Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review

Abstract

Background Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. Objectives The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? Methods The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. Results Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. Conclusions Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.

Appropriate age range for introduction of complementary feeding into an infant's diet

“…EFSA staff hand‐searched through the bibliography of: −the studies included from all the searches described above, −the systematic reviews (those performed by USDA (English et al., , English et al., ; Obbagy et al., ; Obbagy et al., ; Obbagy et al., ) and published shortly before the launch of the public consultation on this Scientific Opinion were searched during the public consultation and relevant papers were added thereafter), −the theses found through the search of grey literature undertaken by the external contractor. …”

“…For outcomes on atopic diseases, Obbagy et al. () reported that there was moderate evidence for no association between the age of CF introduction and the risk of developing food allergy, atopic dermatitis, or childhood asthma. Limited to strong evidence (depending on the specific food studied) suggested that the risk of food allergy and atopic dermatitis did not increase by introducing allergenic foods after 4 months of age but within the first year of life, although it may prevent peanut and egg allergy.…”

Fordel med fullamming til seks måneder

“…I tråd med dette angir den norske retningslinjen (2) at alle spedbarn bør få matvarer som kan vaere allergifremkallende i løpet av det første året. Det er imidlertid ikke grunnlag for å anbefale introduksjon av potensielt allergifremkallende matvarer tidligere enn seks måneders alder (4,13,14). Med dagens kunnskapsgrunnlag er det ikke belegg for å si om introduksjon av potensielt allergifremkallende matvarer ved fire eller seks måneders alder kan forebygge utvikling av allergi.…”

Current Insights on Early Life Nutrition and Prevention of Allergy

“…Results from the Learning Early About Peanut Allergy trial suggested that peanut should be introduced between 4 and 11 months in infants at high risk for allergy (33). According to a recent systematic review, this practice may reduce the risk of peanut allergy, with the strongest evidence supporting a benefit to high risk infants (i.e., with severe atopic dermatitis or egg allergy) but it is also applicable to infants at lower risk (34). In addition to these findings, there is limited high quality evidence suggesting the lack of a relationship between consumption of peanut during weaning and the risk of atopic dermatitis/eczema and asthma, while not enough evidence supports the causal relationship between consuming peanut and developing allergic rhinitis at 2, 5, or 6 years of age (34).…”

“…Previous observational studies have also investigated the effect of the timing of fish introduction on the risk of allergic diseases (40,41). A recent systematic review provided limited evidence to suggest that the introduction of fish between 3 and 8 months of life may lower the risk of atopic dermatitis/eczema (34). However, at present there is not enough evidence of a link between fish consumption and food allergy, asthma, or allergic rhinitis (42).…”