Abstract
Background and objective: The present work reviews the nutritional options during the first year of life that may affect the development of atopic diseases. The main preventive measures are introduced and their role in allergy prevention is evaluated. Method: Based on previously defined criteria, a total of 18 prospective studies on primary alimentary prevention is included in the review. Their results are summarized and discussed. Results: Apart from partially controversial results, current data supports the protective effect of breastfeeding for at least 4 months. If breastfeeding is insufficient, the use of hydrolyzed formula is recommended. For both measures, preventive effects can particularly be obtained in case of atopic eczema, wheezing, and asthma in early childhood. Apart from that, there is no evidence for any beneficial effect of delayed introduction of solid food after the sixth month of age. Complementary food should be introduced one at a time to detect reactions to specific food components. Discussion: The controversial data results from serious methodological differences. Thus, a direct comparison of the studies results seems not feasible. Even though there is strong evidence that allergy prevention can benefit from exclusive breastfeeding and the use of hydrolyzed formula, the optimal timing for the introduction of complementary foods yet has to be studied in a comprehensive manner. On the basis of available data, detailed recommendations for infant feeding after the sixth month of age cannot be formulated. Moreover, the deficiency of risk cohorts and the fact that available data are almost exclusively from observational studies restrict the studies validity concerning the allergy prevention in children with a genetic predisposition for atopic diseases. Conclusion: Further research on primary alimentary prevention of atopic diseases in children at risk needs to be conducted.
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