New guidelines help stem tide of severe allergies in Australian children, study finds | children’s health


The rising rate of Australian children being admitted to hospital with severe food allergies has leveled off since infant feeding guidelines were changed, new research shows.

The rate of hospitalization for food anaphylaxis has risen in Australia in recent decades – but data suggests changes to allergy prevention and infant feeding guidelines in 2008 and 2016 helped stem the rise the number of young children and adolescents.

In 2008 the Australasian Society of Clinical Immunology and Allergy guidelines were amended to recommend that allergenic solid foods should no longer be delayed, and in 2016 they were again updated to suggest that such foods should be introduced during the first year of life.

Study co-author Professor Mimi Tang, an immunologist at the Murdoch Children’s Research Institute, said the biggest benefit of the updated guidelines was for children aged one to four.

In this age group, researchers found that the annual rate of increase in anaphylaxis admissions fell from 17.6% between 1999 and 2007 to 6.2% between 2008 and 2015, and 3.9% after 2016.

During the first two periods, the annual rate of increase among children aged five to nine fell from 22% to 13.9%, and after 2016 the rate of increase was -2.4%.

For 10 to 14 year olds, the annual growth rate fell from 18.0% between 2008 and 2015 to 10.8% after 2016.

Tang said there have been significant changes in allergy prevention advice over the past 15 years. “Before 2008, all food allergy prevention guidelines around the world recommended delaying the introduction of allergenic foods such as eggs, milk, and peanuts until age two to four, according to the food,” she said. .

“The reason these recommendations were in place was based on theoretical concerns that the gut barrier might not be as strong in young babies.”

But a growing body of evidence has shown that delaying allergenic foods is associated with an increased risk of developing food allergies.

In 2015, a randomized controlled trial published in the New England Journal of Medicine found that introducing peanuts to the diet between four and 11 months of age significantly reduced the risk of developing a peanut allergy by age five.

This research “provided the highest-level evidence for the first time that early introduction could prevent food allergies,” Tang said. “Subsequently, other studies showed similar results for egg and milk allergies.”

In the new study published in the Journal of Allergy and Clinical Immunology, Tang and his colleagues noted a continued increase in hospitalization rates for anaphylaxis among adolescents aged 15 and older at the time the research was completed. People in this age group were born before the 2008 changes to Australian guidelines.

“In fact, we only saw a flattening of rates among children who could have benefited from the timing of these updates,” Tang said.

There was, however, an acceleration in the rate of year-on-year increase for children aged one and under.

“Children with food allergies usually react when they eat the food for the first time,” Tang said. The finding in infants suggests “that first exposure occurs in the first year of life rather than beyond,” she said.

“But if you look at the zero-to-four-year-olds, in that cohort, overall, the rates flatten out. So whatever flattening occurs in one- to four-year-olds is greater than the increase in under-ones,” she said.

Overall, annual admission rates for food anaphylaxis in children and adolescents increased ninefold in Australia between 1999 and 2019.

“There are a lot of things in the environment that can contribute to the rise in food allergies,” Tang said. These factors potentially include a change in diet and exposure to a narrower range of microbes.


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