Can nutritional strategies prevent allergic disease in infants not breastfed?

Early attention to maternal diet and infant nutrition may help prevent allergy and food intolerance in high-risk infants who are unable to be completely breastfed, according to recent data and speakers at a dinner symposium Sunday evening. Speakers Peyton Eggleston, MD, professor of pediatrics at Johns Hopkins University School of Medicine; Mark Boguniewicz, MD, National Jewish Medical and Research Center and University of Colorado School of Medicine; and John A. Kerner, MD, Stanford University School of Medicine, discussed the rising prevalence of allergic disease worldwide and the key factors shaping the trend, the progression of atopic disease in genetically predisposed children, the factors associated with risk of developing allergic disease, and the evidence for a role of diet in preventing allergic disease in young children.

The prevalence of allergic disease is increasing in all countries, and is greatest among African-American children in the United States. Food allergy affects 6% to 8% of young children, with cow's milk protein the single most common food allergen, although the prevalence of some other food allergies, such as peanuts, is increasing. Asthma, the most common chronic disease of childhood, affects more than 6 million children. The prevalence of atopic dermatitis also continues to rise, and half of the approximately 17% of US schoolchildren with atopic dermatitis will develop asthma and allergic rhinitis.

Breastfeeding for at least the first 3 months of life confers a significant protective effect against allergic disease, but what of those infants who are unable to be breastfed? The 2003 German Infant Nutritional Intervention Study demonstrated that the cumulative incidence of atopic dermatitis was greater at 36 months of age among those children receiving intact cow's milk formula and extensively hydrolyzed whey formulas than those children who received partially hydrolyzed whey or casein formulas. According to Dr. Kerner, using hydrolyzed infant formulas instead of ordinary cow's milk or soy milk formulas can reduce allergies in infants and children.

Extensively hydrolyzed casein formulas and partially hydrolyzed whey formulas are appropriate alternatives to breast milk for allergy prevention in infants at risk, although risk is somewhat difficult to determine. Dr. Kerner concluded that because atopic disease in children cannot be predicted, the use of these formulas in the general population should be considered, weighing cost, compliance, and long-term benefits.