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PREVENTING ALLERGY BY NUTRITIONAL INTERVENTION

Sibylle Koletzko

Dr. v. Haunersches Kinderspital, Ludwig-Maximilians University of Munich, Germany

In face of the rising incidence of allergic diseases over the last decades, preventive mea-

sures are of increasing importance. Since it has been recognized that early contact to foodallergens plays a major role for the development of both, tolerance and sensitization to foodantigens, nutritional interventions strategies have been thought for primary allergy preven-tion.

Maternal elimination diets during pregnancy and lactation have been proven in ran-domized controlled trials (RCT) to be of no benefit to reduce the risk of allergy in the off-spring (1). There is some evidence for protective effect of fish consumption during preg-nancy and breast-feeding for development of atopic diseases in offspring.

Breastfeeding is preferred for infants after birth because of nutritional, immunologicaland psychological benefits. The potential allergy preventive effect of exclusive or partialbreastfeeding has not been properly assessed because randomization of breastfeeding isnot possible for ethical considerations. Recent meta-analyses do no demonstrate a pro-tective effect of breastfeeding for reducing allergy risk. However, breastfeeding is stronglyrecommended because of its other benefits for all healthy infants, irrespective of atopicrisk.

In case of insufficient breast feeding during the first 4 months, cows milk formula(CMF) is the standard formula for infants. In infants with a familiar predisposition for aller-gies formulae based on partially or extensively hydrolyzed proteins have been investigat-ed in randomized trials compared to cows milk formula (CMF). By far the largest trial, theGerman birth cohort study GINIplus, includes 5991 children. A non-interventional arm (N= 3739) followed children with or without familial predisposition (2-5). Predisposed chil-dren whose parents agreed to participate in the double-blind intervention (N = 2252) were

randomly assigned at birth to one of four formulae: partially (pHF-W), or extensively hy-drolysed whey (eHF-W), extensively hydrolysed casein (eHF-C) or standard CMF. Com-pared CMF, the eHF-C and pHF-W significantly reduced AD, while the eHF-W was inef-fective. The effect developed in the 1st year of live and persisted until 6 years. Predis-posed children without nutritional intervention had a 2.1 times higher risk for AD [95%confidence interval (CI) 1.62.7] than children without a familial predisposition. The riskwas smaller with nutritional intervention, with a HR of 1.3 (95% CI 0.91.9) in children fedeHF-C formula, which was not significant different to children without familiar allergy risk.It is concluded that some, but not all hydrolyzed formulae can reduce the risk for AD.Theresults cannot be generalized to infants without familiar risk for allergies (6). In contrast, asoy based formula can not be recommended for allergy prevention (7)

Solid foods should not be introduced before the 5th months of life, however, delayingsolid food introduction beyond 7 months in children at risk for allergy, may even increasethe risk of atopic dermatitis and food allergy. This applies also to high allergic foods suchas diary products, hens egg, fish and wheat.

1. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lacta-tion, or both, for preventing or treating atopic disease in the child. Cochrane DatabaseSyst Rev 2006;3:CD000133.

2. Berg v A, Koletzko S, Grubl A et al. The effect of hydrolyzed cow's milk formula for al-lergy prevention in the first year of life: the German Infant Nutritional Intervention Study,

a randomized double-blind trial. J Allergy Clin Immunol 2003;111:533-40.3. Berg v A, Filipiak-Pittroff B, Kramer U et al. Preventive effect of hydrolyzed infant for-

mulas persists until age 6: long-term results from the German Infant Nutritional Inter-vention Study GINI. J Allergy Clin Immunol 2008;121:1442-7.

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4. Berg v A, Kramer U, Link E et al. Impact of early feeding on childhood eczema: devel-opment after nutritional intervention compared with the natural course - the GINIplusstudy up to the age of 6 years. Clin Exp Allergy 2010.

5. Berg-v A, Koletzko S, Filipiak-Pittroff B et al. Certain hydrolyzed formulas reduce the in-cidence of atopic dermatitis, but not of asthma: Three year results of the GINI-Study. JAllergy Clin Immunol 2007;119:718-22.

6. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergyand food intolerance in infants. Cochrane Database Syst Rev 2006;CD003664.

7. Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in in-fants. Cochrane Database Syst Rev 2004;CD003741.