Treatment and prevention of food allergies in breastfed infants: practice and evidence

Abstract

Objective: To determine whether current Australian dietetic practice is consistent with research relating to maternal dietary restrictions for treatment and prevention of food allergy in breasted infants. Design: Mail survey to benchmark practice and a systematic review of relevant studies and trials. Subjects and setting: All 15 Australian specialist paediatric allergy dietitians were surveyed. The systematic review was confined to studies involving maternal dietary intervention followed by maternal dietary challenge for the treatment of breasted infants with food allergy, trials investigating maternal dietary restriction during lactation for allergy prevention, and studies where food proteins have been detected in human milk after the ingestion of a specific food challenge. Main outcome measure: Assessment of current practice in relation to the level and quality of evidence on food allergy treatment and prevention in breasted infants. Results: The majority of dietitians (13 out of 15) surveyed follow recommendations of expert committees that breasted infants with food allergy symptoms are trialled on maternal dietary restriction. However, the strength of published evidence in this area is limited and high quality randomised controlled trials are required to test the validity of current practice and recommendations. Maternal dietary restrictions to prevent food allergy were used by six of the 15 dietitians surveyed. No clinical trials have investigated maternal dietary restriction during breast feeding with the specific outcome of reducing the development of food allergy. Conclusion: Insufficient high quality evidence exists to determine the extent of benefit offered by maternal food avoidance diets to breasted infants for the treatment and prevention of food allergy.