Clinical Edge

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Nutrition & Atopic Disease Development in Children

Publish date:

There is a lack of evidence to support maternal dietary restrictions either during pregnancy or during lactation to prevent atopic disease, according to a recent clinical report from the American Academy of Pediatrics (AAP). Among the report’s highlights and recommendations:

  • Although there is evidence that exclusive breastfeeding for 3 to 4 months decreases the incidence of eczema in the first 2 years of life, there are no short- or long-term advantages for exclusive breastfeeding beyond 3 to 4 months for prevention of atopic disease.
  • Evidence now suggests that any duration of breastfeeding ≥3 to 4 months is protective against wheezing in the first 2 years of life, and some evidence suggests that longer duration of any breastfeeding protects against asthma even after 5 years of age.
  • No conclusions can be made regarding the role of breastfeeding in either preventing or delaying the onset of specific food allergies.

Citation:

Greer FR, Sicherer SH, Burks, AW, et al. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods. [Published online ahead of print April 1, 2019]. Pediatrics. doi:10.1542/peds.2019-0281.

Commentary:

Parents and clinicians alike have long been concerned about possible effects of dietary intake or avoidance on the development of atopic symptoms. This guidance article confirms some previous opinions and updates prior recommendations. Maternal diet appears unconnected to risk of atopy in a child. However, new data suggest that exclusive breastfeeding for the first 3-4 months appears to offer some reduction in incidence of atopy and continued breastfeeding may help reduce the incidence of atopic respiratory disease. Also, in stark contrast to previous recommendations it seems clear that early (4-6 months) introduction of peanut reduces future risk of peanut allergy. This may apply to other foods as well but has not been confirmed. This article is highly recommended for all those concerned with the effect of diet on atopy. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY

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