FOOD ALLERGENS IN MATERNAL DIET DURING BREASTFEEDING AND OUTCOME OF ELIMINATION DIET ON INFANT ALLERGY DEVELOPMENT: A SYSTEMATIC REVIEW

Abstract

Introduction: Breastfeeding is recommended to provide sufficient nutrition source to infants. Although adverse reactions to allergenic food in exclusively breastfed infants have been identified yet the assessment among lactation mothers is still lacking. Hence, this study aims to review the effects of food allergens manipulation in maternal diet towards infant allergy reaction. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified through five electronic databases using 15 keywords and were included if they met the following criteria: published in English, assessed mothers free from chronic diseases and included full term infants aged less than 24 months who were exclusively breastfed for at least four months. Results: A total of 1,094 relevant abstracts were screened and 8 full text articles, describing observational studies were reviewed and summarized. All studies reported responsible foods that trigger allergy reaction in infants. Nine food allergens were recognized in the maternal diet such as fish, shellfish, peanut, soy, cow’s milk, tree nuts (chocolate and coffee beans), fermented foods (cheese, yogurt, bread, soy sauce, miso soup and fermented soy beans), egg and pork. All but one study presented significant association between maternal dietary intake and allergy outcome. Nevertheless, only one study recommended maternal dietary elimination during breastfeeding, two agreed but with a few conditions, two rejected the recommendation and the remaining did not give any comment. Conclusion: Food allergens in maternal diet can indeed be transferred through breastmilk. However, maternal elimination diet is not recommended for breastfeeding mothers as some foods are good sources of important nutrients unless the relationship is established. Even then the maternal elimination diet practice must be guided by clinicians so as not to jeopardize the growth and development of infants.

Keywords: Food allergen, maternal dietary intake, breastfeeding, infant, food allergy