Dietary prevention of allergic diseases in infants and small children

Abstract

The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer-reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used.

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas

“…The study has been criticized for retrospective determination of breastfeeding and unclear definitions of atopic heredity. 22 There was also no evidence of a "dose-response" effect of breastfeeding on the incidence of atopy or asthma.…”

“…21 Consideration of a large number of studies on maternal diet, not all of which were randomized or included dietary restriction during lactation, demonstrated no impact on various outcomes among the majority of the studies, particularly when follow-up was beyond 4 years, and led one recent group of reviewers to conclude that there is no convincing evidence for a long-term preventive effect of maternal diet during lactation on atopic disease in childhood. 22 A 2006 Cochrane review also concluded that there was insufficient evidence that antigen avoidance during lactation was beneficial in preventing atopic disease in the breastfed infant, with the exception of atopic dermatitis. 5 Because the available published trials have had methodologic shortcomings, more data are necessary to conclude that the avoidance of antigens during lactation prevents atopic dermatitis in infants.…”

“…40 Investigations of the role of breastfeeding on the outcomes of allergies to specific foods have been few, and the results may have been influenced by additional dietary variables such as length and degree of breastfeeding exclusivity. In reviewing the available studies, Muraro et al 22 concluded that exclusively breastfeeding for at least 4 months in infants who are at risk of developing atopic diseases is associated with a lower cumulative incidence of cow milk allergy until 18 months of age. A Cochrane review included only 1 study with a blinded challenge (using the double-blind, placebo-controlled food-challenge technique) and concluded that at least 4 months of exclusive breastfeeding did not protect against food allergy at 1 year of age.…”

“…In general, these have been nonrandomized, retrospective, or observational in design and, thus, inconclusive. 22,23 Of course, it is not possible to truly randomize breastfeeding, which is always a confounding variable in these studies. Acknowledging this difficulty, Kramer 23 proposed 12 criteria to apply to studies designed to assess the relationship between atopic disease and breastfeeding.…”

“…An expert panel from the European Academy of Allergology and Clinical Immunology has recommended delayed introduction of solid foods for 4 to 6 months in breastfed or formula-fed infants. 22 The AAP has also recommended that solid foods be delayed until 4 to 6 months of age and that whole cow milk be delayed until 12 months of age. 11 Before publication of this clinical report, AAP recommendations for infants who are at risk of developing atopic disease were to avoid eggs until 2 years of age and avoid peanuts, tree nuts, and fish until 3 years of age.…”