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Meta-Analysis
. 2012 Sep 12;2012(9):CD000133.
doi: 10.1002/14651858.CD000133.pub3.

Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child

Michael S Kramer  1 , Ritsuko Kakuma
Affiliations
Meta-Analysis

Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child

Michael S Kramer et al. Cochrane Database Syst Rev. .

Abstract

Background: Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.

Objectives: To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).

Selection criteria: All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.

Data collection and analysis: We extracted data from published reports, supplemented by additional information received from the trialists we contacted.

Main results: The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight.The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years.One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.

Authors' conclusions: Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed.Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 1 Atopic eczema in first 12‐18 months.
1.2
1.2. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 2 Asthma in first 18 months.
1.3
1.3. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 3 Allergic rhinitis/conjunctivitis in first 18 months.
1.4
1.4. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 4 Allergic urticaria in first 18 months.
1.5
1.5. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 5 Any atopic condition in first 18 months.
1.6
1.6. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 6 Positive skin prick test to egg at 6 months.
1.7
1.7. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 7 Positive skin prick test to egg at 18 months.
1.8
1.8. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 8 Positive skin prick test to milk at 6 months.
1.9
1.9. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 9 Positive skin prick test to milk at 18 months.
1.10
1.10. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 10 Detectable cord blood IgE (>= .125 U/ml).
1.11
1.11. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 11 Cord blood IgE > 1 U/ml.
1.12
1.12. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 12 Preterm birth.
1.13
1.13. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 13 Gestational weight gain (as % of prepregnancy weight).
1.14
1.14. Analysis
Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 14 Birthweight (g).
2.1
2.1. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 1 Incidence of atopic eczema in first 18 months.
2.2
2.2. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 2 Positive skin prick test to milk at 1 year.
2.3
2.3. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 3 Positive skin prick test to egg at 1 year.
2.4
2.4. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 4 Positive skin prick test to peanut at 1 year.
2.5
2.5. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 5 Positive skin prick test to milk at 2 years.
2.6
2.6. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 6 Positive skin prick test to egg at 2 years.
2.7
2.7. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 7 Positive skin prick test to peanut at 2 years.
2.8
2.8. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 8 Positive skin prick test to milk at 7 years.
2.9
2.9. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 9 Positive skin prick test to egg at 7 years.
2.10
2.10. Analysis
Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 10 Positive skin prick test to peanut at 7 years.
3.1
3.1. Analysis
Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 1 Eczema area score.
3.2
3.2. Analysis
Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 2 Eczema activity score.
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References

References to studies included in this review

Appelt 2004 {published data only}
    1. Appelt GK, Chan‐Yeung M, Watson WTA, Dimich‐Ward H, Ferguson A, Manfreda J, et al. Breastfeeding and food avoidance are ineffective in preventing sensitization in high risk children. Journal of Allergy and Clinical Immunology 2004;113(2 Suppl):S99.
Cant 1986 {published and unpublished data}
    1. Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. BMJ 1986;293:231‐3. - PMC - PubMed
Falth‐Magnusson 1987 {published and unpublished data}
    1. Falth‐Magnusson K, Kjellman NIM. Allergy prevention by maternal elimination diet during late pregnancy ‐ a 5‐year follow‐up of a randomized study. Journal of Allergy and Clinical Immunology 1992;89:709‐13. - PubMed
    1. Falth‐Magnusson K, Kjellman NIM. Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy ‐ a randomized study. Journal of Allergy and Clinical Immunology 1987;80:868‐75. - PubMed
    1. Falth‐Magnusson K, Oman H, Kjellman NIM. Maternal abstention from cow milk and egg in allergy risk pregnancies. Allergy 1987;42:64‐73. - PubMed
    1. Kjellman NIM, Bjorksten B, Hattevig G, Falth‐Magnusson K. Natural history of food allergy. Annals of Allergy 1988;61:83‐7. - PubMed
Lilja 1988 {published and unpublished data}
    1. Lilja G, Dannaeus A, Falth‐Magnusson K, Graff‐Lonnevig V, Johansson SGO, Kjellman NIM, et al. Immune response of the atopic woman and fetus: effects of high‐ and low‐dose food allergen intake during late pregnancy. Clinical Allergy 1988;8:131‐42. - PubMed
    1. Lilja G, Dannaeus A, Foucard T, Graff‐Lonnevig V, Johansson SGO, Oman H. Effects of maternal diet during late pregnancy and lactation on the development of IgE and egg‐ and milk‐specific IgE and IgG antibodies in infants. Clinical and Experimental Allergy 1991;21:195‐202. - PubMed
    1. Lilja G, Dannaeus A, Foucard T, Graff‐Lonnevig V, Johansson SGO, Oman H. Effects of maternal diet during late pregnancy and lactation on the development of atopic disease in infants up to 18 months of age ‐ in‐vivo results. Clinical and Experimental Allergy 1989;19:473‐9. - PubMed
Lovegrove 1994 {published data only}
    1. Lovegrove JA, Hampton SM, Morgan JB. The immunological and long‐term atopic outcome of infants born to women following a milk‐free diet during late pregnancy and lactation: a pilot study. British Journal of Nutrition 1994;71:223‐38. - PubMed
    1. Lovegrove JA, Morgan JB, Hampton SM. Dietary factors influencing levels of food antibodies and antigens in breast milk. Acta Paediatrica 1996;85:778‐84. - PubMed

References to studies excluded from this review

Arshad 1992 {published data only}
    1. Arshad SH, Mathews S, Gant C, Hide DW. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet 1992;339:1493‐7. - PubMed
    1. Hide DW, Matthews S, Tariq S, Arshad SH. Allergen avoidance in infancy and allergy at 4 years of age. Allergy 1996;51(2):89‐93. - PubMed
Arshad 2007 {published data only}
    1. Arshad SH, Bateman B, Sadeghnejad A, Gant C, Matthews SM. Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study. Journal of Allergy and Clinical Immunology 2007;119(2):307‐13. - PubMed
Chandra 1986 {published data only}
    1. Chandra RK, Puri S, Suraiya C, Cheema PS. Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants. Clinical Allergy 1986;16:563‐9. - PubMed
Chandra 1989 {published data only}
    1. Chandra RK, Puri S, Hamed A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants. BMJ 1989;299:228‐30. - PMC - PubMed
Hattevig 1989 {published data only}
    1. Hattevig G, Kjellman B, Sigurs N, Bjorksten B, Kjellman NIM. Effect of maternal avoidance of egg, cow's milk and fish during lactation upon allergic manifestations in infants. Clinical and Experimental Allergy 1989;19:27‐32. - PubMed
Vance 2004 {published data only}
    1. Vance GH, Grimshaw KE, Briggs R, Lewis SA, Mullee MA, Thornton CA, et al. Serum ovalbumin‐specific immunoglobulin g responses during pregnancy reflect maternal intake of dietary egg and relate to the development of allergy in early infancy. Clinical and Experimental Allergy 2004;34:1855‐61. - PubMed
    1. Vance GH, Lewis SA, Grimshaw KE, Wood PJ, Briggs RA, Thornton CA, et al. Exposure of the fetus and infant to hens' egg ovalbumin via the placenta and breast milk in relation to maternal intake of dietary egg. Clinical and Experimental Allergy 2005;35(10):1318‐26. - PubMed
Zeiger 1989 {published data only}
    1. Zeiger RS, Heller S. The development and prediction of atopy in high‐risk children: follow‐up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. Journal of Allergy and Clinical Immunology 1995;95:1179‐90. - PubMed
    1. Zeiger RS, Heller S, Mellon M, O'Connor R, Hamburger RN. Effectiveness of dietary manipulation in the prevention of food allergy in infants. Journal of Allergy and Clinical Immunology 1986;78:224‐38. - PubMed
    1. Zeiger RS, Heller S, Mellon MH, Forsythe AB, O'Connor RD, Hamburger RN, et al. Effect of combined maternal and infant food‐allergen avoidance on development of atopy in early infancy: a randomized study. Journal of Allergy and Clinical Immunology 1989;84:72‐89. - PubMed
    1. Zeiger RS, Heller S, Mellon MH, Halsey JF, Hamburger RN, Sampson HA. Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents: a prospective randomized study of food allergen avoidance. Pediatric Allergy and Immunology 1992;3:110‐27.

Additional references

Bonnelykke 2008
    1. Bonnelykke K, Pipper CB, Bisgaard H. Sensitization does not develop in utero. Journal of Allergy and Clinical Immunology 2008;121:646‐51. - PubMed
Cant 1985
    1. Cant AJ, Marsden RA, Kilshaw PJ. Egg and cow's milk hypersensitivity in exclusively breast fed infants with eczema, and detection of egg protein in breast milk. BMJ 1985;291:932‐5. - PMC - PubMed
Clarke 2003
    1. Clarke MJ, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.2.0 [updated March 2003]. In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software. Updated quarterly.
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Falth‐Magnusson 1992
    1. Falth‐Magnusson K, Kjellman NIM. Allergy prevention by maternal elimination diet during late pregnancy ‐ a 5‐year follow‐up of a randomized study. Journal of Allergy and Clinical Immunology 1992;89:709‐13. - PubMed
Gerrard 1979
    1. Gerrard JW. Allergy in breast fed babies to ingredients of breast milk. Annals of Allergy 1979;42:69‐72. - PubMed
Harbord 2006
    1. Harbord RM, Egger M, Sterne JA. A modified test for small‐study effects in meta‐analyses of controlled trials with binary endpoints. Statistics in Medicine 2006;25(20):3443‐57. - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Jakobsson 1985
    1. Jakobsson I, Lindberg T, Benediktsson B, Hansson BG. Dietary bovine beta‐lactoglobulin is transferred to human milk. Acta Paediatrica Scandinavica 1985;74:342‐5. - PubMed
Loibichler 2002
    1. Loibichler C, Pichler J, Gerstmayr M, Bohle B, Urbanek R, Szepfalusi Z. Materno‐fetal passage of nutritive and inhalant allergens across placentas of term and pre‐term deliveries perfused in vitro. Clinical and Experimental Allergy 2002;32:1546‐51. - PubMed
O'Keefe 1920
    1. O'Keefe ES. The relation of food to infantile eczema. Boston Medical and Surgical Journal 1920;183:569‐73.
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Shannon 1921
    1. Shannon WR. Demonstration of food proteins in human breast milk by anaphylactic experiments on guinea pigs. American Journal of Diseases of Children 1921;22:223‐31.
Stuart 1984
    1. Stuart CA, Twiselton R, Nicholas MK, Hide DW. Passage of cows' milk protein in breast milk. Clinical Allergy 1984;14(6):533‐5. [PUBMED: 6509768] - PubMed
Talbot 1918
    1. Talbot FB. Eczema in childhood. Medical Clinics of North America 1918;1:985‐96.
Troncone 1987
    1. Troncone R, Scarcella A, Donatiello A, Cannataro P, Tarabuso A, Auricchio S. Passage of gliadin into human breast milk. Acta Paediatrica Scandinavica 1987;76:453‐6. - PubMed
Upton 2000
    1. Upton MN, McConnachie A, McSharry C, Hart CL, Davey Smith D, Gillis CR, et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000;321:88‐92. - PMC - PubMed
Vadas 2001
    1. Vadas P, Wai Y, Burks W, Perelman B. Detection of peanut antigens in breast milk of lactating women. JAMA 2001;285:1746‐8. - PubMed
Williams 1992
    1. Williams HC. Is the prevalence of atopic dermatitis increasing?. Clinical and Experimental Dermatology 1992;17:385‐91. - PubMed
Woolcock 1997
    1. Woolcock AJ, Peat JK. Evidence for the increase in asthma worldwide. CIBA Foundation Symposium 1997;206:122‐34. - PubMed
Zeiger 2003
    1. Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003;111:1662‐71. - PubMed

References to other published versions of this review

Kramer 1996a
    1. Kramer MS. Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk. Cochrane Database of Systematic Reviews 1996, Issue 3. [DOI: 10.1002/14651858.CD000132] - DOI - PMC - PubMed
Kramer 1996b
    1. Kramer MS. Maternal antigen avoidance during lactation for preventing atopic eczema in infants. Cochrane Database of Systematic Reviews 1996, Issue 3. [DOI: 10.1002/14651858.CD000131] - DOI - PMC - PubMed
Kramer 2003
    1. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD000133] - DOI - PubMed

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