A new report by a leading group of US pediatricians suggests that food allergies, asthma, eczema, and other atopic diseases may be delayed or prevented in high risk babies if they are breastfed for at least four months. The same benefits may be conferred by using certain types of infant formulas made without cow's milk protein (some of the hydrolyzed or hypoallergenic formulas).

The report comprises a new policy statement from the American Academy of Pediatrics (AAP) and is published in the January 2008 issue of the journal Pediatrics. The authors are Dr Frank R. Greer, professor of pediatrics and nutrition at the University of Wisconsin Medical School, Madison, and also chairman of the committee on nutrition at the AAP; and Dr Scott H. Sicherer, who is associate professor of pediatrics at Mount Sinai Medical Center, New York City.

The report also suggests there is insufficient evidence to support delaying the introduction of allergy related foods from the diets of high risk children. And there is isufficient evidence to support pregnant or nursing mothers restricting their diets in order to prevent their high risk child from getting an atopic disease.

Both of these practices were recommended in the old policy statement of the AAP. For example, the old policy recommended delaying introducing a high risk child to cow's milk until after it was 12 months old, with other foods such as fish and peanuts until after it was three years old.

According to WebMD Medical News, Greer said that they didn't have the studies to back up the old policy statement. After the first 4 to 6 months, if the high risk child was going to be allergic, it didn't seem to matter when he or she was first introduced to the peanuts or the eggs.

Children are considered to be at high risk of developing atopic diseases or allergies if they have at least one parent or sibling with an atopic disease.

The new report replaces an earlier policy statement from the AAP about the use of of hypoallergenic infant formulas and dietary restrictions in the prevention of allergies and atopic diseases.

The authors said there is evidence that breastfeeding for at least 4 months, compared with giving babies formula made with intact cow's milk protein, delays or prevents atopic dermatitis (eczema), allergy to cow's milk, and wheezing in early childhood.

A number of studies have shown that high risk babies that were not exclusively breastfeeding for 4 to 6 months, atopic disease was more likely to be delayed in those babies given hydrolyzed formulas, compared with those given formula made with intact cow's milk protein. The results were particularly significant for atopic dermatitis (eczema).

However, the authors pointed out that according to comparative studies, not all the hydrolyzed formulas offer the same level of protection. They called for more studies to find out if the hydrolyzed formulas offer protection against onset of allergies in the longer term and not just in the child's early years.

One surprising item in the report is that the authors found no evidence to substantiate claims that soy-based formulas help to prevent or delay atopic diseases in high risk children.

As Sicherer told WebMD:

"If there is a family history of allergy problems, it is clear that moms should breastfeed exclusively for at least four months."

"If that isn't possible and a formula is needed, don't pick a typical soy formula," said Sicherer.

The authors pointed out that the report deals with children at high risk of developing atopic diseases and not those who already have them.

They also said that replacing the old policy on diet restrictions probably won't have a great effect since not many people were following it anyway.

Also, parents who feel guilty that they caused their children's exzema or food allergy because they fed them milk or eggs too soon can relax. There is no evidence to support this, said Sicherer.

"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."
Frank R. Greer, Scott H. Sicherer, A. Wesley Burks and the Committee on Nutrition and Section on Allergy and Immunology.
Pediatrics 2008; 121: 183-191.
Vol. 121 No. 1 January 2008, pp. 183-191.
doi:10.1542/peds.2007-3022.

Click here for Abstract.

Sources: Journal abstract, AAP press release, WebMD Medical News.

Written by: Catharine Paddock