I had to run right to the library to read the article (Isolauri E,
Tahvanainen A, Peltola T, Arvola T. Breast-feeding of allergic infants.
Journal of Pediatrics Jan 1999;134:27-32).  It is very interesting. They
studied 100 babies who had atopic eczema, which developed during
"exclusive breastfeeding" at a mean age of 2 months.  I wondered about
true exclusivity of breastfeeding in this "exclusively breastfed" group,
and found the following.  The babies were born in a hospital where no
infant formula is given, but donor breast milk is used when supplements
needed.  There seemed to be no care to ensuring that the donor milk was
from mothers on elimination diets, so possibly the donor milk could have
acted as a sensitizing source.  55% of the babies received donor breast
milk starting from .8 days of age.  63% had never gotten abm, but in 37%,
a single exposure to cow's milk-based formula had occurred at 4 months of
age (3 to 4.5 months).  In addition, the duration of breastfeeding
"exclusively" was 4 months (range .5 to 7 months), hardly the 6 months of
exclusive we recommend for such high-risk babies. One third of the
patients were receiving no solids, but the remainder were getting some
solids by entry into the study at the mean age of 5 months (the age range
of entry into the study was from 2 to 10 months, but they don't specify
an age range for introduction of solids). Maternal modification of diet
was spotty, with some mothers removing only one allergen (citrus is given
as an example), and others removing several (including milk products,
egg, and fish but not cereals - no mention of soy, peanuts, citrus, corn,
etc) but it appears that the mothers did not modify their diets until
*after* the babies developed eczema.  I guess it's no surprise, then, that
the babies who continued to breastfeed had worse eczema than those who
were given the elemental formula.

This study seems to suggest that once allergens have been introduced,
continued breastfeeding (especially with no real consistent
dietary modification by the mother) is associated with persistence of
eczema as compared with switching to Neocate (an amino-acid derived
elemental formula).  There was really no comparison in this study between
the development of eczema in a group of babies truly exclusively
breastfeeding for the first 6 months vs. other forms of feeding, including
the so-called "exclusive" breastfeeding these authors accepted with the
above noted supplements.  Since modification of mothers'
diet after the eczema appeared was not standardized but left to the
mothers' discretion, there also was no real comparison once eczema had
developed between the elemental formula group and a group whose mothers
really did a formal restriction of all common allergens from their diets.

In my mind, this study really misses the important issue that true
exclusive breastfeeding, possibly with maternal dietary modification from
birth, is probably the most effective primary preventive intervention.  If
this were done in the first place in these high-risk babies, we likely
wouldn't be facing the issue of putting babies on neocate at a later date.

It's so sad that the real important research questions are not being
addressed, while "interventions" such as elemental formulas (despite all
their known and unknown risks) are touted as some kind of cure to a
condition that could have been prevented in the first place.  Dr. Jack, I
hope you don't mind if I borrow your favorite phrase:  AAAARRRGHHHHH!
(Hope I spelled it right!)  Regards, Alicia Dermer, MD, IBCLC.