Literature review for - Flourish Paediatrics

during infancy. Results will be available in 2013. However the applicability of trials on at risk
populations will need to be assessed.
Reverse causality is a real issue as national bodies have been recommending exclusive breastfeeding
for infants with a family history of allergy for 2 or 3 decades (NHMRC since 1979). Mothers of
infants who are at risk of asthma or atopy were more likely to continue breastfeeding. Hence
breastfeeding could be associated with asthma/atopy in case control or cohort studies (Tanaka,
Miyake et al. 2010).
After the onset of symptoms of eczema or a wheeze, mothers would tend to prolong the duration of
exclusive breastfeeding because of the general belief in its protective effect.(Laubereau, Brockow et
al. 2004) This is not the duration of breastfeeding leading to eczema or wheezy disorder, but in fact,
the onset of symptoms has lead to longer duration of breastfeeding. Only long-term observations, of
the start and end of exposure and disease, or randomized controlled trials (that would probably be
unethical) could be used to reduce this source of bias.(Giwercman, Halkjaer et al. 2010) (Bisgaard
and Bonnelykke 2010)
The UK Food Standards Authority Committee on Toxicology summarized the current evidence:
“In common with the advice given for all children, infants with a parent or sibling with an atopic
disease should be breastfed exclusively for around 6 months;”
There would appear to be no reasons to restrict the introduction of any particular foods or groups of
foods to infants in an effort to prevent allergy or promote tolerance.
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