chance to sit down with Dr. Katie Marks-Cogan, and our chat didn’t disappoint. She’s a board certified allergist, and the Chief Allergist for Ready, Set, Food! We asked Dr. Marks-Cogan a few questions about childhood food allergy prevention that we often receive from our followers. 

You asked, we listened!  

1.     Can you talk to us a bit about the latest research around food allergy prevention? What have researchers discovered? 

We’ve seen a surge in food allergy research in the past couple years. 

First, we know that food allergies are on the rise. There are nearly 6 million affected children in the U.S., which translates to 1 in 13 kids. According to an American Academy of Pediatrics (AAP) study, 42% of parents raising children with food allergies reported that their child had experienced at least one severe allergic reaction to their food allergen in their lifetime, and 19% reported that their child had a food allergy-related emergency room visit in the past year. Surprisingly, over 50% of children who suffer from food allergies have no family history of them. Accordingly, all children are at risk. 

Fortunately, recent landmark studies have shown that you can reduce your child's risk of developing a food allergy by up to 80% by feeding them allergenic foods early and consistently, starting when they are 4-11 months of age. 

For many years, experts thought that avoiding allergenic foods in the first year of life was the best way to prevent food allergies. Thanks to recent research, we know the opposite is true. Delaying the introduction of allergenic foods can actually increase a baby’s risk of specific food allergies. Therefore, it’s important for parents not to delay or avoid early introduction!

It’s common for parents to be nervous about introducing allergenic foods; however, in the three clinical trials that started early introduction as early as 4 months (and earlier) in over 2,000 babies, there were no cases of severe anaphylaxis or hospitalizations. 

2.    Will my child’s risk of developing food allergies be reduced if I eat common allergens while I’m pregnant or breastfeeding?

Great question, and one that I think a lot of moms are curious about. 

Breastfeeding provides a wealth of benefits for both mother and child, and mothers who breastfeed pass specific food proteins to their babies through breast milk. However, the impact of breastfeeding on food allergy prevention is still being studied. 

Currently, scientists don't have enough conclusive evidence to say that breastfeeding can help prevent food allergies, even when the mother eats common allergenic foods during pregnancy or lactation. Given this, the new national guidelines on infant food allergy prevention still recommend that families feed babies allergenic foods early and often, regardless of a mother’s diet while breastfeeding.  

3.    Is eczema a sign that my child will develop a food allergy? Would you recommend early introduction of allergenic foods for a child with eczema?

Research has shown that infants with atopic dermatitis, a form of eczema, are at the highest risk for developing food allergies. Up to 67% of infants with severe eczema and 25% of infants with mild eczema will develop a food allergy. Therefore, infants with eczema need early allergen introduction the most. That said, parents of infants with severe eczema should consult with their pediatrician prior to introducing any allergenic foods, as they may consider allergy testing first. 

4.    What is the best method for feeding my young child allergenic foods? When do I start, and how often do I feed them?

Scientists believe that a baby’s immune system begins to develop either a positive or negative response to food proteins at around 4-11 months. Introducing allergenic foods during this critical window of time helps train a baby’s immune system to develop a positive response, and thus helps reduce their risk of developing food allergies. That’s why the AAP, the National Institutes of Health (NIH), and other national health organizations recommend that allergen introduction start within this time frame.

Notably, introducing allergenic foods to your baby once or twice during this eight-month window is likely insufficient to reduce their food allergy risk. In the breakthrough clinical studies I mentioned earlier, infants were introduced to allergenic foods 2-7 times a week for 3-6 months or more. In the landmark LEAP study, children sustained exposure for a period of 4 years thereafter! It is therefore recommended that your baby ingest these allergenic foods multiple times a week for at least several months.

When you’re ready to introduce allergenic foods, pick a time when your baby is healthy, and make sure an adult can closely monitor the baby for at least 2 hours after ingestion in case of a reaction. Symptoms of an allergic reaction to a food can range from mild to severe, and typically occur within minutes of ingesting the food. Watch for hives, swelling, skin redness, coughing, vomiting, or shortness of breath. 

The American Academy of Pediatrics (AAP) also recommends introducing 1 new food every 3-5 days to help identify any foods triggering a reaction. In addition, families should start with small amounts of each common allergenic food before increasing to larger amounts. 

5.    Anything else our readers should know about early food allergy prevention?

Early and sustained allergen introduction is difficult at a young age. As a parent, I’ve experienced these challenges firsthand. When my son David was 5 months old, I prepared egg, peanut, and yogurt snacks for him to eat several times per week (peanut, egg, and milk represent over 80% of all childhood food allergies). Unfortunately, this process was time-consuming and frustrating. Most of what I offered ended up either on my kitchen floor or on David’s bib—not in his mouth. 

Motivated by my clinical and personal experience, along with a team of passionate physicians, leading experts, and parents, we set out to create a product that made early allergen introduction safe, simple, and effective. 

After over a year of research and development, we’re proud to offer families everywhere a gentle, guided system that can help reduce your baby’s risk of developing peanut, egg, and milk allergies by up to 80% with Ready, Set, Food!

 

Dr. Marks-Cogan is board certified in allergy/immunology and internal medicine, and treats both pediatric and adult patients. She received her M.D. with honors from the University of Maryland School of Medicine, completed her residency in internal medicine at Northwestern, and completed her fellowship in allergy/immunology at the University of Pennsylvania and Children's Hospital of Pennsylvania (CHOP). Dr. Marks-Cogan lives in southern California and works in private practice. She is the Chief Allergist for Ready, Set, Food! In her free time she enjoys hiking, building LEGO castles with her kids (3 and 11 months), and cooking with her family.