Pediatric Nutrition in Practice

116 Koletzko

ferent allergic diseases [11]. This effect was also
found for allergenic foods such as hen’s egg, cow’s
milk, fish and wheat [12–14]. A high diversity of
complementary foods seems to decrease the risk
of allergies [15]. Thus it is recommended that
complementary foods should not be introduced
before the 17th week of life or later than the 26th
week of life, regardless of the familial risk of al-
lergy [16, 17].

Probiotics and Prebiotics

The impact of maternal supplementation with
probiotics during pregnancy on atopic eczema
in childhood was investigated by a recent meta-
analysis including 7 randomized, double-blind,
placebo-controlled trials [18]. The authors con-
clude that there is some evidence for lactobacilli

• but not for different mixtures of probiotics – to
  reduce the risk of eczema in the offspring.
  Several studies investigated the effect of probi-
  otics given to infants either as a supplement or as
  a component of the infant formula. A recent posi-
  tion paper of the World Allergy Organization re-
  viewed the evidence and concluded that with the
  current knowledge, probiotics have no established
  role in the prevention or treatment of allergy [19].
  Similarly, a Cochrane review on the addition
  of prebiotics to infant formulae concluded that
  certain prebiotic mixtures of galacto- and fruc-

tooligosaccharides have shown some beneficial

effect in reducing eczema in infants [20]. How-

ever, the heterogeneity of these studies with re-

gard to their design and target groups does not

allow any generalized recommendations on sup-

plementation for reducing the risk of allergy.

Conclusions

• Maternal exclusion diet during pregnancy and
  lactation has no allergy-preventive effect and
  is not recommended


• Exclusive breastfeeding for the first 4 months
  of life and continuous breastfeeding while
  gradually introducing solid foods is recom-
  mended for all infants


• In populations with low infection risks, solid
  foods should not be introduced before the
  17th or after the 26th week of life, regardless of
  the hereditary risk of allergy


• If infant formulae are given during the first 4
  months of life to infants with a family history
  of allergy, a protein hydrolysate formula
  should be used


• Formulae based on other milk proteins (sheep,
  buffalo, mare or goat’s milk), as well as soy or
  rice protein, have no demonstrated allergy-
  preventive effect and are not recommended


• Probiotics and prebiotics do not have an estab-
  lished role in the prevention of allergy

4 Kramer MS, Chalmers B, Hodnett ED,

Sevkovskaya Z, Dzikovich I, Shapiro S,

et al: Promotion of Breastfeeding Inter-

vention Trial (PROBIT): a randomized

trial in the Republic of Belarus. JAMA

2001; 285: 413–420.

5 Kramer MS: Breastfeeding and allergy:

the evidence. Ann Nutr Metab 2011;

59(suppl 1):20–26.

References

1 Kramer MS, Kakuma R: Maternal die-
tary antigen avoidance during pregnan-
cy or lactation, or both, for preventing
or treating atopic disease in the child.
Cochrane Database Syst Rev 2006;
3:CD000133.
2 Björkstén B: Allergy prevention: inter-
ventions during pregnancy and early
infancy. Clin Rev Allergy Immunol
2004; 26: 129–138.

3 Dotterud CK, Storrø O, Simpson MR,

Johnsen R, Øien T: The impact of pre-

and postnatal exposures on allergy re-

lated diseases in childhood: a controlled

multicentre intervention study in pri-

mary health care. BMC Public Health

2013; 13: 123.

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