I looked up the recent pediatrics article on wheat allergy and the timing of 
introduction of solids. Interesting article, but not strong enough evidence 
(in my humble opinion) to change anything you're doing. Here are the main 
points:
- Breastfeeding was only looked at in 2 ways - overall duration (including 
partial) and whether the child was still breastfed when first introduced to 
cereal grains. they did not include duration of exclusive breastfeeding, 
although the data set that they mined the paper from was used previously by 
the same authors to show that breastfeeding did protect against development 
of autoimmunity.
- The study is interesting because the cohort was chosen based on high risk 
for celiac disease and type 1 diabetes (one first-degree relative w/ the 
disease or having HLA genotype). This is not a neutral group to do 
allergy-risk assesment with.
- The numbers with true wheat allergy were very low - only 16 individuals 
out of 1612 in the study. Children diagnosed with celiac disease were 
excluded, as this is not considered true wheat allergy. Only 4 were 
confirmed by a physician to have true wheat allergy.
- of the 4 with diagnosed wheat allergy, 3 reported earlier formula allergy 
(hmmm, now I think we're getting somewhere...)
- Family history of allergy and having another food allergy before 6 months 
(i.e., formula or cow's milk) was predictive of a wheat allergy
- interesting finding: longer overall breastfeeding duration was correlated 
with wheat allergy (but no data on duration of exclusivity was presented)
- The comparison was made between cereal grain introduction at 4-6 months 
vs. after 7 months. I don't know what happened to those introducing grains 
in the 6th month.

Of note: cereal grains do not include rice, so this is introduction of other 
grain cereals (all of which tend to cross-react in terms of allergies - 
wheat, oats, rye, barley)

Odds ratios:
OR for being older than 7 mos at introduction was 3.8, for each 1 month 
increase in bf duration was 1.05, for other food allergy before 6 mos was 
7.6, for family history was 3.9.

I think we need to query the authors about the age of introduction of 
formula and have them run their numbers again. Without that information, I'm 
not sure how much it shows, especially given the population examined.

However, it did steer me in the direction of the AAP committee on nutrition, 
which is recommending introduction of solid foods before 6 months. the 
conclusion states that they did not find a protective effect of 
breastfeeding - although it had been found before by Friedman and Zeiger 
(2005) that exclusive bf did have a protective effect in families with a 
history of food allergies.

So, that concludes our journal club for today. Any questions? I think the 
jury is still out on the age of introduction of solids.

Kirsten Berggren, PhD, CLC
feeling like I'm back in grad school... 

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