For many years it has been recommended to limit early introduction of certain highly allergenic foods to decrease the development of food allergy, eczema and asthma.  A Clinical Report was published in the medical journal Pediatrics with new guidelines for the introduction of foods in the infant, as well as food guidelines during pregnancy and breastfeeding.  Ongoing research is needed to clarify some unanswered questions and show long-term effects of early diet, but current evidence is discussed.

In a nutshell:

• Breastmilk is preferred the first year of life
• Hydrolyzed formulas might be beneficial over traditional formulas
• Delay all foods until 4-6 months
• Avoid foods that a child has shown a reaction to
• If breastfeeding and the infant is allergic to a food, the mother should avoid that food
• More research is still needed

Who is at risk for food allergies?

Babies who have a parent or sibling with allergy, eczema or asthma are at high risk of developing those conditions.

Do I need to avoid certain foods during pregnancy or lactation?

In their review of medical literature, they did not find benefit for pregnant or breastfeeding mothers to limit their diet from any foods (including milk, eggs and nuts) to prevent allergic disease.  However, if an infant is already allergic to a food, an allergic reaction might happen if the breastfeeding mother eats that food.  A mother of an infant with known allergies should avoid those foods.

Breastfeeding can help prevent allergies.

There is evidence that breastfeeding for at least 4 months prevents or delays eczema, cow milk allergy and wheezing in children.  (However it is not proven to prevent asthma after 6 years of age.)  Babies who have a parent or sibling with allergy, eczema or asthma are at high risk of developing those conditions.

What if I’m not breastfeeding?

If you have a family history of any allergies, food intolerance, acid reflux, or eczema a hydrolyzed formula instead of a standard cows milk formula (see below) may prevent or delay development in those conditions in that child.  Extensively hydrolyzed formulas may be more effective than partially hydrolyzed formulas (not more than breastmilk), but more studies on their cost effectiveness need to be done.  Soy formulas did not show a benefit to prevent allergic disease or eczema.

• Examples of extensively hydrolyzed milk formulas:  Enfamil Nutramigen Lipil and Similac Alimentum Advance.
• Examples of partially hydrolyzed milk formulas:  Good Start Supreme (whey), Enfamil Gentlease Lipil (whey/casein).

When to start foods:

It has been common practice to delay the introduction of solid foods until 6 months, and to delay highly allergic foods until 2-3 years of age to decrease allergic disease.  Reviewing the studies did not support waiting beyond 4-6 months for any foods.  Although more studies need to be done, at this time it does not appear that delaying any foods thought to be highly allergic (cow milk, fish, eggs, and nuts) offers any benefit.


Adapted from FR Greer, SH Sicherer, AW Burks, and the Committee on Nutrition and Section on Allergy and Immunology. “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: 183-191