Literature review for - Flourish Paediatrics

Table 20.2 Studies used to make evidence statement for age of introduction of solid foods and allergic syndromes
Reference [1] Snijders 2008 Zutavern 2008 Filipiak 2007
Type of study [2] Cohort Cohort RCT
Level of evidence II II II
Intervention/
comparator [4]
Effect of duration of breast feeding,
age at introduction of cow's milk
and age at introduction of solids on
development of eczema, atopic
dermatitis, recurrent wheeze and
sensitisation at age 2 yrs.
Effect of delayed introduction of solids until after 4
mo or introduction of a diversity of foods at 4 mo
on development of allergy
Effect of delayed introduction of
solids on development of eczema
in a high risk group
N [5] 2558 infants 2073 children Intervention group 2,252
Control group 3739
Population/study
information [6]
KOALA birth cohort Study, The
Netherlands. Healthy infants.
from L I S A birth cohort study, Germany.
Examined both total cohort, and subset of cohort
with no skin or allergic symptoms.
Quality [7] P P P
Results [8] Introduction of solids after 7 mo
increases the risk of eczema at age
2 yrs OR 2.10 (1.17-3.76),
recurrent wheeze OR 3.52 (1.42-
8.73), atopic dermatitis OR 9.46
(2.05-43.61), any sensitisation OR
4.31 (1.14-16.22), and the risk of
sensitisation to one or more inhaled
allergens OR 20.86 (2.17- 200.75).
Introduction of solids after 7 mo
was not associated with
sensitisation to cow's milk OR 1.85
(0.35-9.37), peanut OR 7.85 (0.58-
106.55), or hen's egg OR 5.88
1. Delay in introducing solid foods until 4-6 mo
(OR range from 0.60-1.35) or > 6 mo (OR range
from 0.44-1.45) has no effect on the diagnosis or
symptoms of eczema, asthma, or allergic rhinitis.
2. Delay in introducing solid foods until 4-6 mo or
> 6 mo appears to increase the odds of sensitisation
to food allergens: Introduced 4-6 mo, OR 2.15
(1.28-3.62); Introduced > 6mo, OR 1.88 (0.98-
3.58).
3. Relative to infants not introduced to solids in the
first 4 mo, introduction of a diversity of food groups
by 4 mo has no effect on diagnosis or symptoms of
eczema, asthma, or allergic rhinitis or on the
development of sensitisation to inhaled allergens
birth cohort Germany. Examined
both entire cohort and subset of
cohort with a family history of
allergy.
1. No association between the time
of introduction of solids and the
development of doctor diagnosed or
symptomatic eczema
2. No association between
diversity of solid foods at 4 months
and the development of doctor
diagnosed or symptomatic eczema
3. With family history of allergy,
delaying the introduction of solids
until after 6 mo had no effect on
development of doctor diagnosed or
symptomatic eczema
4. With family history of allergy
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