Early solid feeding may increase the risk of eczema

Article Outline

• Tarini BA, Carroll A, 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;160:502-7
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Tarini BA, Carroll A, 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;160:502-7 

Question Does early solid feeding (before age 4 months) increase the risk of allergic disease?

Data Sources MEDLINE, the Cochrane Library, and the Drugs and Pharmacology section of EMBASE with key words “infant,” “food,” and “allergy.”

Study Selection and Assessment 2719 article citations and references of relevant articles were reviewed. The authors critically evaluated the methods and results of articles that met inclusion criteria and identified 13 studies that met inclusion criteria. There was only 1 controlled trial.

Results Five studies found a positive association between early solid feeding and eczema, with a persistence of the association for 10 years in 1 study. Four studies found no association. One study found an association between early solid feeding and pollen allergy. The authors found no strong evidence to support the association between early solid feeding and the development of persistent asthma, persistent food allergy, allergic rhinitis, or animal dander allergy.

Conclusions Available evidence suggests that early solid feeding may increase the risk of eczema. However, there are little data supporting an association between early solid feeding and other allergic conditions. Since many studies had problematic methods, additional controlled trials are needed to help guide physicians as they advise parents about the allergic risks of early introduction of solids.

Commentary One of the great controversies in pediatric allergy—and one of the most commonly asked questions by the parents of allergic children—regards the potential to prevent the development of allergy and asthma. The controversy stems from both a lack of quality studies and widely conflicting data from the studies that have been done, with a few demonstrating significant protection and most showing little or no effect. Among the many possible approaches for allergy prevention, delaying the introduction of solid foods into the infant’s diet is one of the most commonly recommended. As with most of these recommendations, this advice arose on the basis of a few studies that suggested benefit, largely ignoring other negative studies. We are therefore indebted to Tarini and colleagues for their excellent review of this topic. Unfortunately, however, as with most studies on allergy prevention, the available data do not provide any consensus for this recommendation. The authors recommended that additional controlled trials are needed, and that is certainly a logical next step.

As we await more conclusive data, is this something that we should recommend to our patients? While we should certainly not be dogmatic about any advice that is not supported by objective evidence, it is still something that I at least inform my patients about. It may provide some benefit, and, while other equally questionable approaches to allergy prevention can be expensive and may even put infants at nutritional risk, at least delaying the introduction of solid foods is entirely benign.