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Pregnancy and Birth to 24 Months Systematic Review

Systematic Review Question

What is the relationship between types and amounts of complementary foods and beverages consumed and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis?

Conclusion Statement

Peanut, tree nuts, seeds: 

  • Strong evidence suggests that introducing peanut in the first year of life (after 4 months of age) may reduce risk of food allergy to peanuts. This evidence is strongest for introducing peanut in infants at the highest risk (with severe atopic dermatitis and/or egg allergy) to prevent peanut allergy, but is also applicable to infants at lower risk. However, the evidence for tree nuts and sesame seeds is limited. 
  • Limited evidence also suggests that there is no relationship between consumption of peanut, tree nuts, or sesame seeds during the complementary feeding period and risk of atopic dermatitis/eczema and asthma. 
  • There is not enough evidence to determine if there is a relationship between consuming peanut, tree nuts, or seeds as complementary foods and allergic rhinitis.

Egg: 

  • Moderate evidence suggests that introducing egg in the first year of life (after 4 months of age) may reduce risk of food allergy to egg. 
  • Limited evidence suggests that there is no relationship between the age of introduction to egg and risk of atopic dermatitis/eczema and asthma. 
  • There is not enough evidence to determine if there is a relationship between consuming egg as a complementary food and allergic rhinitis.

Fish: 

  • Limited evidence suggests that introducing fish in the first year of life (after 4 months of age) may reduce risk of atopic dermatitis/eczema. 
  • There is not enough evidence to determine if there is a relationship between consuming fish as a complementary food and risk of allergy to fish or other foods, asthma, or allergic rhinitis. There is also not enough evidence to determine if there is a relationship between consuming shellfish as a complementary food and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis.

Cow’s milk products: 

  • Limited evidence suggests there is no relationship between age of introduction of cow’s milk products, such as cheese and yogurt, and risk of food allergy and atopic dermatitis/eczema. 
  • There is not enough evidence to determine if there is a relationship between consuming milk products during the complementary feeding period and risk of asthma or allergic rhinitis.

Wheat: 

  • There is not enough evidence to determine if there is a relationship between wheat consumption during the complementary feeding period and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis.

Soy: 

  • There is not enough evidence to determine if there is a relationship between soybean consumption during the complementary feeding period and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis.

Foods and beverages that are not common allergens: 

  • Limited evidence from observational studies suggests that introducing foods not commonly considered to be allergens, such as fruits, vegetables, and meat, in the first year of life (after 4 months of age) is not associated with risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis.

Diet diversity and dietary patterns: 

  • There is not enough evidence to determine a relationship between diet diversity or dietary patterns and risk of food allergy, atopic dermatitis/eczema, asthma, or allergic rhinitis.

Grade: Strong – Peanut; Moderate - Egg; Limited – Fish, cow’s milk products, tree nuts or seeds, foods and beverages that are not common allergens; Grade Not Assignable – Wheat, soy, diet diversity, dietary patterns