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Suggestions from the American Academy of Pediatrics on maternal and infant eating to avoid allergies

Clinical Question

What can mothers do to prevent eczema or allergies in their infants?

Bottom line

Although this is not official policy or even a practice guideline, the American Academy of Pediatrics summarized the current evidence as lacking support for any dietary restrictions during pregnancy or breastfeeding as a means of preventing atopic disorders in children. Exclusive breastfeeding early in life, for a few months at least, decreases the likelihood of infant eczema in the first 2 years of life. Regarding infant feeding, holding off on foods associated with allergy until 6 months of age is not effective in preventing allergy, and the introduction of peanut products before then may prevent a peanut allergy from developing. 5

Reference

Greer FR, Sicherer SH, Burks AW; Committee on Nutrition; Section on Allergy and Immunology. 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. Pediatrics 2019;143(4):e20190281.

Study design: Practice guideline

Funding: Foundation

Setting: Various (guideline)

Synopsis

This is a clinical report from the American Academy of Pediatrics. It's not a policy statement, a guideline, or a review article. It's sort of a "trust-us-we're-the-experts" summary of available research in a nontransparent way. Pointing out the weak research evidence base, the group finds that the current evidence does not support a role for dietary restrictions during pregnancy and lactation. Exclusive breastfeeding for the first 3 months to 4 months of age is associated with a decreased likelihood of eczema in the first 2 years of life, but breastfeeding beyond that time is not. Breastfeeding for at least 3 months may protect against wheezing in the first 2 years of life, and longer may provide protection for up to age 5 years. Delaying introduction of peanuts, eggs, and fish until after the first 4 months to 6 months of life does not prevent atopic disease, and early peanut exposure may prevent peanut allergy.

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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