Maternal diet during lactation
Common allergenic food proteins are present in human milk and sensitisation
may occur through breastfeeding.
The Cochrane review of antigen avoidance during lactation found that this may
substantially reduce the baby’s risk of developing atopic eczema.9
Other atopic conditions such as asthma have not been studied and the effect of
elimination diets is not separable from those of other interventions.
There is no evidence that an elimination diet during lactation is of benefit
in the prevention of asthma.9
Formula feeding
Some mothers may be unable or choose not to breastfeed and will need to be
advised on an appropriate alternative for their baby. Most infant formulas are
derived from cow’s milk, which contains powerful food allergens, and if the risk
is considered high, an alternative formula should be considered.19
Alternatives include hydrolysed formulas, in which the protein has been
enzymatically hydrolysed and heat denatured resulting in smaller molecules with
reduced allergic potential, and soya-based formulas. Partially hydrolysed
formulas are available in Australia without a prescription. Extensively
hydrolysed formulas are available with prescription but only subsidised for the
treatment of infants with combined cow’s milk and soya allergy.
Current evidence on infant formulas
Breastfeeding vs hydrolysed formula
There is no evidence to support feeding with a hydrolysed formula for the
prevention of allergy in preference to exclusive breast feeding.10
Partially hydrolysed formula
Initial studies into early feeding of infants at high risk of atopy with a
protein hydrolysate formula found a long-term protective effect on the
prevalence of eczema but not of asthma.6
Recent trials using hydrolysed milk formulas for at least four months found a
reduced prevalence of asthma in the first two years.19
In those trials, use of formulas was combined with other dietary restrictions
and house dust mite reduction measures, which may have contributed to the
benefit of the intervention.
Partially hydrolysed vs extensively hydrolysed formula
Further trials are required to determine if there is any additional benefit
from use of an extensive compared to a partially hydrolysed formula.10
What about soya formulas?
Although soya-based formulas have been popularly used in infants at risk of
allergies, there is no evidence to support their use in the prevention of
asthma.19
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If breastfeeding is not possible, mothers should be encouraged to feed their
babies with a partially hydrolysed formula for at least 4 months.10
Level I Evidence
Infant feeding after six months of age
The NHMRC Infant Feeding Guidelines38
recommend that solids should not be introduced until about 6 months of age in
infants at high risk of allergy. They suggest that parents should start by
offering low-allergenic foods such as single-grain baby cereals, followed by
vegetables and fruits, then meats. Only one food should be added at a time, with
ideally 5 to 10 days before a new food is introduced. If there is a family
history of allergy, cow’s milk and other dairy products, soya products, eggs,
nut spreads (eg peanut butter) and fish should not be introduced in the first
year.
Current recommendations on feeding for infants at high risk of developing
allergies
Up to 6 months
Exclusive breastfeeding or use of partially hydrolysed formula
6-12 months
Introduce low allergenic foods one at a time
After 12 months
Cow’s milk, dairy products, soya products, eggs, nut spreads and fish may be
gradually introduced |
