Changes to infant feeding guidelines. "Hypoallergenic formulas are a waste of time and peanuts and eggs to be introduced earlier."

Parents who turn to special cow or soy milk formulas to help lower the risk of asthma or allergies in their babies are wasting their time new research has suggested.

With allergies and autoimmune conditions rising throughout the world the popularity of hydrolysed formulas (usually labelled HA or hypoallergenic) has increased but a study out of the UK and endorsed by the Australasian Society of Clinical Immunology and Allergy has shown that  there is no evidence to suggest these expensive formulas lower the incidence of allergies or auto immune conditions.

A paper in the British Medical Journal by the Imperial College London found no consistent proof that hydrolysed milk formula can deliver the touted benefits.

“Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease,” wrote the study authors.

The team conducted a review and meta-analysis of 37 intervention trials that included more than 19,000 individuals from 1946 to 2015. The trials compared hydrolysed milk formula with natural human breast milk and standard cows’ milk formula, and reported on relevant conditions such as asthma, eczema, food allergy and type 1 diabetes.

They said, "We found no consistent evidence to support a protective role for partially or extensively hydrolysed formula."

The findings have promoted new advice issued for parents on infant feeding and guidelines for allergy prevention by the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak body for allergy and critical immunology in Australia.

They have updated their guidelines recommending that hyper-allergic formulas don’t work for the prevention of any allergic disease as well as encouraging new mothers to increase their consumption of oily fish.

“Where we once suggested that partially hydrolysed infant formulas may provide some benefit, the combined weight of evidence no longer supports this.” Professor Dianne Campbell, Chair of the ASCIA Paediatric Committee told The Motherish.

The peak body have also changed recommendations around the introduction of egg and peanuts.

With to two in five children in Australia and New Zealand affected by allergic disorders and hospital admissions for severe allergic reactions (anaphylaxis) in children increasing five-fold over the last decade it’s an issue that touches us all.

Prof Campbell told The Motherish that the reason for the continued rise in allergic diseases in developed countries is complex and research in this area is ongoing.

“Although children with a family history of allergy are at higher risk many children with no family history also develop allergies. Therefore, these guidelines are relevant for all families.”

ASCIA's Infant Feeding Advice and Guidelines for Allergy Prevention in Infants were last updated in 2010.

Prof Campbell says that the new guidelines are valid for all families. ASCIA recommend infants are introduced to solids between the ages of four months and six months irrespective of whether they are considered “allergenic.” ASCIA also recommends breastfeeding for at least 6 months.

The four big changes are:

1.  The recognition that there is no consistent, convincing evidence to support that hydrolysed formulas (usually labelled HA or hypoallergenic) assists in allergy prevention in infants or children.
2.  Recommendations that women consume up to three serves of oily fish per week during pregnancy and breastfeeding. They say this may be beneficial in preventing eczema in early life.
3.  Changes to peanut recommendations. They say “there is evidence that for infants at high risk of food allergies, such as those with severe eczema or who already had a food allergy reaction to egg, introduction of regular peanut before 12 months of age can reduce a subsequent peanut allergy."
4. Changes to egg recommendations. There is now a recommendation for the introduction of cooked egg into the diet of infants, especially those with a family history of allergy, before eight months of age to try and reduced the risk of egg allergy.

Researchers are still trying to establish just why food allergies are on the increase with theories ranging from the hygiene hypothesis, studies on the changes in microbiome- a complex set of microogransisms which colonise the human body and thoughts around the delayed compared to earlier introduction of allergenic foods (e.g. egg, peanut, tree nuts) where introduction later in life might reduce the development, as well as other theories around methods of food processing and vitamin D deficiency.

It’s a mind-boggling time for parents who often feel conflicted about differing advice. Prof Campbell says it’s incredibly confusing.

“Feeding is such a personal and emotional thing. Parents have so many different people telling them what they should and should not do. It’s very hard, that’s why we try and write documents specifically for parents. “

She says that parents shouldn’t worry though if they haven’t followed their guidelines yet.

“There is not like there is a magic time, like you have to do it by eight months and three days. It’s a continuum. If you go to 12 months and you haven’t already introduced egg and there is no reason to suspect otherwise that your baby is going to be egg allergic then introduce it now. It’s still going to be better than waiting till they are three.”

For more information visit the ASCIA webpage.