Laubereau B, Brockow I, Zirngibl A, et al. J Pediatr. 2004;144:602–607
Purpose of the Study.
Most studies have shown a protective effect of breastfeeding on atopic disease, but some have shown an increased risk. This study examined the impact of exclusive breastfeeding for the first 4 months of infancy on the prevalence of atopic dermatitis (AD) during the first 3 years of life.
A large birth cohort of healthy term neonates in Germany enrolled between 1995 and 1998 for a study designed to investigate risk factors for and course and prevention of allergic disease.
Group I (interventional) consisted of infants with a family history of allergy who were either exclusively breastfed for the first 4 months or were not breastfed or supplemented (by randomization) with hydrolyzed formula (study formula) or conventional cow’s milk formula. Group NI (noninterventional) consisted of infants whose parents did not wish to participate in the intervention trial or who did not have a family history of allergy. Both groups received a yearly self-administered questionnaire on health, nutrition, and living conditions. Parents in group I also received dietary recommendations to avoid allergenic food and participated in structured interviews at the study centers.
Of the 5538 infants recruited at birth, 4194 (75.7%) completed the 3-year questionnaires. Of these, 3903 (93.1%) completed data on feeding regimen and physician-diagnosed AD. Fifty-two percent of these infants were breastfed exclusively and 522 (13.4%) were bottle-fed exclusively during the first 4 months of life. The overall prevalence of physician-diagnosed AD and intermittent itchy rash for at least 6 months was 20% and 9.1%, respectively. There was no significant adverse association between exclusive breastfeeding and physician-diagnosed AD in infants with a family history of AD (odds ratio [OR]: 0.92), in those without a family history of AD (OR: 0.97), or in those with itchy rash (OR: 1.2 and 0.92, respectively). In group I, exclusive breastfeeding was protective for AD, compared with feeding with a conventional cow’s milk formula (OR: 0.64). If stratified by family history of AD, there was no difference in effect of breastfeeding on physician-diagnosed AD and itchy rash in group I. The difference in the NI group was not determined because of the small number of participants.
Exclusive breastfeeding for the first 4 months of infancy was not shown to increase the risk of developing AD in infants with or without a family history of AD.
A number of studies have shown that breastfeeding could be a risk factor for atopic dermatitis and even suggest a detrimental effect of continuing to breastfeed infants with severe AD and food allergy. The role of breastfeeding in allergic diseases has been controversial, but the weight of the evidence in meta-analyses and in this study support a protective effect in regard to prevention.