Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk

To assess the effects of prescribing an antigen avoidance diet during lactation on the nutritional status of the mother and newborn and on the development of atopic disease in the child. The main focus is on women whose infants are at high risk for developing an atopic condition, based on a history of atopic disease in the mother, father, or a previous child.

The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group.

All acceptably controlled comparisons of maternal antigen avoidance prescribed to lactating women at high risk, regardless of the degree of antigen avoidance (number of foods eliminated from the diet) or its duration. Trials of multimodal interventions that include manipulation of the infant's diet other than breast milk or of other nondietary aspects of the infant's environment (eg, exposure to inhaled allergens) have been excluded from the review.

Data were extracted by the author from published reports, and supplemented by additional information from trialists contacted by the author.

Three trials involving 209 women were included. The combined data from the three available trials suggest a strong protective effect of maternal antigen avoidance on the incidence of atopic eczema during the child's first 12-18 months of life. Methodologic shortcomings in all three trials, however, argue for caution in applying these encouraging results. In particular, the high incidence of atopic eczema in the control groups of all three trials might be explained by nonblinding or de-blinding of the examining physicians.

Prescription of an antigen avoidance diet to a high-risk woman during lactation may substantially reduce her child's risk of developing atopic eczema, but better trials are needed.