Breastfeeding and allergies: time for a change in paradigm?

Purpose of review This review examines recent studies of the relationships between breastfeeding and the epidemiology of allergic diseases, especially atopic dermatitis in infants and asthma in early and later childhood. Recent findings Results from observational birth cohort studies, case-control studies, and one cluster randomized intervention trial have generally failed to demonstrate a protective effect of breastfeeding on outcomes of atopic dermatitis, allergic sensitization, wheezing, or asthma. Difficulties in interpretation relate to the absence of nonbreastfed control or reference groups in some studies, meaning outcomes can only be compared between different durations of breastfeeding. Studies with a nonbreastfed control group suggest there is an increased risk for atopy and asthma associated with breastfeeding and that prolonged breastfeeding may eventually reduce this increased risk. The family history, sex of the child, and the presence of other risk factors for allergy and asthma also influence the outcome. Summary Although breastfeeding is strongly recommended for its multiple benefits on child health, most recent studies do not confirm the 'conventional wisdom' that breastfeeding is protective against allergy and asthma. Early reduction in childhood wheezing may reflect protection from viral infections, but allergies and asthma at later ages may be increased.