5 things expecting parents should be told regarding asthma, food allergies
HOUSTON — Women who are pregnant, and their spouses, or those who have recently become new parents, are likely to have many questions about asthma and food allergy, according to a panel at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.
“Almost daily, as my office visits with patients are winding down, the mother will say ‘I’m pregnant again,’” Angela D. Hogan, MD, FACAAI, a pediatric allergist with Children's Hospital of The King's Daughters in Norfolk, Virginia, and panel moderator, told attendees. “These patients go on to say ‘Is there anything you can tell me very quickly that might be helpful ... for the baby I am carrying?’”
“This [presentation] will have a lot of practical information that will be helpful in your day- to-day practice,” she added.
Some of those clinical pearls that the panel provided follow.
Pregnant women who ingest vitamin D supplementation of 600 IU or higher may prevent asthma and wheeze in offspring.
That particular dosage is higher than the Institute of Medicine recommendation for vitamin D intake in pregnant women, Carina Venter, PhD, RD, an assistant professor of pediatrics at Children’s Hospital Colorado and University of Colorado Denver School of Medicine, told attendees.
When it comes to infant vitamin D intake, more is not necessarily always better.
Infants who began consuming 30 g (1,200 IU) of vitamin D daily at age 2 weeks were no more sensitive to wheeze and allergy sensitization at 12 months than a different cohort of infants who began consuming 10 g (400 IU) daily and also reviewed for wheeze and sensitization at 12 months, according to Venter.
But those infants who ingested the higher amounts of vitamin D were more susceptible to cow’s milk allergy, Venter continued. “Just because something is good doesn’t mean giving a lot of it is even better,” she added.
Mandatory routine skin or specific IgE blood testing before a potential allergen is consumed for the first time is not recommended.
“There is a high risk of confusing, false-positive results in these instances,” said Edmond S. Chan, MD, FACAAI, a clinical associate professor at the University of British Columbia in Canada and head of the allergy clinic within the department of pediatrics at British Columbia Children's Hospital. “There is also typically a long waiting list for skin testing and for infant food challenges.”
Timing may be critical to determining food allergens in infants.
“Introduce infants to a variety of healthy, diverse foods, including all major allergens, starting around 6 months of age but not before 4 months of age, and within the first year of life,” to start the process of determining their food allergens, David Fleischer, MD, FACAAI, associate professor of pediatrics and director, Allergy and Immunology Center at Children's Hospital Colorado, told attendees.
He added that there is moderate evidence to suggest introducing peanut before they turn 1 year old could decrease the infant’s risk for peanut allergy as they grow older.
Be practical when testing for food allergy.
According to Chan, some of these practicalities include choosing nonchoking forms of each food; avoiding rubbing the food on the skin as a test as it is more susceptible to false-positive; feeding a fingernail-sized amount during first exposure, waiting a half hour and if no reaction then feed more; and introducing one food at a time, but not unnecessary delaying between different foods. – by Janel Miller
Chan ES. Let the babies eat: How to discuss introduction of foods with parents.
Fleischer D. Prevention of allergic conditions: What conversations to have with expecting parents.
Varina C. Probiotics, prebiotics, vitamin D and fish oil supplements: How to combat misinformation surrounding allergy prevention.
All presented at: American College of Allergy, Asthma and Immunology Annual Scientific Meeting; Nov. 7-11, 2019; Houston.
Disclosures: Chan reports receiving grants and research support from AllerGen, BCCH Foundation, CIHR, DBV Technologies; receiving speakers bureau, honoraria and consulting fees from Kaleo, Leo Pharma, Pediapharm and Pfizer; serving on the expert panel for the National Institute of Allergy & Infectious Diseases early peanut introduction addendum guidelines; serving on the committee for the American Gastroenterological Association & American Academy of Allergy, Asthma and Immunology/ACAAI Joint Task Force guidelines for management of eosinophilic esophagitis; and membership in several other allergy associations. Venter reports consulting for Abbott, DBV Technologies, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition; and speaking and teaching responsibilities for Lil Mixins and Nutricia. Healio Primary Care was unable to determine Fleischer and Venter’s relevant financial disclosures prior to publication.