Advice for midwives and health visitors

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.

Following a major review of the scientific evidence surrounding maternal and infant consumption/avoidance of peanut and the early life risks of developing peanut allergy, the UK Government has revised its advice to consumers - 25.08.09.

The revised advice, issued jointly by the Foods Standards Agency and Department of Health, is summarised below:

• During Pregnancy and whilst breastfeeding: The revised advice states that if mothers would like to eat peanuts or foods containing peanuts during pregnancy or breastfeeding, then they can choose to do so as part of a healthy balanced diet, irrespective of whether their child has a family history of allergies.

• When introducing peanut into a child's diet: General advice is that all mothers should try to exclusively breastfeed their baby for the first 6 months of life. The revised advice states that if mothers choose to start giving their baby solid foods before 6 months of age, they should not introduce peanuts or other allergenic foods (such as other nuts, seeds, milk, eggs, wheat, fish or shellfish) before this time, and when they do, these foods should be introduced one at a time so that they can spot any allergic reaction.

The revised advice additionally advises that where a child already has another kind of allergy (e.g. diagnosed eczema or a diagnosed allergy to foods other than peanut), or if there is a history of allergy in the child's immediate family (parents, siblings), then mothers should talk to their GP, health visitor or medical allergy specialist before giving peanut to the child for the first time, because these children are at higher risk of developing peanut allergy.

The full text of the revised advice, which was trialled with Health Professionals and Consumers from across the UK prior to issue, is available on the Food Standards Agency's website

www.food.gov.uk/safereating/allergyintol/peanutspregnancy

The revised advice is also being included within general advice given to mothers about pregnancy and development of their baby, such as the 'Pregnancy' and 'Birth to Five' books that have recently been revised and re-launched in England, and via appropriate dissemination routes in Scotland, Wales and Northern Ireland.

The Food Standards Agency has an active research programme on food allergy and intolerance and research into the determinants of peanut sensitisation (the precursor to peanut allergy) and peanut allergy is currently ongoing.

Alternatives to milk for infants with milk allergy

The Chief Medical Officer has advised that soya-based infant formulas should not be used as the first choice for the management of infants with proven cow’s milk sensitivity or lactose intolerance.

Soya-based formulas have a high phytoestrogen content, which could pose a risk to the long-term reproductive health of infants, according to a 2003 report from the Committee on Toxicity (COT).

Furthermore, the Scientific Advisory Committee on Nutrition (SACN), another independent advisory body, has advised that there is no unique clinical condition that particularly requires the use of soya-based infant formulas. 

There is also concern that the early use of soy formula in milk allergic infants might not only increase the chance of allergy to soy but also peanut.

Goat's milk and sheep's milk are usually not suitable alternatives to cow's milk as they share similar proteins with cow's milk that could result in cross-reactivity.

As an alternative, health professionals often recommend special hydrolysed formulas, which are made from cow's milk that is treated to change the proteins.

These include Nutramigen or Pregestimil (which are casein based) and Cow and Gate Pepti or Pepti Junior (which are whey based).

A few milk allergic children react to these and need an elemental formula called Neocate. These milk substitutes are obtained from a pharmacy on prescription. 

It would be sensible to have the diagnosis of the allergy confirmed by an allergy clinic and advice obtained from a dietician on the use of alternative formulas.