The Journal of Allergy and Clinical Immunology: In Practice
Review and feature articlePrimary Prevention of Allergic Disease Through Nutritional Interventions
Section snippets
Maternal avoidance of highly allergenic foods during pregnancy
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Maternal avoidance of cow’s milk and egg during pregnancy does not affect the incidence of allergic disease.8, 9, 10, 11, 12, 13
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Earlier studies found no association between maternal peanut avoidance during pregnancy and lactation and the incidence of subsequent peanut allergy in their children.14, 15, 16 A small retrospective study of 25 subjects showed an increased risk of peanut allergy in the children with maternal consumption of peanut more than once per week during pregnancy.17 A more
Effect of breast-feeding on atopic dermatitis in the children
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In a meta-analysis, exclusive breast-feeding for 3 months appears to reduce the incidence of atopic dermatitis in the children compared with conventional formula feeding.25 However, this effect was lost when a controversial study was removed from a more recent systematic review and meta-analysis.26
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Reports are conflicting about whether exclusive breast-feeding longer than 3 months decreases, increases, or has no effect on the incidence of atopic dermatitis in the children.27, 28, 29, 30, 31, 32,
Cow’s milk formulas versus partial whey hydrolysate formulas
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Studies suggest that partial whey hydrolysate formulas (pHFs) have a preventive effect on atopic disease and cow’s milk protein allergy.4, 57, 58, 59, 60, 61, 62, 63, 64
pHFs versus extensive casein or extensive whey hydrolysate formulas (ehF)
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A meta-analysis of 2 studies found no significant difference between a pHF and an eHF in the development of infant allergic diseases, including asthma and food allergy.65, 66
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One large study found that hydrolyzed formulas, especially the extensively hydrolyzed casein formulas, have the potential to reduce the risk of atopic
Timing of introduction
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Between 4 and 6 months of age, complementary foods are necessary to support growth and to supplement nutritional needs. The introduction of complementary foods should be delayed, however, until the infant is able to sit with support and has sufficient head and neck control.71
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The AAP recommends the introduction of complementary foods be delayed until the infant is at least 4 months old, but exclusive breast-feeding is preferred until 6 months of age.72 The expert panel from the European Academy
General advice for complementary food introduction for all children regardless of predisposition to develop allergic disease
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Most pediatric guidelines suggest first introducing single-ingredient foods between 4 and 6 months of age, at a rate not faster than one new food every 3 to 5 days.71
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Complementary foods in the United States are typically rice or oat cereal, yellow/orange vegetables (eg, sweet potato, squash, and carrots), fruits (eg, apples, pears, and bananas), green vegetables, and then age-appropriate staged foods with meats.92
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It is common for acidic fruits (eg, berries, tomatoes, citrus fruits, and
Avoidance diets
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Maternal avoidance diets during pregnancy and lactation are not recommended at this time on the basis of current data; more research is necessary to generate a recommendation about maternal avoidance of peanut.
Breast-feeding
Exclusive breast-feeding is recommended for at least 4 months and up to 6 months of age
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To possibly reduce the incidence of atopic dermatitis for those younger than the age of 2 years,
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To reduce early onset wheezing before age 4 years, and
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To reduce the incidence of cow’s milk allergy in the
References (102)
- et al.
Allergy prevention by maternal elimination diet during late pregnancy–a 5-year follow-up of a randomized study
J Allergy Clin Immunol
(1992) - et al.
The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry
J Allergy Clin Immunol
(2007) - et al.
Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants
J Allergy Clin Immunol
(2010) - et al.
Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies
J Am Acad Dermatol
(2001) - et al.
Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies
Br J Dermatol
(2009) - et al.
Breast-feeding reduces the risk for childhood eczema
J Allergy Clin Immunol
(2005) - et al.
Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life–results from the GINI-birth cohort study
J Pediatr
(2004) - et al.
Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants
J Allergy Clin Immunol
(2010) - et al.
Breast-feeding reduces the risk of asthma during the first 4 years of life
J Allergy Clin Immunol
(2004) - et al.
Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study
Lancet
(2002)
Breast-feeding and atopic disease: a cohort study from childhood to middle age
J Allergy Clin Immunol
Development of childhood allergy in infants fed breast, soy, or cow milk
J Allergy Clin Immunol
Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old
Lancet
Prolonged breast-feeding as prophylaxis for atopic disease
Lancet
The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study
J Allergy Clin Immunol
Breast-feeding, aeroallergen sensitization, and environmental exposures during infancy are determinants of childhood allergic rhinitis
J Allergy Clin Immunol
Long-term prevention of allergic diseases by using protein hydrolysate formula in at-risk infants
J Pediatr
The effect of hydrolyzed cow’s milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial
J Allergy Clin Immunol
Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma: three-year results of the German Infant Nutritional Intervention Study
J Allergy Clin Immunol
Preventive effect of hydrolyzed infant formulas persists until age 6 years: long-term results from the German Infant Nutritional Intervention Study (GINI)
J Allergy Clin Immunol
Household peanut consumption as a risk factor for the development of peanut allergy
J Allergy Clin Immunol
Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy
J Allergy Clin Immunol
Can early introduction of egg prevent egg allergy in infants? A population-based study
J Allergy Clin Immunol
Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy
J Allergy Clin Immunol
Early complementary feeding and risk of food sensitization in a birth cohort
J Allergy Clin Immunol
A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants
J Allergy Clin Immunol
US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up
J Allergy Clin Immunol
A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada
J Allergy Clin Immunol
Utility of food-specific IgE concentrations in predicting symptomatic food allergy
J Allergy Clin Immunol
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
Pediatrics
Dietary prevention of allergic diseases in infants and small children. Part I: immunologic background and criteria for hypoallergenicity
Pediatr Allergy Immunol
Dietary prevention of allergic diseases in infants and small children. Part II: evaluation of methods in allergy prevention studies and sensitization markers. Definitions and diagnostic criteria of allergic diseases
Pediatr Allergy Immunol
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations
Pediatr Allergy Immunol
Dietary prevention of allergic diseases in infants and small children
Pediatr Allergy Immunol
Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Pediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition
Arch Dis Child
Food allergy: a practical update from the gastroenterological viewpoint
J Pediatr (Rio J)
Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy-a randomized study
J Allergy Clin Immunol
Effects of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age-in-vivo results
Clin Exp Allergy
Effect of maternal avoidance of eggs, cow's milk and fish during lactation upon allergic manifestations in infants
Clin Exp Allergy
Prospective study of the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation
Eur J Pediatr
Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child
Cochrane Database Syst Rev
Factors associated with the development of peanut allergy in childhood
N Engl J Med
Government advice on peanut avoidance during pregnancy–is it followed correctly and what is the impact on sensitization?
J Hum Nutr Diet
Exposure to peanuts in utero and in infancy and the development of sensitization to peanut allergens in young children
Pediatr Allergy Immunol
Maternal food consumption during pregnancy and the longitudinal development of childhood asthma
Am J Respir Crit Care Med
Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort
J Allergy Clin Immunol
Peanut sensitisation and allergy: influence of early life exposure to peanuts
Br J Nutr
The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study
Br J Nutr
Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age
Acta Paediatr
Maternal avoidance of eggs, cow’s milk, and fish during lactation: effect on allergic manifestations, skin-prick tests, and specific IgE antibodies in children at age 4 years
Pediatrics
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No external funding was received for this report.
Conflicts of interest: J. M. Spergel has received consultancy fees from Danone and Abbott, has received research support from Nutricia, and is on the medical advisory boards for APFED and the International Assoc Food Protein Induced Enterocolitis. The rest of the authors declare that they have no conflicts of interest.
Cite this article as: Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol: In Practice 2013;1:29-36. http://dx.doi.org/10.1016/j.jaip.2012.09.003.