Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 401-411 (doi:10.1542/10.1542/peds.2004-2521)

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Timing of Solid Food Introduction in Relation to Atopic Dermatitis and Atopic Sensitization: Results From a Prospective Birth Cohort Study

Anne Zutavern, MD, MSc^a,j, Inken Brockow, MD, MPH^a,b, Beate Schaaf, MD^c, Gabriele Bolte, PhD, MPH^a,d, Andrea von Berg, MD^e, Ulrike Diez, MD, PhD^f, Michael Borte, MD, PhD^f, Olf Herbarth, PhD^g,h, H-Erich Wichmann, MD, PhD^a,i, Joachim Heinrich, PhD^a the LISA Study Group

^a Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany
^b Department of Pediatrics, Technical University of Munich, Munich, Germany
^c Medical Practice for Pediatrics, Bad Honnef, Germany
^d Department of Environmental Health, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
^e Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
^f Municipal Hospital "St Georg," Teaching Hospital of the University of Leipzig, Children's Hospital, Leipzig, Germany
^g Department of Human Exposure Research and Epidemiology, UFZ Leipzig-Halle, Leipzig, Germany
^h Faculty of Medicine, Department of Environmental Hygiene and Epidemiology (Environmental Medicine), University of Leipzig, Leipzig, Germany
ⁱ Institute of Medical Data Management, Biometrics and Epidemiology, Ludwig Maximilians University, Munich, Germany
^j Dr von Haunersches Kinderspital, University Children’s Hospital, Munich, Germany

OBJECTIVE. Prophylactic feeding guidelines recommend a delayed introduction of solid foods for the prevention of atopic diseases. Scientific evidence for this is scarce. This study investigates whether a delayed introduction of solids (past 4 months or 6 months) is protective against the development of atopic dermatitis (AD) and atopic sensitization when considering reverse causality.

METHODS. Data from 2612 infants in an ongoing birth cohort study were analyzed at 2 years of age. Information on diet and on symptoms and diagnoses of AD was collected semiannually, and information on specific immunoglobulin E levels was collected at 2 years of age.

RESULTS. Solid food introduction past the first 4 months of life decreased the odds of symptomatic AD but not for doctor-diagnosed AD, combined doctor-diagnosed and symptomatic AD, or atopic sensitization. Postponing the introduction beyond the sixth month of life was not protective in relation to either definition of AD or atopic sensitization. There was also no evidence for a protective effect of a delayed introduction of solids on AD and atopic sensitization in children of atopic parents. There was clear evidence for reverse causality between early skin or allergic symptoms and the introduction of solids.

CONCLUSIONS. This study does not find evidence supporting a delayed introduction of solids beyond the sixth month of life for the prevention of AD and atopic sensitization. We cannot rule out that delaying the introduction of solids for the first 4 months of life might offer some protection. Measures to avoid reverse causality have to be considered in the conduction, analysis, and interpretation of cohort studies on the topic.

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Key Words: eczema • sensitization • dermatitis • cohort • reverse causality • solid food

Abbreviations: AD—atopic dermatitis • LISA—Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood • IgE—immunoglobulin E • aOR—adjusted odds ratio • CI—confidence interval

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Accepted Feb 28, 2005.

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