There are no studies investigating the effect of maternal elimination diets in the treatment of food allergy in breastfed infants. In contrast there are several studies relating to the prevention of atopic disease. In these studies the diet of the lactating mother has been addressed with the aim to prevent the infant from developing atopy. These studies have been carried out in families with affected members, which in turn places the child at an increased risk of developing the illness. A systematic review included three studies involving a total of 209 mothers 1. There was a protective effect on the incidence of atopic eczema during the first 12 months, but the non-blind nature of the studies remains a problem. It is not known how good was the maternal adherence to the diet. Neither was the maternal nutritional state evaluated.
The views of the parents (mothers) regarding the benefit and harm of elimination diets was evaluated by the means of a questionnaire study 2. The questionnaire was designed for the study, and it was piloted but not validated. The children had been referred to specialist health care due to their atopic eczema. Food allergies were diagnosed and treated, based on the patient's history as well as skin and blood tests (approximately 25 % had a positive reaction to more than one food); milk allergy was diagnosed with a challenge test. The children were cared for by a team comprising two paediatricians and a paediatric nurse. The parents were able to easily contact the nurse. A dietitian and a dermatologist were consulted. The mother was asked to complete the questionnaire during the first attendance and again after a 9-month (range 5 - 15) intervention period, i.e. during the last study visit. Eighty-one of the 92 mothers completed the questionnaire at least once. During breast-feeding, 42 % of the mothers had started an elimination diet (citrus fruits etc.). Furthermore, 23 % avoided milk, 22 % milk and cereals; 13 % of the mothers had introduced no dietary restrictions. The mothers felt generally that the stricter their diet the better it is for the child. The most difficult problems encountered by the parents were (as compared with caring for a healthy child) the child's atopic eczema, pruritus, restlessness, sleeplessness, difficulties caring for the skin problems and the adherence to a strict diet. In the second questionnaire many of these problems had eased, even though the parents still found the care of an atopic infant more demanding than that of a healthy child. There was a significant correlation between the improvement of symptoms and parental satisfaction with the treatment.
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