Elimination of allergens in the diet of mother and child in the primary prevention of atopic dermatitis

Abstract

Introduction: Eliminating allergens from the diets of pregnant and breastfeeding women, as well as feeding infants formula and soy milk, is promoted as a way to prevent the development of atopic dermatitis (AD). However, it is difficult to separate scientific evidence from marketing in this field. Aim: To assess the effectiveness of diets recommended for the prevention of atopic dermatitis using an umbrella review - a compilation of the results of multiple systematic reviews in a coherent and easier-to-understand format. Materials and Methods: In March 2008, we searched The Cochrane Database of Systematic Reviews. Of the 12 identified, three systematic reviews of randomized or quasi-randomized controlled trials that assessed the effects of the following diets met the inclusion criteria: 1) an elimination diet in pregnant and lactating women, 2) slightly or extensively hydrolyzed cow's milk protein hydrolysates in infants and children, and 3) soy milk in infants. Results: The results of randomized controlled trials indicate that elimination diets in pregnant and lactating women do not reduce the risk of atopic dermatitis. Furthermore, the use of an elimination diet in pregnant women may adversely affect the child's birth weight, which may increase the risk of metabolic disorders later in life. The results of previous (quasi-)randomized studies suggest a slightly lower risk of atopic dermatitis in children fed cow's milk hydrolysates and a slightly higher risk in those fed soy milk compared to children fed whole cow's milk. However, the observed differences do not reach the assumed level of statistical significance (low or medium credibility). Conclusions: An elimination diet is not recommended for the primary prevention of atopic dermatitis in pregnant women due to the potential adverse effects on the infant's birth weight (risk of cardiovascular and metabolic diseases later in life) and the increased risk of premature birth. Eliminating allergens from the diet of breastfeeding mothers does not reduce the risk of atopic dermatitis in children from the high-risk group. If breastfeeding is not possible for newborns and infants not belonging to the high-risk group, there is no evidence of the superiority of protein hydrolysates and soy formulas over standard cow's milk formulas in the primary prevention of atopic dermatitis. In newborns and infants from the high-risk group for whom breastfeeding is not possible, there is no evidence of a beneficial effect of using cow's milk protein hydrolysates in the prevention of atopic dermatitis. Breast milk remains the best food for newborns and infants.

Key words: atopic eczema, atopic dermatitis, prevention, diet, protein hydrolysates, soy formulas, Cochrane review, systematic review, umbrella review.

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Dermatologist and allergist in Krakow (Cracow), Poland

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