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Maternal and Infant Diets for Prevention of Allergic Diseases:
Understanding Menu Changes in 2008
Scott H. Sicherer, MD and A. Wesley Burks, MD
Allergic diseases such as asthma, food allergies and skin allergies appear to be increasing, which has generated interest in prevention strategies. The American Academy of Pediatrics (AAP) Committee on Nutrition and Section on Allergy and Immunology published a 2008 updated "Clinical Report" reviewing recent and historical data regarding the impact of nutritional interventions on the development of atopic disease in infants and children. In the July issue of the Journal of Allergy and Clinical Immunology, Sicherer and Burks discuss the report in an Editorial where they consider it in context of current scientific information, taking into account the approaches and advice that the AAP and other professional societies worldwide have given on this topic. The reader will come to appreciate the challenge faced when advice is given to patients and primary care physician colleagues about how to adjust the maternal and infant diet to reduce the likelihood of allergic disease in the "high risk" infant when the data upon which to give advice are limited.
The authors review approaches that are found in most studies to be "generally effective" such as breastfeeding for the first 4 to 6 months of life, or if not breastfeeding to use or supplement with specific low-allergenic infant formulas, and delaying introduction of solid foods until 4 to 6 months of age. They also review approaches that have been tried but "remain unproven," like maternal dietary restrictions during pregnancy and breast-feeding. The authors advise that the "educated consumer" should be aware of the limitations of currently available data, and they present options that doctors can review with their patients to decide what may be a best approach when the studies are not so clear. The authors underscore the need for additional research on prevention and treatment of allergic diseases and in the meantime to advise families "in the context of the limitations of our current evidence base". Sometimes the best clinicians can say "I don't know" in a way that comforts with honest empathy.
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