Send to

Choose Destination
Pediatrics. 2019 Apr;143(4). pii: e20190281. doi: 10.1542/peds.2019-0281. Epub 2019 Mar 18.

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.


This clinical report updates and replaces a 2008 clinical report from the American Academy of Pediatrics, which addressed the roles of maternal and early infant diet on the prevention of atopic disease, including atopic dermatitis, asthma, and food allergy. As with the previous report, the available data still limit the ability to draw firm conclusions about various aspects of atopy prevention through early dietary interventions. Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation. Although there is evidence that exclusive breastfeeding for 3 to 4 months decreases the incidence of eczema in the first 2 years of life, there are no short- or long-term advantages for exclusive breastfeeding beyond 3 to 4 months for prevention of atopic disease. The evidence now suggests that any duration of breastfeeding ≥3 to 4 months is protective against wheezing in the first 2 years of life, and some evidence suggests that longer duration of any breastfeeding protects against asthma even after 5 years of age. No conclusions can be made about the role of breastfeeding in either preventing or delaying the onset of specific food allergies. There is a lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease. There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease. There is now evidence that early introduction of peanuts may prevent peanut allergy.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Sicherer received royalties from UpToDate and Johns Hopkins University Press; grants to his institution from HAL Allergy Group, Food Allergy Research and Education, the Immune Tolerance Network, and the National Institute of Allergy and Infectious Diseases; and honoraria from the American Academy of Allergy, Asthma, and Immunology (as an associate editor) and is a medical advisor to the Food Allergy Fund and the International Association for Food Protein Enterocolitis. He was a member of the following sponsored expert panel: Guidelines for the Prevention of Peanut Allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases; and Drs Greer and Burks have indicated they have no potential conflicts of interest to disclose.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center