This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Atopic disease:

• Atopic dermatitis
• Asthma
• Food allergies

Incidence of atopic diseases (asthma, atopic dermatitis, food allergies) in infants and children

Databases for this report included PubMed and Google Scholar. The time frame of the search was 1980 through June of 2007. The search was for clinical trials and review articles on the prevention of atopic disease in infants and children. Search terms included atopic disease, atopic dermatitis, asthma, food allergy, lactation, pregnancy, breast milk, breast feeding, hydrolyzed formula, solid foods, complementary foods . There were no specific inclusion or exclusion criteria, though randomized controlled trials were preferred over cohort studies in making the summary statement of the report.

Not stated

Not applicable

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not applicable

It is evident that inadequate study design and/or a paucity of data currently limit the ability to draw firm conclusions about certain aspects of atopy prevention through dietary interventions. In some circumstances in which there are insufficient studies (pregnancy and lactation avoidance diets, timing of introduction of specific complementary foods), the lack of proven efficacy does not indicate that the approach is disproved. Rather, more studies would be needed to clarify whether there is a positive or negative effect on atopy outcomes. The following statements summarize the current evidence within the context of these limitations.

1. At the present time, there is lack of evidence that maternal dietary restrictions during pregnancy play a significant role in the prevention of atopic disease in infants. Similarly, antigen avoidance during lactation does not prevent atopic disease, with the possible exception of atopic eczema, although more data are needed to substantiate this conclusion.
2. For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least 4 months compared with feeding intact cow milk protein formula decreases the cumulative incidence of atopic dermatitis and cow milk allergy in the first 2 years of life.
3. There is evidence that exclusive breastfeeding for at least 3 months protects against wheezing in early life. However, in infants at risk of developing atopic disease, the current evidence that exclusive breastfeeding protects against allergic asthma occurring beyond 6 years of age is not convincing.
4. In studies of infants at high risk of developing atopic disease who are not breastfed exclusively for 4 to 6 months or are formula fed, there is modest evidence that atopic dermatitis may be delayed or prevented by the use of extensively or partially hydrolyzed formulas, compared with cow milk formula, in early childhood. Comparative studies of the various hydrolyzed formulas have also indicated that not all formulas have the same protective benefit. Extensively hydrolyzed formulas may be more effective than partially hydrolyzed in the prevention of atopic disease. In addition, more research is needed to determine whether these benefits extend into late childhood and adolescence. The higher cost of the hydrolyzed formulas must be considered in any decision-making process for their use. To date, the use of amino acid–based formulas for atopy prevention has not been studied.
5. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention.
6. Although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow milk protein formula or human milk. This includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.
7. For infants after 4 to 6 months of age, there are insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.
8. Additional studies are needed to document the long-term effect of dietary interventions in infancy to prevent atopic disease, especially in children older than 4 years and in adults.
9. This document describes means to prevent or delay atopic diseases through dietary changes. For a child who has developed an atopic disease that may be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment may require specific identification and restriction of causal food proteins. This topic was not reviewed in this document.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Appropriate early nutritional intervention to prevent or delay the onset of atopic disease in at-risk infants

Not stated

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

American Academy of Pediatrics

Committee on Nutrition

Section on Allergy and Immunology

Committee on Nutrition, 2006-2007: Frank R. Greer, MD, Chairperson; Robert D. Baker, Jr, MD, PhD; Jatinder J. S. Bhatia, MD; Stephen Robert Daniels, MD, PhD; Marcie B. Schneider, MD; Janet Silverstein, MD; Dan W. Thomas, MD

Liaisons: Sue Ann Anderson, PhD, RD, Food and Drug Administration; Donna Blum-Kemelor, MS, RD, US Department of Agriculture; Margaret P. Boland, MD, Canadian Paediatric Society; Laurence Grummer-Strawn, PhD, Centers for Disease Control; Capt Van S. Hubbard, MD, PhD, National Institutes of Health; Benson M. Silverman, MD, Food and Drug Administration

Staff: Debra Burrowes

Section on Allergy and Immunology, 2006-2007: Paul V. Williams, Chairperson; Michael J. Welch, MD, Immediate Past Chairperson; Sami L. Bahna, MD; Bradley E. Chipps, MD; Mary Beth Fasano, MD; Mitchell R. Lester, MD; Scott H. Sicherer, MD; Frank S. Virant, MD

Liaisons: Todd A. Mahr, MD, American College of Allergy, Asthma, and Immunology; Dennis R. Ownby, MD, National Conference and Exhibition Planning Group Liaison; Gary S. Rachelefsky, MD, American Academy of Allergy, Asthma, and Immunology

Staff: Debra Burrowes

Consultants: A. Wesley Burks, MD

Not stated

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Electronic copies: Available from the American Academy of Pediatrics (AAP) Policy Web site .

Print copies: Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

None available

None available

This NGC summary was completed by ECRI Institute on April 7, 2009. The information was verified by the guideline developer on April 23, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.