| | Solid Food Introduction in Relation to Eczema: Results from a Four-Year Prospective Birth Cohort StudyReceived 16 October 2006; received in revised form 21 March 2007; accepted 4 May 2007. published online 24 August 2007.
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Food for Thought on Prevention and Treatment of Atopic Disease Through Diet
Scott H. Sicherer
The Journal of Pediatrics
October 2007 (Vol. 151, Issue 4, Pages 331-333)
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Breast-Feeding Duration and Infant Atopic Manifestations, by Maternal Allergic Status, in the First 2 Years of Life (KOALA Study)
, 15 July 2007
Bianca E.P. Snijders, Carel Thijs, Pieter C. Dagnelie, Foekje F. Stelma, Monique Mommers, Ischa Kummeling, John Penders, Ronald van Ree, Piet A. van den Brandt
The Journal of Pediatrics
October 2007 (Vol. 151, Issue 4, Pages 347-351.e2)
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IgE Food Sensitization in Infants with Eczema Attending a Dermatology Department
, 07 August 2007
David J. Hill, Ralf G. Heine, Cliff S. Hosking, Jennifer Brown, Leone Thiele, Katrina J. Allen, John Su, George Varigos, John B. Carlin
The Journal of Pediatrics
October 2007 (Vol. 151, Issue 4, Pages 359-363)
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ObjectiveTo assess the association between the introduction of solid foods in the first 12 months and the occurrence of eczema during the first 4 years of life in a prospective study of newborns. Study designData were taken from annually administered questionnaires from a large birth cohort (recruited 1995–1998) comprised of an intervention and a nonintervention group. Outcomes were doctor-diagnosed and symptomatic eczema. Multiple generalized estimation equation models were performed for the 2 study groups. ResultsFrom the 5991 recruited infants, 4753 (79%) were followed up. The 2 study groups were different in their family risk of allergies and feeding practices. No association was found between the time of introduction of solids or the diversity of solids and eczema. In the nonintervention group, a decreased risk was observed for avoidance of soybean/nuts, but an increased risk was seen in doctor-diagnosed eczema for the avoidance of egg in the first year. ConclusionThe evidence from this study supports neither a delayed introduction of solids beyond the fourth month nor a delayed introduction of the most potentially allergenic solids beyond the sixth month of life for the prevention of eczema. However, effects under more extreme conditions cannot be ruled out. Infant feeding guidelines recommend a delayed introduction of solids to beyond 4 to 6 months of age to prevent atopic diseases.1, 2, 3, 4 In 2001, the World Health Organization tightened their recommendations and proposed exclusive breastfeeding for the first 6 months of life and the introduction of solids only thereafter.3 However, scientific evidence supporting a delayed solid food introduction for the prevention of atopic diseases is scarce and inconsistent.5, 6 The discussion was revived, and new studies were demanded taking into account reverse causality and confounding factors for population subgroups.7 See editorial, p 331 and related articles, p 347 and p 359 Recently, we published results from the German LISA cohort (Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood), which considered reverse causality in the relationship between the introduction of solids and eczema at 2 years of life.8 In the GINI (German Infant Nutritional Intervention Program) cohort study, we used the same questions as in the LISA cohort to investigate eczema outcomes and feeding exposure. New to this analysis is the extended length of observation period (from 2 years8 to 4 years of age) and the presence of 2 comparison groups for different family risks of allergy and feeding recommendations. The aims of our analyses were to compare feeding practices in 2 study groups with different family risks of allergy and to investigate whether a delayed introduction of solids (past 4 months or past 6 months) is protective against the development of eczema. Methods  Study Population Between September 1995 and July 1998, a total of 5991 term newborn infants were recruited from 2 regions of Germany (urban Munich, Bavaria, and rural Wesel, North-Rhine-Westfalia). Family risk of atopy was assessed by questionnaire, and parents of infants at high risk for allergic diseases were asked to participate in the intervention study. The cohort is composed of an intervention (n = 2252) and nonintervention group (n = 3739). Self-administered questionnaires were sent annually to all parents around the children’s birthdays. The intervention subgroup (I group) was infants with a family history of allergy described in detail elsewhere.9 Briefly, this study was a prospective, randomized, double-blind trial that investigated the effect of hydrolyzed formulas compared with conventional cow’s milk formula in preventing allergies. Mothers were encouraged to breast feed for at least 4 months and were advised to feed a randomized formula in case of insufficient breast feeding. Furthermore, it was recommended not to introduce solid foods during the first 4 months of life and thereafter to introduce only 1 new food item per week. Potentially allergenic food such as cow’s milk and dairy products, eggs, fish, tomatoes, nuts, soy products, and citrus fruits were to be avoided entirely during the first year. The nonintervention subgroup (NI group) was infants who did not have a family history of allergy or whose parents did not wish to participate in the intervention trial. This group did not receive any dietary recommendations. Written informed consent was obtained from all participating families, and the study protocol was approved by local ethics committees. Questionnaires Basic information on family history of allergy, siblings, parental education, maternal smoking, and age was included in the initial questionnaire at recruitment. The subsequent annual questionnaires (at infants’ age 1, 2, 3, and 4 years) included questions on doctor diagnoses and symptoms of eczema, other medical conditions, some lifestyle and environmental factors, such as exposure to tobacco smoke, keeping of and contact with pets, and early contact with other children. At the end of the first year, questions about feeding practices during the first year were also included. Outcomes Doctor-diagnosed eczema was defined by parents reporting a physician’s diagnosis of eczema from the preceding 12 months. (The question was: “Did a physician diagnose any of the following diseases during the 1st/2nd/3rd/4th year of life: … allergic or atopic eczema/dermatitis?”). Symptomatic eczema was defined by parents reporting an itching eczema within the preceding 12 months that was either recurrent or lasted for more than 6 months (first year)/2 weeks (second to fourth year) and that affected the skin creases, face, neck, extremities, hands, feet, or trunk (not underneath the diaper). Exposure When the infants were 12 months old, parents were asked about breast feeding practices and about the timing of solid food introduction into the child’s diet. Possible answer choices included “1st until 4th month,” “5th/6th month,” “7th to 12th month,” and “solid food item not yet introduced.” Forty-eight single food items were classified into the following 8 solid food groups: vegetables, cereal, fruit, meat, dairy products, egg, fish, and other (soybean, nuts, cocoa, chocolate). Summary exposure variables included any solids, defined by the timing of first introduction of any of the above mentioned solid food items, and solids diversity, defined at 4 months and at 6 months by summing up the number of different food groups that were included in the child’s diet at that time. The classification of food groups and the definition of summary exposure variables followed the definitions of Fergusson et al10 and LISA.8 Risk Factors or Confounder For sociodemographic factors we considered sex, study region (Munich, Wesel), number of older siblings, and parental education (categorized by the highest number of years of school attendance by either parent). Family history of allergy was classified in “no,” “single,” and “double.” A single family history was defined by at least 1 parent or sibling ever having allergic eczema, asthma, allergic rhinitis, urticaria, or food allergy. A double history of allergy was present if both parents had at least 1 of the above allergic diseases. Family history of allergic eczema was considered positive if either 1 parent or sibling ever had allergic eczema. Passive tobacco smoke exposure was asked about in the annual questionnaires in and after the second year. Mothers who smoked before pregnancy were identified from the questions at recruitment. The type of milk feeding during the first 6 months was defined separately from solid food introduction. The question at year 1 was “What kind of milk did your child drink during the 1st/2nd/3rd/4th/5th and 6th month of life?” The infant was defined as “breast fed only” if parents selected “human milk only” for the first 4 months. The other categories were “formula only” or “mixed feeding” during the first 4 months of life. The type of formula (cow’s milk–based, partial or extensive hydrolysate) was known for the compliant infants in the I group for the first 4 months and, for all others, the type was defined by the given brand names. Statistical Analysis Stratified analyses were performed to account for possible effect modification by study group. For the descriptive analyses, proportions were given and tested by χ2 testing. Multiple repeated measures models were performed to investigate the association between different solid food measures and eczema outcomes. To model longitudinal data with missing outcome because of loss to follow-up, generalized estimation equations were used, and results were presented as adjusted odds ratio with 95% confidence intervals. Solid food measures examined comprised single food groups and the summary exposure variables. The exposure groups of solids were combined if a cell size covered less than 40 observations in the analyzed strata. All models were controlled for the fixed set of risk and confounding factors, family history of allergic eczema, and type of milk feeding (different dummy variables). The factors—sex, study area, siblings, parental education, maternal smoking before pregnancy, exposure to passive smoking, and birth weight—were considered but not included in the models because no confounding effects were seen. After performing sensitivity analyses, missing information in the confounder or in the exposure variables was assigned to the most frequent category, or in case of more than 50 observations, as a new category. Statistical analyses were done with the statistical software SAS for Windows, version 9.1 (SAS Institute, Cary, NC). Results Study Population and Follow-up From the 5991 recruited newborns (2252 in the I group and 3739 in the NI group), total loss to follow-up was 25% in the NI group and 14% in the I group. First-year questionnaires were filled out by 75% of participants in the NI group and 83% of participants in the I group; every annual questionnaire was available only in 64% of participants and 66% of participants in each group, respectively (Table I). Baseline Characteristics The I group comprised only infants with single or double heredity of allergy, whereas, in the NI group, 67% of infants with follow-up had no positive family history of allergy. Allergic eczema in the family history was present in only 10% in the NI group compared with 40% in the I group. The 2 groups differed in parental education and number of siblings, but not in sex, birth weight, or tobacco exposure (Table II). Significantly (P < .001) more eczema (doctor diagnosed as symptomatic) was reported in the I group than in the NI group at all stages of follow-up (Table I). Feeding Practices The I and NI groups differed strongly (statistically significant with P < .001) in their feeding practices (Table III). In the I group, solid foods were introduced later (14% in the first 4 months vs 34% in the NI group) and with less diversity (5% “more than 5 solid groups” at 6 months vs 24% in the NI group). The potentially allergenic foods such as dairy products and egg were often avoided in the first half year: dairy products were given in the first 6 months by only 6% in the I group compared with 26% in the NI group, and eggs 2% versus 13%, respectively. The proportion of breast feeding was higher in the I group (55%) than in the NI group (47%) (Table II). Association of Feeding Practices and Eczema For neither the I group nor the NI group was any association between doctor-diagnosed or symptomatic eczema and time of introduction and diversity seen (Table III). Looking at the single food groups of early introduced solids such as vegetables, fruits, and cereals, no evidence for a protective effect on eczema was seen for delayed introduction beyond 4 months. In the I group, no effect for a delayed introduction of potentially allergenic foods beyond the sixth month was observed. The introduction of meat in the second half of the first year is associated with higher doctor-diagnosed eczema. In the NI group, we observed a protective effect on both eczema outcomes if soybean, nuts, and cocoa were introduced in the second half of the first year. In those of the NI group who avoided eggs in the first year of life, we observed a significantly increased risk in doctor-diagnosed eczema, but not in symptomatic eczema. A tendency of a higher increased risk of doctor-diagnosed eczema than symptomatic eczema was also seen in those who avoided meat, dairy products, and fish. Discussion In this large population-based prospective birth cohort study, there was no evidence for a protective effect in relation to eczema from delayed introduction of solids beyond the fourth month and of most potentially allergenic solids beyond the sixth month of life. Only the avoidance of soybeans, nuts, and cocoa in the first 6 months seemed to have advantage in those infants of the NI group. The results of this study are consistent with the findings of LISA, another large German birth cohort,8 where reverse causation was considered. This analysis strategy was based on the assumption that most parents were aware of current prophylactic feeding recommendations and would delay the introduction of solids when they noticed symptoms of eczema in their infant. In symptomatic infants, a late introduction of solids could be associated with increased frequency of eczema (reverse causality), or a true protective effect could be masked. The infants were therefore stratified by the presence of allergic symptoms within the first 6 months of life, and occurrence of eczema in months 6 to 24 was examined. The strata of infants without early allergic symptoms were interpreted as unaffected from reverse causality. Exclusion of children with eczema during the period of breast-feeding was 1 of 3 modes that were described to avoid disease-related modification of exposure in the analyses of the relationship between breast-feeding and asthma and eczema.11, 12 The 2 other modes were analysis of the whole cohort and take into account only the exposure before the onset. These methods seemed open to criticism.6 In GINI, the information used to control for reverse causation was not available. Early skin or allergic symptoms were first assessed at age 1 year, and no further information was available to decide whether early symptoms occur before or after introduction of a single solid. Later introduction of allergenic solids may be a result of early skin or allergic symptoms and may lead to reverse causation. However, family risk and awareness of allergies may influence the delayed introduction of allergic solids as well. The analyses showed that feeding recommendations of a delayed introduction of solids2, 3 were well accepted in families with high allergy risk. Adherence to the general feeding guidelines was better in the I group that had received special feeding recommendations. Feeding practice in the NI group was very similar to the LISA study in which no special feeding recommendations were given.8 This was not expected because family risk of allergy and education was higher in LISA, and we expected more awareness of solid food avoidance in LISA, which was only present for egg introduction. In considering the study results on the association between allergies and solids, it should be noted that feeding practice of single solids differs between countries and has changed in the last 30 years10, 13, 14, 15, 16, 17, 18, 19 and that the introduction of solids is associated with milk feeding practice.20, 21 No consistent evidence for an association between early solid feeding and eczema was found by studies in the last 25 years.8, 10, 13, 18, 22, 23, 24, 25, 26, 27 A recently published review28 included 4 studies with no association and 5 studies with a positive association; of these 5, 3 studies were based on an identical birth cohort with different follow-up times. Early introduction of solids was found to be a risk factor for eczema in a study conducted in New Zealand in the 1970s with different follow-up times,10, 13, 22 studies with a short follow-up period,23, 24 and in a study based on preterm infants with a history of allergy.26 The study in New Zealand10, 13, 22 followed a population-based cohort for 10 years. At 2 years of age, eczema was significantly more frequent in infants fed solids before 4 months of age than in those fed no solids (18% vs 13%). Furthermore, the association was found to be dose dependent; the prevalence of eczema increased with the number of different food types from 13% for no foods, 16% for 1 to 3, and up to 20% for 4 and more food types. However, feeding practices substantially differed at that time (1970s and 1980s), with a much lower breast feeding rate (on average, only exclusively 18% were breast fed in comparison to more than 49% in GINI and LISA) and a much earlier introduction of solids with higher diversity compared with the GINI and LISA studies. For example, 34% of solids were introduced in the first 4 months in the German cohort, whereas the proportion in the New Zealand cohort was 72% (where cereals were introduced in 56%, vegetables in 43%, fruits in 44%, and egg in 13% of participants). In the New Zealand cohort, the very early introduction of solids within the first 4 months in the absence of human milk may produce a different immunologic response than solid introduction after 3 or even 4 months of age in the presence of breast feeding. The differences in feeding behavior are most likely due to increased awareness of allergy and the increasing awareness of feeding recommendations from 1977 to 1996. This should be considered in the comparison of different results. Few studies considered specific food types.8, 17, 22 In a 10-year follow-up study,22 no particular food type was significantly associated with eczema. A statistically significant increased risk of eczema in relation to late introduction of egg and milk has been observed in 1 study.17 This is in line with our result of an increased risk in doctor-diagnosed eczema when egg was introduced in the second year. In those infants where soybean, nuts, and cocoa were avoided in the first 6 months, we observed a decreased risk. The findings concerning single solids should be interpreted with caution. The introduction of a single food may interact with other single foods. If cow’s milk was not tolerated by an infant, or if it was recommended to avoid cow’s milk protein–based formulas during infancy, the soy protein–based formula could be an alternative. If we suppose that these infants have an increased risk for eczema and were introduced to soybean products in the first 4 months, then we would expect an increased risk for early introduction and, therefore a decreased risk for a delayed introduction. Similar cases may be responsible for our findings with eggs; the introduction of any other solid may result in the onset of eczema with the possible consequence that potentially allergenic foods, especially eggs, may be avoided in the first year. This would be characterized as reverse causation. The more pronounced weaker association in symptomatic eczema may support reverse causation because prevalence of this outcome was lower than a doctor’s diagnosis in the first year because of strict definition (itching for more than 6 months), and therefore the risk of those avoiding eggs should be less increased than in those with doctor-diagnosed eczema. The current recommendations on the introduction of specific allergenic foods are not evidence based, and the recently published consensus document on food allergy6 confirmed the need for practice guidelines based on special epidemiologic and clinical studies. Selection bias because of loss to follow-up (11% in the second to fourth year) has to be considered in the interpretation of the results. No difference was found between infants lost to follow-up after first year and those not lost to follow-up in relation to family risk of allergy or eczema, nor doctor-diagnosed and symptomatic eczema in the first year. Those who dropped out introduced solids more frequently in the first 4 months and with more diversity at 4 months. Therefore no bias may be expected because of “family risk” (an important factor) or because of an eczema outcome, but the association between early food introduction or high food diversity and eczema may be underestimated. However, it has to be considered that our population is restricted to families with a high level of parental education and homogenous feeding practices. Exposure was assessed retrospectively at age 1 year, and misclassification because of recall bias cannot be excluded. In the second half of the first year, the incidence of eczema is relatively high, and symptoms or diagnoses may influence the recall of exposure. Fruit or vegetable juices were not explicitly named in the questionnaire, and these solids may be underreported. The time of first introduction was asked with the implication that even if the solid was given only once, it was of interest. The recall of egg in a self-administered questionnaire may be problematic, because perhaps not all parents knew that egg may be included in noodles, sauces, or biscuits. Because we found a similar pattern of solid feeding in the LISA study, for which data were gathered at 6 months, we believe that the parents’ recall should be sufficiently precise to avoid substantial misclassification. This study does not find evidence supporting a delayed introduction of solids beyond the fourth month or a delayed introduction of most potentially allergenic solids beyond the sixth month of life for the prevention of eczema. Our results question the strict recommendations given by the World Health Organization and the American Academy of Pediatrics for delayed solid food introduction for allergy prevention. We would like to thank the families for participation in the study, the obstetric units for allowing the recruitment procedure, and the GINI team for excellent work. GINI-Study group: Wesel: D. Berdel, A.von Berg, B. Albrecht, A. Baumgart, Ch. Bollrath, S. Büttner, S. Diekamp, T. Jakob, I. Groβ, K. Klemke, S. Kurpiun, T. Müller-Wening, A. Varhelyi, C. Zorn; LMU Munich: D. Reinhardt, S. Koletzko, B. Bäumler-Merl, R. Göhlert, I. Jesch, M. Koch, T. Sauerwald, C. Sönnichsen, C. Tasch, M. Waag, H. Weigand, D. Mühlbauer; TU Munich: C.P. Bauer, A. Grübl, P. Bartels, I. Brockow, A. Fischer, U. Hoffmann, R. Mayrl, K. Negele, E.-M. Schill, B. Wolf; GSF Institute of Epidemiology Neuherberg: H.E. Wichmann, I. Brockow, M. Engl, B. Filipiak-Pittroff, K. Franke, U. Gehring, J. Heinrich, K. Honig-Blum, G. Kruse, M., B. Laubereau, Popescu, A. Sindl, A. Schoetzau, A. Zirngibl, A Zutavern. References 1. 1Host A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P, et al. Dietary products used in infants for treatment and prevention of food allergy (Joint statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition). Arch Dis Child. 1999;8:80–84. 2. 2American Academy of Pediatrics. Committee on Nutrition (Pediatric Nutrition Handbook). 5th ed.. Elk Grove IL: AAP; 2004;. 3. 3WHO. Fifty-fourth world health assembly. WHA54.2. Agenda item 13.1. Infant and young child nutrition. 2004;. 4. 4Muraro A, Dreborg S, Halken S, Host A, Niggemann B, Aalberse R, et al. Dietary prevention of allergic diseases in infants and small children (Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations). Pediatr Allergy Immunol. 2004;15:291–307. MEDLINE |
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5. 5Foote KD, Marriott LD. Weaning of infants. Arch Dis Child. 2003;88:488–492.
CrossRef
6. 6Fiocchi A, Assa’ad A, Bahna S. Food allergy and the introduction of solid foods to infants: a consensus ducument. Ann Allerg Asthma Immunol. 2006;97:10–21. 7. 7Khakoo GA, Lack G. Introduction of solids to the infant diet. Arch Dis Child. 2004;89:295.
CrossRef
8. 8Zutavern A, Brockow I, Schaaf B, Bolte G, Von Berg A, Diez U, et al. The timing of solid food introduction in relation to atopic dermatitis and sensitisation considering reverse causality: results from a prospective birth cohort study. Pediatrics. 2006;117:401–411. 9. 9von Berg A, Koletzko S, Grübl A, Filipiak-Pittroff B, Wichmann HE, Bauer CP, et al. The effect of hydrolyzed cow’s milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol. 2003;111:533–540. Abstract | Full Text |
Full-Text PDF (96 KB)
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10. 10Fergusson DM, Horwood LJ, Beautrais AL, Shannon FT, Taylor B. Eczema and infant diet. Clin Allergy. 1981;11:325–331. MEDLINE 11. 11Kull I, Almqvist C, Lilja G, Pershagen G, Wickmann M. Breast-feeding reduces the risk of asthma during the first 4 years of life. J Allergy Clin Immunol. 2004;114:755–760. Abstract | Full Text |
Full-Text PDF (162 KB)
|
CrossRef
12. 12Kull I, Böhme M, Wahlgren CF, Nordvall L, Pershagen G, Wickmann M. Breast-feeding reduces the risk for childhold eczema. J Allergy Clin Immunol. 2005;116:657–661. Abstract | Full Text |
Full-Text PDF (101 KB)
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CrossRef
13. 13Fergusson DM, Horwood LJ, Shannon FT. Risk factors in childhood eczema. J Epidemiol Community Health. 1982;36:118–122.
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14. 14Donath SM, Amir LH. The introduction of breast milk substitutes and solid foods: evidence from the 1995 National Health Survey. Aust N Z J Public Health. 2002;26:481–484. MEDLINE |
CrossRef
15. 15Donath SM, Amir LH. Breastfeeding and the introduction of solids in Australian infants: data from the 2001 National Health Survey. Aust N Z J Public Health. 2005;29:171–175. MEDLINE |
CrossRef
16. 16Crocetti M, Dudas R, Krugman S. Parental beliefs and practices regarding early introduction of solid foods to their children. Clin Pediatr (Phila). 2004;43:541–547. MEDLINE |
CrossRef
17. 17Giovannini M, Riva E, Banderali G, Scaglioni S, Veehof SH, Sala M, et al. Feeding practices of infants through the first year of life in Italy. Acta Paediatr. 2004;93:492–497. MEDLINE |
CrossRef
18. 18Zutavern A, von Mutius E, Harris J, Mills P, Moffatt S, White C, et al. The introduction of solids in relation to asthma and eczema. Arch Dis Child. 2004;89:303–308.
CrossRef
19. 19Brekke HK, Ludvigsson JF, van Odijk J, Ludvigsson J. Breastfeeding and introduction of solid foods in Swedish infants: the All Babies in Southeast Sweden study. Br J Nutr. 2005;94:377–382. MEDLINE |
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20. 20Laubereau B, Brockow I, Zirngibl A, Koletzko S, Gruebl A, Von Berg A, et al. Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life—results from the GINI-birth cohort study. J Pediatr. 2004;144:602–607. Abstract | Full Text |
Full-Text PDF (135 KB)
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21. 21Schoetzau A, Filipiak-Pittroff B, Franke K, Koletzko S, Von Berg A, Gruebl A, et al. Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. Pediatr Allergy Immunol. 2002;13:234–242. MEDLINE |
CrossRef
22. 22Fergusson DM, Horwood LJ, Shannon FT. Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study. Pediatrics. 1990;86:541–546. 23. 23Forsyth JS, Ogston SA, Clark A, Florey CD, Howie PW. Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. BMJ. 1993;306:1572–1576. 24. 24Kajosaari M, Saarinen UM. Prophylaxis of atpoic diseases by six months’ total solid food elimination: evaluation of 135 exclusively breast fed infants of atopic families. Acta Paediatr Scand. 1983;72:411–414. 25. 25Kajosaari M. Atopy prophylaxis in high-risk infants (Prospective 5-year follow-up study of children with six months exclusive breastfeeding and solid food elimination). Adv Exp Med Biol. 1991;310:453–458. MEDLINE 26. 26Morgan J, Williams P, Norris F, Williams CM, Larkin M, Hampton S. Eczema and early solid feeding in preterm infants. Arch Dis Child. 2004;89:309–314.
CrossRef
27. 27Zeiger RS, Heller S. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol. 1995;95:1179–1190. Abstract | Full Text |
Full-Text PDF (1050 KB)
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28. 28Tarini BA, Carroll AE, Sox CM, Christakis DA. Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Arch Pediatr Adolesc Med. 2006;160:502–507. MEDLINE |
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a GSF-National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany b Department of Pediatrics, Ludwig Maximilians University, the Technical University of Munich, Germany c Institute of Medical Data Management, Biometrics and Epidemiology, Ludwig Maximilians University, the Technical University of Munich, Germany d Department of Pediatrics, Munich, Germany e Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.  Reprint requests: Joachim Heinrich, PhD, GSF-National Research Center for Environment and Health, Institute of Epidemiology, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany.
Supported by the Federal Ministry for Education, Science, Research and Technology, Grant No. 01 EE 9401-4 and the Child Health Foundation. Nestlè, Hipp, Milupa, Numico, and Mead Johnson provided the study formulas for the intervention study. The nonintervention subgroup of the GINI-Study was founded by GSF National Research Center for Environment and Health. PII: S0022-3476(07)00466-0 doi:10.1016/j.jpeds.2007.05.018 © 2007 Mosby, Inc. All rights reserved. | |
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