The research below explores the effects of breastfeeding, formula feeding and the early introduction of certain foods on the prevalence of allergies in babies and young children.
Frequency of guideline-defined cow’s milk allergy symptoms in infants: Secondary analysis of EAT trial data
Conclusions from a secondary analysis of the Enquiring About Tolerance (EAT) randomised controlled trial indicate that guideline defined symptoms of non-IgE cow’s milk allergy are very common in infants, thereby having the potential to promote milk allergy over-diagnosis by labelling normal infant symptoms as possible milk allergy.
Allergy societies and the formula industry
From the early years, the formula industry aligned itself with allergists and other trusted sources of infant feeding information, leading to widespread inappropriate guidance for infant feeding and false promotion of special health-promoting properties of formula. Hydrolysed formula has been inappropriately recommended for allergy prevention for over 30 years and there is excessive consumption of specialised formula in some regions due to milk allergy overdiagnosis. Formal analysis of allergy societies’ relationships with formula companies has not yet been undertaken, but it is likely that most societies and many conferences and educational activities are sponsored by formula companies. This article discusses the World Allergy Organization’s alignment with the formula industry and calls on them to follow WHO guidance, protect the patients that their members serve and stop accepting funding from formula companies.
Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems
This review summarises current knowledge and new discoveries about human milk and mucosal immunity, including how certain microbes in maternal milk seed and shape the infant gut microbiota which helps to regulate gut barrier integrity and training of the developing immune system. Human milk oligosaccharides have been shown to directly modulate gene expression in mast and goblet cells in the gastrointestinal tract, with data showing a reduced risk of peanut sensitisation among infants breastfed by peanut-consuming mothers, thereby suggesting a role for milk-borne food antigens in tolerance development. Finally, interest in human milk antibodies surged during the pandemic with the identification of neutralizing severe acute respiratory syndrome coronavirus 2 antibodies in maternal milk following both natural infection and vaccination. In summary, human milk provides critical immune protection and stimulation to breastfed infants.
Dawod, Bassela,b; Marshall, Jean S.a,b; Azad, Meghan B.c,d,e Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems, Current Opinion in Gastroenterology: November 2021 – Volume 37 – Issue 6 – p 547-556 doi: 10.1097/MOG.0000000000000778
Hydrolysed formula and allergy prevention
Over the past 30 years, hydrolysed formula has been recommended to prevent allergy in infants – an endorsement supported by historically fraudulent research and selectively reported trials. New TRIGR trial results are discussed in this editorial which reinforce the evidence that whilst extensively hydrolysed formula has a role in managing children with certain intestinal conditions or milk allergy, there is little evidence that hydrolysed formula aids in feeding healthy infants or helps to reduce allergy risk.
This study aims to understand whether cows’ milk allergy (CMA) guideline recommendations might promote CMA over-diagnosis or undermine breastfeeding, particularly in light of recent increases in sales of specialized formula for managing CMA. Authors reviewed recommendations made in CMA guidelines and critically appraised 2 key recommendations. In their key conclusions, the authors found that recommendations to manage common infant symptoms as CMA are not evidence-based, especially in breastfed infants who are not directly consuming cow’s milk. Such recommendations may cause harm by undermining confidence in breastfeeding.
Munblit D, Perkin MR, Palmer DJ, Allen KJ, Boyle RJ. Assessment of Evidence About Common Infant Symptoms and Cow’s Milk Allergy. JAMA Pediatr. 2020;174(6):599–608. doi:10.1001/jamapediatrics.2020.0153
- Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 Years
- Assessing the health benefits and risks of the introduction of peanut and hen’s egg into the infant diet before six months of age in the UK
- Hydrolysed formula and allergies
- Breastfeeding and asthma and allergies
Lodge, C.J. et al (2015) Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 38-53.