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February 20, 2014

Mothers, especially of breast fed infants with eczema often worry about whether their dietary habits might exacerbate or be a reason for their children’s eczema.  Mothers should find the summary of recommendations from the Canadian Society of Allergy and Clinical Immunology below both reassuring & helpful:

Recommendations:

Breast Milk benefits

Based on current evidence, and always conceding that much more research needs to be performed, the CPS and the Canadian Society of Allergy and Clinical Immunology recommend the following approach to prevent allergy in infants who have a first-degree relative with an allergic condition, and are, therefore, considered to be high risk. The levels of evidence reported in the recommendations have been described using the evaluation of evidence criteria outlined by the Canadian Task Force on Preventive Health Care.

  • Do not restrict maternal diet during pregnancy or lactation. There is no evidence that avoiding milk, egg, peanut or other potential allergens during pregnancy helps to prevent allergy, while the risks of maternal undernutrition and potential harm to the infant may be significant. (Evidence II-2B)
  • Breastfeed exclusively for the first six months of life. Whether breastfeeding prevents allergy as well as providing optimal infant nutrition and other manifest benefits is not known. The total duration of breastfeeding (at least six months) may be more protective than exclusive breastfeeding for six months. (Evidence II-2B)
  • Choose a hydrolyzed cow’s milk-based formula, if necessary. For mothers who cannot or choose not to breastfeed, there is limited evidence that hydrolyzed cow’s milk formula has a preventive effect against atopic dermatitis compared with intact cow’s milk formula. Extensively hydrolyzed casein formula is likely to be more effective than partially hydrolyzed whey formula in preventing atopic dermatitis. Amino acid-based formula has not been studied for allergy prevention, and there is no role for soy formula in allergy prevention. It is unclear whether any infant formula has a protective effect for allergic conditions other than atopic dermatitis. (Evidence IB)
  • Do not delay the introduction of any specific solid food beyond six months of age. Later introduction of peanut, fish or egg does not prevent, and may even increase, the risk of developing food allergy. (Evidence II-2B)
  • More research is needed on the early introduction of specific foods to prevent allergy. Inducing tolerance by introducing solid foods at four to six months of age is currently under investigation and cannot be recommended at this time. The benefits of this approach need to be confirmed in a rigorous prospective trial. (Evidence II-2B)
  • Current research on immunological responses appears to suggest that the regular ingestion of newly introduced foods (eg, several times per week and with a soft mashed consistency to prevent choking) is important to maintain tolerance. However, routine skin or specific IgE blood testing before a first ingestion is discouraged due to the high risk of potentially confusing false-positive results. (Evidence II-2B)