Introducing Wheat in the Infant

In today's world parents are very concerned about food allergies. Perhaps we have become a more allergic society because of all the refinement and processing that goes into making a food product or perhaps it is because many foods are genetically modified and contain high levels of pesticides. What ever the reason, to reduce allergies many parents will introduce foods slowly to their infants, often one at a time to observe for any possible allergy to the food.

What exactly is a food allergy in an infant? Food allergies can manifest in many ways and degrees of severity. The most commonly known food allergies are peanuts and strawberries. In cases of a peanut allergy, the child can have a reaction so severe that the airway begins to close off and a visit to the ER is warranted. Other less severe food allergies can also be referred to as food sensitivities. These may manifest as a skin rash or eczema, increased mucous in the stool, or low immune function. These food sensitivities may exist without a parent knowing, or sometimes parents suspect a food allergy/sensitivity when one truely does not exist.

Thoughts around food introduction have changed drastically in the last 2 decades. Now many parents are so concerned about the development of allergies that they delay introduction to 6 months in most cases, some parents are going to extremes and waiting until 12 months. Usually less allergenic foods are first introduced such as fruits and vegetables, then more allergenic grains and animal proteins are next. Does this method of thinking truely work, or is it creating a headache for the family and denying important nutrients for the child?

A study published this month in the journal Pediatrics investigated the incidence of wheat allergy in more than 1600 children who were followed from birth to kindergarten. Parents completed dietary questionaires at 3,6,9 and 12 months of age to determine the timing of wheat introduction as well as recorded parents reports of allergy.

After the first year there were 16 reported cases of wheat allergy. Of those, 4 had been exposed to wheat before age 6 months, and 12 had been exposed after 6 months of age. Only four of the sixteen children had a documented wheat allergy based on blood tests, all of whom had wheat introduced after 6 months of age.

Based on these results the authors stated that the best time to introduce wheat was between 4 and 6 months of age, and waiting until after 6 months may increase the risk. These results are similar to a study released in 2005 that was published in the Journal of American Medical Association that found children with a family history of Celiac disease are best served to introduce gluten containing foods between 4 and 6 months of age.

The JAMA study also found that early introduction before 4 months of age had the greatest risk for development of a wheat allergy specific to that found in Celiac disease. This year's study was unable to draw any conclusions about introduction before 4 months of age due to low number of children with a reported allergy in that introduction group.

So as it stands the best time to introduce wheat and gluten containing grains may be between 4 and 6 months of age. However, each person has individual susceptibilities and discussing food introduction with your healthcare provider may be the best avenue to take.

References

1. Norris JM et al. "Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of the disease." JAMA, 2005 May, 293(19): 2343-2351.

2. Poole JA et al. " Timing of initial exposure to cereal grains and the risk of wheat allergy." Pediatrics, 2006 June, 117(6): 2175-2182.