0826 Delayed introduction of cow’s milk and/or solids and development of allergic disease

In the South African context, continued exclusive breast feeding is recommended by many as a strategy to prevent infectious diseases of early infancy and/or to protect against vertical transmission of HIV. This argument aside, there are also strong proponents of delayed introduction of solids, cow’s milk and cow’s milk products so as to protect against sensitisation and the development of allergic disease. The ‘hygiene hypothesis’ has recently been mentioned in this series in a summary that focused on house dust mite avoidance, and the same principles probably apply here in this discussion around risks associated with early vs late introduction of cow’s milk, its products and other solid foods. Several articles have appeared in this regard, mostly from Europe (Germany, Netherlands, UK), with most of the evidence pointing towards a lack of protection from delayed introduction. ‘Early’ is typically defined as starting within the 1st four months of , and apart from some work that suggests that cessation of breastfeeding and early introduction may be deleterious and associated with atopic disease in children who are at risk because of a family history, there is little published support for delaying the introduction of solids and/or cow milk products in order to prevent allergic disease in childhood. In fact several of these studies have gone on to show that delayed introduction may actually be associated with an increased risk of atopic disease. Some of the studies have been relatively short on follow-up, while others have followed birth cohorts for at least 6 years.

Read more:
Pediatrics 2008;122: e115-22 and e44-52
Pediatrics 2006; 117: 401-11
Arch Dis Child 2004; 89: 303-8
Pediatr Allergy Immunol 2002; 13: 234-42