Pediatric Nutrition in Practice

Allergy Prevention through Early Nutrition 115

2

studies even of high quality were excluded be-
cause of dropout rates of more than 20%. For this
and other reasons, the Cochrane review has been
criticized, and the conclusions were challenged
by an international panel of allergy experts [7].
The German Infant Nutritional Intervention
study is by far the largest double-blind, random-
ized, controlled intervention trial in this area, and
the only trial sponsored by a governmental grant
rather than by industry funds [8, 9]. The trial eval-
uated allergy-preventive effects of three hydro-
lyzed formulae compared with a cow’s milk for-
mula in high-risk infants provided during the first
4 months of life. Among different atopic manifes-
tations (atopic dermatitis, asthma, gastrointestinal
manifestations, allergic rhinitis and urticaria),
only the risk of atopic dermatitis was reduced by
the hydrolyzed formulae. Compared with the
cow’s milk formula, both an extensively hydro-
lyzed casein formula and a partly hydrolyzed whey
formula significantly reduced atopic dermatitis. In
contrast, the risk reduction with the extensively
hydrolyzed whey formula did not reach signifi-
cance. The effect developed in the first year of live
and persisted until the age of 10 years ( fig. 1 ). No
significant effect was observed on asthma, allergic
rhinitis or sensitization pattern.

Protein Sources other than Cow’s Milk in
Infant Feeding

The use of unmodified mammalian milk protein,
including unmodified sheep, buffalo, mare or
goat’s milk, or unmodified soy or rice milk, is not
recommended for infants because their composi-
tion is inadequate to serve as the sole food source
for infants. Moreover, these milks are not recom-
mended for infants with suspected or proven
cow’s milk protein allergy because of the risk of
possible allergenic cross-reactivity. A Cochrane
review concluded that infant formulae based on
soy protein do not reduce allergy risk, including
food allergy [10]. There is no evidence to support

allergy-preventive effects of infant formulae

based on protein sources other than hydrolyzed

cow’s milk proteins.

Complementary Foods

Most available data originate from large cohort

studies. Very early introduction of solid food

within the first 3 months of life seems to increase

the risk of eczema, and possibly also of food al-

lergy. However, delaying the introduction of solid

foods beyond the 6th month of life has no protec-

tive effect and may even increase the risk of dif-

45

CMF

eHF-W

pHF-W

eHF-C

40

35

30

15

10

9 8 7 6 0 1

Physician-diagnosed eczema (adj. %)

25

20

2 3 4

Age (years)

5 678910

Fig. 1. Cumulative incidence of parent-reported, physi-

cian-diagnosed atopic dermatitis in 988 infants who

were fed 1 of 4 study formulae during the first 4 months

of life and were followed until 10 years of age (per-pro-

tocol analysis). Results are adjusted (adj.) for sex, BMI at

birth, parental education, biological siblings at birth,

study region, maternal smoking during pregnancy and/

or during the child’s first 4 months, smoking in the pres-

ence of the child during the child’s first 4 months, furry

pets in the home during the child’s first year of life, and

age of mother at birth. CMF = Cow’s milk formula; pHF-

W = partially hydrolyzed whey formula; eHF-W = exten-

sively hydrolyzed whey formula; eHF-C = extensively

hydrolyzed casein formula [9].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 113–117
DOI: 10.1159/000360328