Can Breastfeeding Reduce the Risk of Asthma, Atopic Dermatitis, and Food Allergies?
By Lisa A. Goldstein
Atopic disease—which could be atopic dermatitis, asthma, or a food allergy—may be delayed or prevented in high-risk infants if they are breastfed for at least four months, or given certain hydrolyzed (hypoallergenic) formulas without cow milk protein. This is one of the findings published in the January 2008 issue of Pediatrics. Another is that maternal dietary restrictions during pregnancy or lactation don’t seem to have a protective effect.
Revised Report
This policy report, “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,” actually replaces an earlier American Academy of Pediatrics one from 2000.
It’s all about prevention, not treatment.
According to the report, “over the past several decades, the incidence of atopic diseases such as asthma, atopic dermatitis and food allergies has increased dramatically. Among children up to 4 years of age, the incidence of asthma has increased 160 percent, and the incidence of atopic dermatitis has increased twofold to threefold. The incidence of peanut allergy has also doubled in the past decade. Thus, atopic diseases increasingly are a problem for clinicians who provide healthcare to children.”
As it turns out, the documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to high-risk infants. A high-risk infant is one who has at least one first-degree relative—such as a parent or sibling—with atopic disease.
Such nutritional intervention includes breastfeeding for at least four months, or using hydrolyzed formulas without cow milk protein. “Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit,” the report states. Soy formula should not be used for this purpose.
Additionally, the old recommendation of avoiding certain foods during pregnancy has been modified. “The new report simply states that there is currently a lack of evidence that mothers’ diets during pregnancy plays a significant role,” says study co-author Dr. Scott Sicherer, an associate professor of Pediatrics at Jaffe Food Allergy Institute, Mount Sinai School of Medicine in New York, New York. “The prior report suggested these mothers eliminate peanuts, nuts and possibly egg, milk, fish, and other foods while breastfeeding,” he says. “The new report indicates that such avoidance has not been shown to prevent allergic disease.”
There is some evidence, however, that eczema may be lessened by a breastfeeding mother’s elimination diet, but the studies are limited, Dr. Sicherer says.
The report also says that there is insufficient evidence that any dietary intervention after 4 to 6 months of age prevents allergic disease. This includes delaying the introduction of complementary foods.
What’s a Parent to Do?
How will this revised report change things for pregnant and lactating women?
“First, I think that each woman should consult her own health care provider and her baby’s provider,” says Dr. Sessions Cole, director of the Division of Newborn Medicine at St. Louis Children’s Hospital and Professor of Pediatrics at Washington University School of Medicine. “Second, based on the recent AAP Clinical Practice guideline, I think women should understand that elimination diets used to try to prevent development of allergies may not benefit their babies by reducing risk of allergies and may not provide their fetuses or themselves with optimal nutrition during pregnancy or breastfeeding.”
While not everyone can breastfeed, the consensus is that this method is best. As Dr. Cole says, optimizing the baby’s nutritional health by breastfeeding and maintaining a healthy maternal diet should be the first priorities.
“For moms whose babies are at high risk, after consultation with their babies’ health care providers, the best recommendation to help reduce the risk of developing allergies for their babies is for them to breastfeed as long as they are able,” Dr. Cole says. Hopefully this means a minimum of four months and up to a year.
Family History
One mom who took family history into account when making the decision to breastfeed is Shari Rager of Gaithersburg, Md. Both she and her husband have significant seasonal and indoor allergies. This puts her children at high-risk for atopic disease. “It was one of the many reasons that I felt that breastfeeding would be the best choice for my children,” Rager says.
Rager breastfed her son, who is now 4 1/2 years old, for eight months. He weaned himself earlier than she would have liked. She is now breastfeeding her daughter, who is 8 months old. “Anything I can do to try to keep my kids from suffering, I’ll try to do,” she says.
The Bottom Line
“The new AAP statements are basically like truth in advertising, saying there are some things for which studies show a difference, and others where it is not so clear—either because the studies fail to show a difference or the studies are too limited to draw conclusions,” Dr. Sicherer says.
As a result, Dr. Sicherer says a mother should talk to her doctor about what makes sense for her to do. It’s important to note that the new AAP statement applies to infants who are well—it’s all about prevention, not treatment. “If a baby has allergic problems like rashes, etc., then altering the diet may be needed for treatment,” Dr. Sicherer says. “Again, ask your doctor.”
