Primary prevention of allergic disease: Maternal diet in pregnancy and lactation
- David M Fleischer, MD
David M Fleischer, MD
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- University of Colorado Denver School of Medicine
The term "allergy" refers to a hypersensitivity reaction initiated by immunologic mechanisms. The available literature concerning manipulation of a woman's diet in pregnancy or lactation (or both) in an attempt to achieve primary prevention of allergic disease in her child will be reviewed here. The fetus can make immunologic responses to foods and other allergens . It is unclear if these responses represent normal immunologic phenomena, are related to the subsequent development of allergy, or both. The impact of breastfeeding and probiotics on the development of allergic disease and general issues related to food allergen avoidance are presented separately. (See "Management of food allergy: Avoidance" and "The impact of breastfeeding on the development of allergic disease" and "Prebiotics and probiotics for prevention of allergic disease".)
The most prevalent allergic or atopic disorders include atopic dermatitis, asthma, allergic rhinitis, and food allergies. These conditions afflict 20 percent of the population of the United States, and their prevalence is rising in developed nations. The increase in atopic diseases has been recognized as a pandemic, thus emphasizing the need for effective allergy prevention .
Early interventions — Three factors are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s), and environmental factors. Convincing studies support the existence of a critical time early in infancy and possibly even in prenatal life, in which the genetically predisposed atopic infant is at higher risk for becoming sensitized (ie, developing specific immunoglobulin E [IgE] to an allergen) . Therefore, dietary interventions instituted during pregnancy, lactation, and the first year of life have been proposed. These include maternal avoidance of allergenic foods and the addition of certain supplements to the maternal diet.
Types of prevention — There are three types of allergy prevention :
●Primary prevention, which blocks the initial immunologic sensitization (ie, the development of IgE specific to an allergen).
- Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003; 111:1662.
- Eichenfield LF, Hanifin JM, Beck LA, et al. Atopic dermatitis and asthma: parallels in the evolution of treatment. Pediatrics 2003; 111:608.
- Pali-Schöll I, Renz H, Jensen-Jarolim E. Update on allergies in pregnancy, lactation, and early childhood. J Allergy Clin Immunol 2009; 123:1012.
- Fälth-Magnusson K, Kjellman NI. Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy--a randomized study. J Allergy Clin Immunol 1987; 80:868.
- Lovegrove JA, Hampton SM, Morgan JB. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. Br J Nutr 1994; 71:223.
- Lilja G, Dannaeus A, Fälth-Magnusson K, et al. Immune response of the atopic woman and foetus: effects of high- and low-dose food allergen intake during late pregnancy. Clin Allergy 1988; 18:131.
- Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. Br Med J (Clin Res Ed) 1986; 293:231.
- Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2012; :CD000133.
- American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346.
- Høst A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999; 81:80.
- Greer FR, Sicherer SH, Burks AW, et al. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121:183.
- Muraro A, Halken S, Arshad SH, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69:590.
- Bunyavanich S, Rifas-Shiman SL, Platts-Mills TA, et al. Peanut, milk, and wheat intake during pregnancy is associated with reduced allergy and asthma in children. J Allergy Clin Immunol 2014; 133:1373.
- Fälth-Magnusson K, Kjellman NI. Allergy prevention by maternal elimination diet during late pregnancy--a 5-year follow-up of a randomized study. J Allergy Clin Immunol 1992; 89:709.
- Lilja G, Dannaeus A, Foucard T, et al. Effects of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age--in-vivo results. Clin Exp Allergy 1989; 19:473.
- Muraro A, Dreborg S, Halken S, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol 2004; 15:291.
- Lack G, Fox D, Northstone K, et al. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003; 348:977.
- Hourihane JO, Aiken R, Briggs R, et al. The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007; 119:1197.
- Dean T, Venter C, Pereira B, et al. Government advice on peanut avoidance during pregnancy--is it followed correctly and what is the impact on sensitization? J Hum Nutr Diet 2007; 20:95.
- Kemp AS, Ponsonby AL, Dwyer T, et al. Maternal antenatal peanut consumption and peanut and rye sensitization in the offspring at adolescence. Clin Exp Allergy 2011; 41:224.
- Frazier AL, Camargo CA Jr, Malspeis S, et al. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr 2014; 168:156.
- Frank L, Marian A, Visser M, et al. Exposure to peanuts in utero and in infancy and the development of sensitization to peanut allergens in young children. Pediatr Allergy Immunol 1999; 10:27.
- Sicherer SH, Wood RA, Stablein D, et al. Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants. J Allergy Clin Immunol 2010; 126:1191.
- Herrmann ME, Dannemann A, Grüters A, et al. Prospective study of the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation. Eur J Pediatr 1996; 155:770.
- Sigurs N, Hattevig G, Kjellman B. Maternal avoidance of eggs, cow's milk, and fish during lactation: effect on allergic manifestations, skin-prick tests, and specific IgE antibodies in children at age 4 years. Pediatrics 1992; 89:735.
- Hattevig G, Sigurs N, Kjellman B. Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age. Acta Paediatr 1999; 88:7.
- Pollard C, Phil M, Bevin S. Influence of maternal diet during lactation upon allergic manifestations in infants: tolerization or sensitization. J Allergy Clin Immunol 1996; 97:240.
- Järvinen KM, Westfall JE, Seppo MS, et al. Role of maternal elimination diets and human milk IgA in the development of cow's milk allergy in the infants. Clin Exp Allergy 2014; 44:69.
- Metcalfe JR, Marsh JA, D'Vaz N, et al. Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial. Clin Exp Allergy 2016; 46:1605.
- Yepes-Nuñez JJ, Fiocchi A, Pawankar R, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D. World Allergy Organ J 2016; 9:17.
- Litonjua AA, Carey VJ, Laranjo N, et al. Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial. JAMA 2016; 315:362.
- Chawes BL, Bønnelykke K, Stokholm J, et al. Effect of Vitamin D3 Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring: A Randomized Clinical Trial. JAMA 2016; 315:353.
- Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database Syst Rev 2015; :CD010085.
- Best KP, Gold M, Kennedy D, et al. Omega-3 long-chain PUFA intake during pregnancy and allergic disease outcomes in the offspring: a systematic review and meta-analysis of observational studies and randomized controlled trials. Am J Clin Nutr 2016; 103:128.