Breastfeeding and maternal elimination diets in infants with atopic dermatitis

Breast-feeding is generally considered the most appropriate form of infant feeding, although it probably does not prevent food sensitization or the subsequent development of atopic disease.17,129,130,135 In breast-fed infants, AD may develop within the first weeks of life, often while being exclusive breast-fed. Onset of AD during the early lactation period may indicate sensitiza-tion of the infant to maternally ingested food aller-gens.136 Food antigens are secreted into breast milk and may cause similar immunological reactions as seen in formula-fed infants.92

In breast-fed infants with clinical manifestations of food allergies, including AD, a maternal exclusion diet is often effective.18,93,137 An experienced dietitian should closely supervise the maternal diet, and a dietary calcium supplementation may be required for the mother.138 In infants with severe AD, the maternal diet may consist of mainly vegetables, fruits, cereals, and meats. Dairy products, soy, egg, peanut, tree nuts, fish, and/or wheat are initially withheld and cautiously reintroduced into the mother's diet, while observing the infant's symptoms.

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