Influence of dietary manipulation on incidence of atopic disease in infants at risk. Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. Maternal diet rich in saturated fat during breastfeeding is associated with atopic sensitization of the infant Prospective study on the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy--a randomized study. Relationship of diet in the development of atopy in infancy Effects of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age—in‐vivo results Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants Prevention of atopic diseases in high risk babies (long-term follow-up). Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years follow‐up Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3-4 months: the Osaka Maternal and Child Health Study. Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Prevention of atopic disease in "at-risk newborns" by prolonged breast-feeding. Compliance with a Dietary Manipulation Programme in Families with Infants Prone to Atopy Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy.
Of 5,500 newborn infants whose family histories were screened , 900 were found to have anamnestic risk .  Cord-blood IgE was evaluable in 4,677 of these newborns , of which 394 had levels > or = 1 IU/mL ; 84 infants had both anamnestic risk and elevated cord-blood IgE levels . Parents of infants with anamnestic risk were informed of their child 's risk of atopy . Additionally , for 391 infants at two of the three participating hospitals , a preventive diet was prescribed that recommended breastfeeding for the first 6 months of life , with maternal diet restricted to no more than 200 dL of cow milk per day , no more than one egg per week , and no tomato , fish , shellfish , nuts , or foods allergenic to the mother . Only soy formula was recommended , and introduction of solid foods was also carefully prescribed . Furthermore , doctors recommended against exposure to tobacco smoke , animal allergens , and early entrance into daycare . Evaluable infants whose parents complied with the prescribed diet were found to have a lower incidence of atopy during the first year of life ( 13.3 % , n = 158 ) than infants whose parents had ignored the prescribed diet ( 54.7 % , n = 86 ) or infants whose parents were offered no dietary recommendations ( 28.9 % , n = 218 ) . Differences between the compliant group and the two groups with unrestricted diets were significant , indicating that this prescribed diet may protect against or delay onset of food allergies during the first year of life The effect of maternal and infant avoidance of allergenic foods on food allergy was examined in a prenatally r and omized , controlled trial of infants of atopic parents . The diet of the prophylactic-treated group ( N = 103 ) included ( 1 ) maternal avoidance of cow 's milk , egg , and peanut during the third trimester of pregnancy and lactation and ( 2 ) infant use of casein hydrolysate ( Nutramigen ) for supplementation or weaning , and avoidance of solid foods for 6 months ; cow 's milk , corn , soy , citrus , and wheat , for 12 months ; and egg , peanut , and fish , for 24 months . In the control group ( N = 185 ) , mothers had unrestricted diets , and infants followed American Academy of Pediatrics feeding guidelines . The cumulative prevalence of atopy was lower at 12 months in the prophylactic-treated ( 16.2 % ) compared to the control ( 27.1 % ) group ( p = 0.039 ) , result ing from reduced food-associated atopic dermatitis , urticaria and /or gastrointestinal disease by 12 months ( 5.1 % versus 16.4 % ; p = 0.007 ) , and any positive food skin test by 24 months ( 16.5 % versus 29.4 % ; p = 0.019 ) , caused primarily by fewer positive milk skin tests ( 1 % versus 12.4 % ; p = 0.001 ) . The prevalences of allergic rhinitis , asthma , and inhalant skin tests were unaffected . Serum IgE levels in the prophylactic-treated group were marginally lower only at 4 months . Thus , reduced exposure of infants to allergenic foods appeared to reduce food sensitization and allergy primarily during the first year of life Infants born to atopic parents have been found to be at high risk of allergy development . The present study investigated the effect of a maternal milk-free diet during late pregnancy and lactation on the immune response and allergy incidence in at-risk and control infants . Atopic mothers were r and omly allocated into an intervention group ( n 12 ) or an unrestricted-diet group ( n14 ) and compared with  non-atopic mothers following an unrestricted diet ( n 12 ) . The intervention involved a maternal milk-free diet during late pregnancy and lactation . Infants were followed up for 18 months postnatally . A significant fall in maternal serum beta-lactoglobulin (beta-Lg)-immunoglobulin G ( IgG ) antibody levels ( P < 0.05 ) was observed after a 7-week milk-exclusion diet . In maternal and cord serum sample s the levels of beta-Lg-IgG and alpha-casein-IgG antibodies were significantly correlated ( r 0.89 , P < 0.0001 and r 0.71 , P < 0.001 respectively ) . Higher levels of beta-Lg-IgG ( P < 0.05 ) were observed in the cord serum sample s compared with paired maternal serum sample s. Single-blind allergy assessment by a paediatrician at 12 and 18 months showed that the infants born in the non-atopic group had a significantly lower allergy incidence compared with the infants born in the atopic group following an unrestricted diet ( P < 0.008 and P < 0.02 respectively ) . The allergy incidence in the infants born in the atopic diet group was significantly lower compared with that of the atopic group following an unrestricted diet ( P < 0.04 ) . It was observed that the atopic nature of the parents significantly affected the allergy incidence in their children . A trend towards a beneficial effect of a maternal milk-free diet during late pregnancy and lactation was also observed in infants born to atopic parents Objective : To investigate the impact of maternal diet during breastfeeding on  atopic sensitization of infants at risk . Design : Prospect i ve cohort study . Setting : Turku University Central Hospital , Finl and .Subjects and methods : Altogether 114 infants with a family history of atopic disease were followed during their first year of life . The mothers completed a 4 day food record during breastfeeding just before the infants were 3 months old . Atopic sensitization of the infants was determined by a positive skin prick test result at 12 months . Results : Positive skin prick test reactivity to at least one antigen was detected in 27/114 ( 24 % ) infants at 12 months . The energy intake of the mothers was low , mean 8.0 MJ/day ( 95 % CI 7.7–8.3 ) , and the proportion of energy derived from fat was high , mean 36.6 E% ( 95 % CI 35.6–37.6 ) . Atopic mothers had a higher intake of total fat and saturated fat and a lower intake of carbohydrate as a percentage of total energy intake than non-atopic mothers ; P=0.017 , P=0.050 , P=0.004 respectively . Maternal intake of saturated fat during breastfeeding was associated with atopic sensitization of the infant , OR=1.16 ( 95 % CI 1.001–1.36 ) ; P=0.048 irrespective of the maternal atopic status . Conclusions : Our results show that an unbalanced maternal diet during breastfeeding may be a risk factor underlying the later development of atopic sensitization of the infant regardless of maternal atopic disease . The observation thus extends findings implying that early nutrition programmes the subsequent health of the child to the risk of developing atopic disease . Sponsorship : Academy of Finl and and National Technology Agency . European Journal of Clinical Nutrition ( 2000 ) 54 , Abstract The preventive effect of maternal avoidance of cow 's milk and eggs on the development of atopic dermatitis and sensitization to food allergens was studied in a prospect i ve trial with families at high risk for atopy . intervention included encouraging exclusive breast feeding for at least 3 months and delaying the controlled introduction of solid foods . In addition , one group received a maternal diet with the complete avoidance of milk and eggs in the last trimester of pregnancy and during the period of exclusive breast feeding , another group had the same diet starting after delivery , and mothers of the third group had no dietary restrictions . The period prevalences of atopic dermatitis as well as the rates of specific sensitization to eggs and milk at 6 and 12 months were not significantly different between groups . We were unable to demonstrate a significant preventive effect of maternal diet . Conclusion While breast feeding should be promoted for children at risk for atopy , mothers can be encouraged to stay on normal diet during pregnancy and the breast feeding period In a prospect i ve , r and omized study , we have monitored the effect of maternal abstention from cow 's milk and egg on the development of  atopy in babies . Two hundred twelve women were followed from midpregnancy . We report the occurrences of allergies in their babies up to 18 months of age , as assessed by skin prick testing , determination of serum IgE , question naires , and blinded physical examination by a pediatric allergist . Whatever the method that was used , there was no statistically significant difference between babies whose mothers received the " diet " or the " nondiet . " Other factors known to influence the risk of atopy like heredity , sex , month of birth , breast-feeding , and exposure to tobacco smoke , animal d and ruff , and solid food did not differ between the groups . The mothers receiving the exclusion diet , by their own choice , had diminished their intake of milk and egg during lactation also , and therefore , their babies were significantly less exposed to cow 's milk before 6 months . Still , atopy was equally abundant among their children . Thus , maternal elimination diet during late pregnancy did not protect the baby against allergy We examined the relationship of diet to the development of atopic manifestations in a group of infants with an immediate family history of atopy , followed prospect ively from birth for up to 20 months of age . There was no relationship between the development of atopic dermatitis , rhinitis and wheeze and either 2 or 4 months exclusive breast feeding , or the introduction of cow 's milk or solids in the first 4 months of life . In addition there was no relationship between the introduction of milk , egg or wheat into the diet and the development of skin‐test positivity to these foods . In fact , five infants developed positive skin tests to the food prior to its introduction into the diet , suggesting exposure via maternal breast milk . Thus we have been unable to show a protective effect of either breast feeding or cow 's milk or solid avoidance on the development of atopic disease in infancy One hundred and sixty‐two women with respiratory allergy to animal d and ers and /or pollens were r and omly allocated to a diet consisting of either a very low ingestion of hens ' egg and cows ' milk or a daily ingestion of one hens ' egg and about 11 of cows ' milk during the last 3 months of pregnancy .  One hundred and sixty‐three infants were followed prospect ively up to 18 months of age when the cumulated incidence of atopic disease in each child was evaluated blindly . No significant differences in the distribution of atopic disease were found among the infants in relation to the maternal diet during late pregnancy . The numbers of skin‐prick tests positive to ovalbumin , ovomucoid , β‐lactoglobulin and cows ' milk were likewise not influenced by differences in the maternal diet during late pregnancy . Genetic factors rather than maternal diet during the perinatal period probably have a greater effect on the incidence of atopic diseases during early infancy Abstract . One hundred and twenty‐one women with history of a previous child with atopic disease were r and omly allocated during the next pregnancy to antigen avoidance or control groups . Dietary advice consisted of almost complete exclusion of milk and dairy products , egg , fish , beef and peanut throughout pregnancy and lactation . A total of 109 completed the study . Maternal antigen avoidance was associated with reduced occurrence of atopic eczema and the skin involvement was less extensive and milder . The beneficial effect was observed mainly in the breast‐fed group . Among the fifty‐five who completed the trial of antigen avoidance , seventeen infants developed atopic eczema , five out of thirty‐five who were breast‐fed and twelve out of twenty who were formula‐fed . Among the offspring of fifty‐four control mothers given no dietary restriction , eczema was observed in twenty‐four infants , eleven out of thirty‐six breast‐fed and thirteen of eighteen formula‐fed . Avoidance of common dietary allergens during pregnancy and lactation enhanced the preventive beneficial effect of exclusive breast feeding on the incidence of atopic eczema among infants at high risk Several studies have demonstrated that dietary and environmental manipulations in the first months of life have a protective effect on the development of allergic diseases in babies " at risk " of atopy . We have prospect ively followed up 174 " high risk " infants who underwent dietary and environmental manipulations , such as exclusive breast-feeding for the first 6 months of life , supplemented if necessary with soy-protein formula ( Isomil , Abbott ) , delayed weaning beyond the 6th month of life , and rigorous environmental manipulations for the elimination of house-dust mite and passive smoking . The low prevalence of atopic disease ( 10 % ) and the trivial course of the allergic manifestations in this " at risk " population confirm the effectiveness of this preventive program . Moreover , this study demonstrates that the incidence of atopic dermatitis peaks at 6 months , and decreases until it disappears . Food allergy appears only at 6 months and may disappear later . The incidence of asthma peaks at 6 and 36 months and decreases at low levels in the intervals . Allergic rhinitis develops not sooner than 36 months ABSTRACT A prospect i ve case‐control study is presented to assess an allergy prevention programme in children up to 36 months of age . Infants born at three maternity hospitals were followed from birth : 279 infants with high atopic risk ( intervention group ) were compared with 80 infants with similar atopic risk but no intervention ( non‐intervention group ) . The intervention programme included dietary measures ( exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet ) and environmental measures ( avoidance of parental smoking in the presence of the babies , day care > 2 years of life ) . Mothers in this group who had insufficient breast milk were r and omly assigned to one of two coded formulas : either a hydrolysed milk formula ( Nidina HA , Nestlé ) or a conventional adapted formula ( Nan , Nestlé ) . Other environmental measures remained the same as for the breastfeeding mothers . The non‐intervention group were either breastfed or received the usual Italian milk feeding and weaning diet , without environmental advice . The main outcome measures were anthropometric measurements and allergic disease manifestations . Normal anthropometric data were observed both in the intervention group and in the nonintervention group . The incidence of allergic manifestations was much lower in the intervention group than in the nonintervention group at 1 year ( 11.5 versus 54.4 % , respectively ) and at 2 years ( 14.9 versus 65.6 % ) and 3 years ( 20.6 versus 74.1 % ) . Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non‐intervention group from birth up to the second year of life , while urticaria and gastrointestinal disorders were only present in the non‐intervention group in the first year of life . Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non‐intervention group . Relapse of the same allergic symptom was less in the intervention group ( 13.0 % ) than in the non‐intervention group ( 36.9 % ) . In comparison to the non‐intervention group , there were fewer intervention group cases with two or more different allergic symptoms ( 8.7 versus 32.6 % ) , and they were more likely to avoid steroid treatment ( 0 versus 10.8 % ) and hospital admission ( 0 versus 6.5 % ) . Babies in the non‐intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group . In the intervention group the breastfed infants had the lowest incidence of allergic symptoms , followed by the infants fed the hydrolysed formula ( ns ) . Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants , although less than their counterparts in the non‐intervention group . Of the affected subjects in the intervention group , 80.4 % were RAST and /or Prick positive to food or inhalant allergens . Total serum IgE values detected at birth in the intervention group were not predictive , but at 1 and 2 years of age , IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy . In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups . Of the various factors tested in the non‐intervention group , the following were the most important in the pathogenesis of allergic symptoms : ( i ) formula implementation begun in the first week of life ; ( ii ) early weaning ( < 4 months ) ; ( iii ) feeding beef ( < 6 months ) ; ( iv ) early introduction of cow 's milk ( < 6 months ) ; and ( v ) parental smoking in the presence of the babies and early day care admission ( < 2 years of life ) . All the preventive measures used in this study ( exclusive breastfeeding and /or hydrolysed milk feeding , delayed and selective introduction of solid foods , and environmental advice ) were effective at the third year of follow‐up , greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions Interest has increased in the possibility that maternal dietary intake during pregnancy might influence the development of allergic disorders in children . The present prospect i ve study examined the association of maternal intake of selected foods high in fatty acids and specific types of fatty acids during pregnancy with the risk of suspected atopic eczema among Japanese infants aged 3 - 4 months . Subjects were 771 mother-child pairs . Information on maternal dietary intake during pregnancy was assessed with a vali date d self-administered diet history question naire . The term ' suspected atopic eczema ' was used to define an outcome based on results of our question naire completed by mothers 3 - 4 months postpartum . The risk of suspected atopic eczema was 8.4 % ( n = 65 ) . Higher maternal intake of  meat  during pregnancy was significantly associated with an increased risk of suspected atopic eczema in the offspring : the multivariate odds ratio ( OR ) for the highest vs. lowest quartile was 2.59 [ 95 % confidence interval ( CI ) : 1.15 - 6.17 , p for trend = 0.01 ] . The positive association was strengthened when the definition of the outcome was confined to a definite physician 's diagnosis of atopic eczema ( n = 35 ) : the multivariate OR between extreme quartiles was 3.53 ( 95 % CI : 1.19 - 12.23 , p for trend = 0.02 ) . No material exposure-response relationships were observed between maternal intake of eggs , dairy products , fish , total fat , saturated fatty acids , monounsaturated fatty acids , n-3 polyunsaturated fatty acids , alpha-linolenic acid , eicosapentaenoic acid , docosahexaenoic acid , n-6 polyunsaturated fatty acids , linoleic acid , arachidonic acid and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid consumption and the risk of suspected atopic eczema . Higher maternal meat intake may increase the risk of infantile atopic eczema , whereas we found no evidence that maternal intake of fish and n-3 polyunsaturated fatty acids are preventive against infantile atopic eczema The aim of this study was to assess the preventive effect of exclusive breast-feeding and early solid food avoidance on  atopic dermatitis ( AD ) in infancy . This study is part of a dietary clinical trial in a prospect i ve cohort of healthy term newborns at risk of atopy . It was recommended to breast-feed for at least 4 months and to avoid solid food in the same time-period . Eight hundred and sixty-five infants exclusively breast-fed , and 256 infants partially or exclusively formula-fed , were followed-up until the end of the first year following birth . AD and sensitization to milk and egg were considered as study end-points . The 1-year incidence of AD was compared between the two study groups . Adjusted odds ratios ( OR ) with 95 % confidence intervals ( CI ) were calculated by multiple logistic regression . The incidence of AD was calculated in relation to age at introduction of solid food and amount of food given . In the breast-fed group , the adjusted OR for AD was 0.47 ( 95 % CI 0.30 - 0.74 ) . The strongest risk factor was the occurrence of AD in the subject 's core family . The risk of infants with AD to be sensitized to milk was four times higher , and to egg eight times higher , than in infants without AD . Age at first introduction of solid food and diversity of solid food showed no effect on AD incidence . We conclude that in infants at atopic risk , exclusive breast-feeding for at least 4 months is effective in preventing AD in the first year of life BACKGROUND Some breastfed infants with atopic eczema benefit from elimination of cow milk , egg , or other antigens from their mother 's diet . Maternal dietary antigens are also known to cross the placenta . OBJECTIVES To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation , or both , on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child . SEARCH METHODS We search ed the Cochrane Pregnancy and Childbirth Group 's Trials Register ( 6 July 2012 ) . SELECTION CRITERIA All r and omized or quasi-r and omized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women . We excluded trials of multimodal interventions that included manipulation of the infant 's diet other than breast milk or of non-dietary aspects of the infant 's environment . DATA COLLECTION AND ANALYSIS We extracted data from published reports , supplemented by additional information received from the trialists we contacted . MAIN RESULTS The evidence from five trials , involving 952 participants , does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life . Data on allergic rhinitis or conjunctivitis , or both , and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences . Longer-term atopic outcomes have not been reported . The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain , a non-significantly higher risk of preterm birth , and a non-significant reduction in mean birthweight . The evidence from two trials , involving 523 participants , did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk , egg , or peanut antigen at one , two , or seven years . One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity . AUTHORS ' CONCLUSIONS Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child 's risk of atopic diseases , and such a diet may adversely affect maternal or fetal nutrition , or both . Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child 's risk of developing atopic eczema , but better trials are needed . Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema , but larger trials are needed The protective effect of breast feeding against atopic disease ( AD ) has been confirmed in several prospect i ve studies , while some retrospective studies have yielded controversial results . We have evaluated the prophylactic effect of prolonged breast feeding on the development of AD in 101 newborns at hereditary risk for allergic disease . The study design also included a strict dietary avoidance regimen of the nursing mothers . Our data demonstrate that breast feeding or breast feeding supplemented with soy milk exert a prophylactic effect on the development of AD in these at-risk infants . Mechanisms by which breast feeding protects from atopy are discussed ABSTRACT . The success of familial compliance with a dietary manipulation programme was studied prospect ively in 91 newborn babies from atopic families for up to 12 months . The control group consisted of 72 infants from non‐atopic families . The percentages of infants breast‐fed at the age of six months were 58 % and 38 % in the study group and control group , respectively . The introduction of cow 's milk based formulas was postponed until the age of three months in 63 % of the infants in the study group and 47 % of the infants in the control group . Solid food was avoided during the first three months in 76 % and 45 % of the infants in the study group and control group , respectively . Maternal age , smoking and low social class were associated with poor compliance . The existence of atopic dermatitis in any member of the family was associated with good compliance . The main advantages of our programme were the increased number of children breast‐fed until the age of six months , and the reduced number of infants introduced to cow 's milk based formulas or solid food before three months of age Polyunsaturated fatty acids ( PUFAs ) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis ( AD ) . The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants . Based on the parents ' decision on their babies ' primary feeding , mothers and newborns were r and omized to the supplementation with gamma-linolenic acid ( GLA ) or placebo for up to 6 months . Breastfed infants received GLA by supplementing their mothers . Formula diet was commercial whey hydrolysate unsupplemented with PUFAs .  Of 131 eligible infants , 24 developed AD within the first year of life . Of these , nine belonged to the exclusively breastfed group ( n = 58 ) , 14 to the combined-fed group ( n = 53 ) , and one to the never breastfed group ( n = 20 ) . We could not find an influence of GLA on the development of AD . In subjects with AD , at 1 yr of age the serum-immunoglobulin E ( IgE ) was the lowest in the GLA-supplemented group A-subjects . In the GLA-supplemented group , GLA-levels in breast milk were similar in atopic and non-atopic infants . In the non-supplemented group the GLA-content of breast milk was 0.07 % of total fatty acids in atopic infants vs. 0.17 % in non-atopic infants ( p < 0.01 ) . Dietary GLA-supplementation could not prevent AD . Interestingly , the number of infants developing AD was the lowest in never breastfed children . In infants suffering from AD , GLA-supplementation seemed to reduce total IgE in the first year of life
Based on the existing information , it is not possible to establish the role of antioxidants and vitamin D supplementation in atopic disease development .
There is no evidence of major effects of prenatal use of folic acid on asthma or allergies .
The association of some nutritional interventions with less atopic sensitization seems rather speculative even if such an effect has not been found for some other foods .
The findings indicate rather a balanced and diverse diet without restrictions than a special dietary protocol .
Farming-related exposures may protect against the development of atopic disorders in children .
Long-chain polyunsaturated fatty acids and probiotics seem to be promising c and i date s for allergy prevention .
The paper refers to the recently published empirical data and systematic review s on the impact of diets , foods , nutrients and bioactive substance exposures in pregnancy and in early infancy , on the development of atopic disorders .