Atopic Dermatitis and its Relation to Food Allergy

François Graham; Philippe A. Eigenmann

Disclosures

Curr Opin Allergy Clin Immunol. 2020;20(3):305-310. 

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Breastfeeding/Hydrolyzed Formulas

Guidelines generally recommend exclusive breastfeeding till the age of four months in high-risk infants, with hydrolyzed formula recommended in infants who are unable to breastfeed.[44] There is however a lack of robust data supporting the prevention of food allergy and/or atopic dermatitis in high-risk patients with breastfeeding. Some data suggests breastfeeding may prevent cow's milk allergy by the age of two.[64,65] On the other hand, a higher proportion of egg sensitization was found in breastfed infants with atopic dermatitis compared with nonbreastfed infants.[66] Confounding factors such as length of breastfeeding, as well as variability in personal and familial atopic risk may explain heterogenous data in the literature. Although some individual studies have suggested hydrolyzed formula may prevent eczema in high-risk infants,[67] a recent Cochrane metaanalysis found only very low-quality evidence that short-term use of an extensively hydrolyzed formula compared with cow's milk formula (CMF) for the prevention of cow's milk allergy,[68] with no evidence to support a hydrolyzed formula compared with a CMF for prevention of allergic disease. This is supported by a recent large population-based study (n = 11 720) which found a higher risk of food allergy at two years in at-risk infants using partially hydrolyzed formula with hypoallergenic labels compared with nonhydrolyzed formula.[69] Guidelines may be changed in the future.[70]

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