Key messages for midwives and health visitors

Revised May 2006

There has been much speculation that babies in families prone to allergies may become sensitised while they are in the womb, or through their mother’s breast milk. The Department of Health issued guidelines to women in 1998, suggesting that they “may wish” to avoid nuts and peanuts during pregnancy and while breastfeeding if there is allergy in the immediate family (i.e. if they or their partners are allergic, or if they have an allergic child, e.g. with asthma, eczema, hay fever or food allergy). The guidelines also state that peanuts and tree nuts should not be introduced to children until after three years of age.

Research in this field is incomplete. No studies have yet shown conclusively that avoiding dietary allergens during pregnancy and lactation reduces the incidence of allergic disease in children. However, the Government guidelines relating to peanuts and tree nuts still stand and therefore should not be ignored.

Other allergens such as dairy products, eggs, sesame, wheat and fish also remain open to debate. Two leading experts, Prof John Warner and Kate Grimshaw, stated in 2005 that no pregnancy or lactation advice should be given to families. Whilst acknowledging that the Government advice relating to peanuts and tree nuts should be followed, they could find no evidence that slow introduction of weaning foods made any difference to subsequent allergy.

Reference: Strategies for Preventing Allergic Disease, Kate Grimshaw and John Warner, Current Paediatrics (2005) 12, 221-227.

Nevertheless there is some sound advice that can be given to mothers if there is allergy in their immediate family:

Avoid smoking during the pregnancy or afterwards, and avoid exposing your baby to cigarette smoke.

While pregnant and breastfeeding, eat a healthy balanced maternal diet with sufficient portions of fresh fruit, vegetables and n-3 fatty acids. Going on a diet is not advised.

Exclusively breastfeed for at least four months (preferably six).

If breastfeeding is not possible, an extensively hydrolysed casein formula should be given until the age of six months.

Avoid exposure to high levels of house dust mite. A high-efficiency vacuum cleaner with filter is important. Reduce other environmental allergens, such as moulds, cat and dog hair, and bird feathers. Keep the humidity levels down. Consider doing away with carpets, and using blinds instead of curtains.

Introduce one food group at a time e.g. dairy products (milk, yoghurt, cheese) and wait five days before introducing a new food, e.g. wheat (bread, pasta, cereal). Keeping a food/symptom diary during this period may well be useful to identify allergic symptoms.

The above points were approved by John Warner, Professor of Child Health at the University of Southampton.

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