Can exclusive breastfeeding in the first 4 months reduce food allergy?: A retrospective questionnaire study

IgE-mediated food allergy (FA) is a major global health concern. Although the early introduction of allergenic foods and breastfeeding are potential preventive strategies, the role of breast milk in reducing the incidence of FAs remains inconclusive.

To investigate the impact of exclusive breastfeeding for the first 4 months compared with partial breastfeeding or cow's milk formula (CMF) on the development of IgE-mediated FAs in an Israeli cohort.

A cross-sectional online survey in 3030 mothers with infants aged 6 to 24 months collected data on early feeding practices, allergen introduction, atopic conditions, and family history. It documented suspected allergic reactions, symptoms, and diagnostic procedures.

Of the 3030 mothers surveyed, 2920 provided complete feeding data for the first 4 months. Among them, 39.0% exclusively breastfed, 12.1% used CMF, and 48.9% partially breastfed. There were 392 infants with FAs, totaling 480 cases involving cow's milk, sesame, egg, or peanut. Of these cases, 122 (25.4%) were in the breastfeeding group, and 358 (74.6%) were in the other groups. Exclusively breastfed infants had lower odds of egg (odds ratio [OR] = 0.53), sesame (OR = 0.58), and peanut (OR = 0.53) allergies than others. The interaction between feeding patterns and atopic dermatitis (AD) related to these FAs was not significant. Exposure to CMF in the nursery, exclusively breastfed, was associated with higher odds of developing a cow's milk allergy. Delayed exposure to sesame in infants with AD has been linked to increased odds of developing a sesame allergy.

Exclusive breastfeeding may reduce the risk of IgE-mediated FA development, regardless of AD status.