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The relationship of breastfeeding to the development of atopic disorders.

Allergy prevention efforts must be instituted early in life since there appears to be a critical period for sensitization to food allergens shortly after birth. Some atopic risk factors susceptible to modulation include: (1) intact protein formula feeding; (2) early introduction of allergenic foods, and (3) environmental tobacco smoke. Since Grulee and Sanford [1] reported in 1939 a significant 7-fold reduction in eczema in infants who were breastfed, much uncertainly has surrounded this potential benefit of breastfeeding. Methodological differences and design limitations were observed among studies. However, the complex immunological characteristics of breast milk and maternal–infant interactions may also be at play. Do genetic differences in infant/mother pairs affect the composition of breast milk and influence the modulating effect of breast milk on emerging allergic disorders? Are the nanogram concentrations of food allergens found in breast milk sensitizing or protective? What is not controversial is that breast milk is the preferred infant nutrition with rare exception (maternal HIV infection) owing to its nutritional, immunological, and psychological benefits. It is included as an important element in allergy prevention guidelines [2, 3]. Since breastfeeding is the recommended infant feeding method, it is more appropriate to examine breastfeeding in the light of ‘what may be lost by not breastfeeding?’ rather than in its allergy-preventive attributes. From the evidence that will be presented here and that we reported in more detail elsewhere [4], one can expect a higher incidence of eczema and wheezing illnesses in early childhood in highrisk infants fed intact formula to the exclusion of breast milk. Lucas A, Sampson HA (eds): Primary Prevention by Nutrition Intervention in Infancy and Childhood. Nestlé Nutr Workshop Ser Pediatr Program, vol 57, pp 93–108, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2006.