Atopic Eczema and Early Introduction of Solid Foods

C, based on a single cohort study.) Evidence Summary Evidence suggesting that early introduction of solid foods does not increase the incidence of eczema comes from two large prospective cohort studies that relied heavily on parental recall.1,2 The first was a four-year study (n = 6,905 infants) in which parents used validated questionnaires to report when common food allergens were introduced and whether their child had been diagnosed with eczema.1 By four years of age, children who had been exposed to potential allergens before six months of age did not have an increased risk of eczema compared with exposure after six months for the following foods: cow's milk (adjusted odds ratio [AOR] = 0.95; 95% confidence interval [CI], 0.77 to 1.2), chicken eggs (AOR = 1.1; 95% CI, 0.81 to 1.4), peanuts (AOR = 0.87; 95% CI, 0.65 to 1.2), tree nuts (AOR = 1.1; 95% CI, 0.72 to 1.6), soy (AOR = 0.97; 95% CI, 0.80 to 1.2), and gluten (AOR = 1.0; 95% CI, 0.81 to 1.3). A two-year case-control study (n = 557 infants drawn from a larger prospective cohort study) found evidence that early introduction of solid foods may have a protective effect on the subsequent development of eczema.3 All data were obtained by parental questionnaire. Recommendations from Others The American Academy of Pediatrics recommends starting solid foods around four to six months of age, stating that there is no convincing evidence that delaying solids beyond this time increases rates of atopic disease.5 The American Academy of Allergy, Asthma, and Immunology recommends introducing solid foods at four to six months of age.6 It also recommends that highly allergenic foods be given after a few other solid foods have been well tolerated, and that these foods should initially be given at home rather than child care or a restaurant.