A Cochrane review [Abstract] 1 included 3 studies of antigen avoidance during lactation involving 540 subjects. One study reporting on only 26 lactating women found no significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the child's first 18 months of life (RR 0.73, 95% CI 0.32 to 1.64). A larger included study (n=497) did not report on atopic eczema or other allergic disease outcomes, but found no evidence of a significant protective effect of maternal antigen avoidance during lactation on positive skin-prick tests to cow milk, egg, or peanut antigen 1, 2, or 7 years of age. One small crossover trial involving 17 lactating mothers found that dietary antigen avoidance by mothers of infants with established atopic eczema was associated with a nonsignificant reduction in eczema severity.
A systematic review 2 included 42 studies (over40 000 children): 11 intervention studies (including 7 RCTs), 26 prospective cohort studies, 4 retrospective cohort studies, and 1 case-control study. In the randomized control trials, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish, and foods containing vitamin D and Mediterranean dietary patterns were among the few consistent associations with lower risk for allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts, and fast food.
Comment: The quality of evidence is downgraded by study limitations (lack of allocation concealment and failure to adhere to the intention-to-treat principle) and by imprecise results (wide confidence intervals).
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