Breast-feeding of allergic infants☆,☆☆,★

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Abstract

Objective: Infants may have allergic disease even during exclusive breast-feeding. The aim of this study was to evaluate whether allergic infants should continue breast-feeding. Study design: We studied 100 infants who had atopic eczema during exclusive breast-feeding. The extent and severity of the eczema, allergic sensitization, and the patients’ growth and nutrition were assessed during and after cessation of breast-feeding. Results: The mean body length SD score decreased at the onset of allergic disease, and an association was seen between the duration of symptoms and poor growth (r = –.23, P = .04). Some improvement could be achieved by strict elimination diet by the mothers. The atopic eczema improved significantly after breast-feeding was stopped: SCORAD score 20 (range 15 to 27) during and 7 (range 4 to 11) after breast-feeding; t = 5.38, P < .0001, and the relative length of patients increased, in parallel with improved nutritional parameters. Conclusions: Breast-feeding should be promoted for primary prevention of allergy, but breast-fed infants with allergy should be treated by allergen avoidance, and in some cases breast-feeding should also be stopped. This particularly applies to infants with atopic eczema who also have impaired growth. (J Pediatr 1999;134:27-32)

Section snippets

Patients and Study Design

We studied 100 infants fulfilling the Hanifin criteria for atopic eczema in children.16 Atopic eczema had begun during exclusive breast-feeding at a mean age of 2 months (range 0.5 to 6 months). Written informed consent was obtained from the children’s parents. The Committee On Ethical Practice of Tampere University Hospital approved the study. During primary health care the parents had received the same advice on allergy prevention, promoting exclusive breast-feeding for 4 to 6 months. The

Clinical Characteristics

A family history of atopic disorders was verified in 77 patients, and 54 had several family members with atopic disorders. The mean (95% CI) duration of pregnancy was 39 weeks (39 to 39.5 weeks), and the range was 35 to 42 weeks.

During the immediate postnatal period at the maternity ward for healthy children, 55% had received donor breast milk, starting from .8 days of age (.7 to .9 days). The total quantity consumed was 118 mL (41 to 194 mL) with a mean (95% CI). The duration of breast-feeding

DISCUSSION

For the last 2 decades a resurgence in breast-feeding has been associated with a rise in the prevalence of allergic diseases.1, 2 Consequently, the question addressed in this study, whether to continue breast-feeding of infants with allergic manifestations, now arises frequently in pediatric practice. Elimination diets, designed for the lactating mother or her infant, are commonly used in attempts to prevent or treat allergy. The families in this study had selected breast-feeding and also

Acknowledgements

We thank Tuija Poussa, MSc, for able statistical consultations.

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    ☆

    Supported by the Academy of Finland and the Emil Aaltonen Foundation.

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    Reprint requests: Erika Isolauri, MD, Department of Pediatrics, University of Turku, 20520 Turku, Finland.

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