Maternal Modification and Breastfeeding
Environmental exposure to food protein in early life increases the chance of sensitisation (Arshad, Bateman, & Matthews, 2003). Maternal elimination diets during pregnancy, and also lactation, age of solid food introduction (Fergusson, Horwood, & Shannon, 1990) and breastfeeding have all been found to influence the development of atopy.
Evidence suggests that allergens can pass from a mothers’ diet to her child through breast milk and also across the placenta. In a study by Szepfalusi et al. (2000), allergen injections in vitro to the maternal side of the placenta were transferred to the fetal side of the placenta. Infants who were exclusively breast fed have showed cutaneous hypersensitivity to foods (Cant, Marsden & Kilshaw, 1985). Allergens such as peanut and egg proteins have also been detected in breast milk (Cant et al., 1985, Vadas, Wai, Burks, Perelman, 2002).
Maternal dietary interventions for allergy prevention during pregnancy and lactation have had conflicting results. A randomized controlled study by Hide, Matthews, Tariq & Arshad (1996) found that breastfeeding mothers excluding highly antigenic foods from their diet showed significantly less total allergy sensitisation, asthma and eczema at age 1. After follow up at 2 and 4 years, total allergy continued to be higher in the control group. A similar modification intervention has also been found to be successful in preventing allergy (Arshad, Matthews, Gant & Hide, 1992). In this study, mothers eliminated dairy products, eggs, fish and nuts from their diets and also took measures to avoid airborne allergy exposure. The intervention group was four time less likely to develop sensitisation or asthma than the control group.
In a study by Hattevig, Kjellman, Sigurs, Bjorksten & Kjellman, (1989), an intervention group followed a modified maternal diet in the first 3 months postpartum free from eggs, cow’s milk and fish. It showed significantly lower rates of atopic dermatitis at 6 months compared to a control but not after this age (Hattevig et al., 1989). Similarly, Lilja et al.(1991) found that maternal egg and cows milk reduction in atopic mothers in the third trimester of pregnancy or in pregnancy and lactation did not influence the immune response in infants.