Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child

Michael S Kramer; Ritsuko Kakuma

doi:10.1002/14651858.CD000133

Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child

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References

References to studies included in this review

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excluded studies
additional references
other published versions

Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. BMJ 1986;293:231‐3.

Chandra RK, Puri S, Suraiya C, Cheema PS. Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants. Clinical Allergy 1986;16:563‐9.

Chandra RK, Puri S, Hamed A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants. BMJ 1989;299:228‐30.

Falth‐Magnusson K, Kjellman NIM. Allergy prevention by maternal elimination diet during late pregnancy ‐ a 5‐year follow‐up of a randomized study. Journal of Allergy and Clinical Immunology 1992;89:709‐13.

Falth‐Magnusson K, Kjellman NIM. Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy ‐ a randomized study. Journal of Allergy and Clinical Immunology 1987;80:868‐75.

Falth‐Magnusson K, Oman H, Kjellman NIM. Maternal abstention from cow milk and egg in allergy risk pregnancies. Allergy 1987;42:64‐73.

Lilja G, Dannaeus A, Falth‐Magnusson K, Graff‐Lonnevig V, Johansson SGO, Kjellman NIM, et al. Immune response of the atopic woman and fetus: effects of high‐ and low‐dose food allergen intake during late pregnancy. Clinical Allergy 1988;8:131‐42.

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Lilja G, Dannaeus A, Foucard T, Graff‐Lonnevig V, Johansson SGO, Oman H. Effects of maternal diet during late pregnancy and lactation on the development of IgE and egg‐ and milk‐specific IgE and IgG antibodies in infants. Clinical and Experimental Allergy 1991;21:195‐202.

Lilja G, Dannaeus A, Foucard T, Graff‐Lonnevig V, Johansson SGO, Oman H. Effects of maternal diet during late pregnancy and lactation on the development of atopic disease in infants up to 18 months of age ‐ in‐vivo results. Clinical and Experimental Allergy 1989;19:473‐9.

Lovegrove JA, Hampton SM, Morgan JB. The immunological and long‐term atopic outcome of infants born to women following a milk‐free diet during late pregnancy and lactation: a pilot study. British Journal of Nutrition 1994;71:223‐38.

Lovegrove JA, Morgan JB, Hampton SM. Dietary factors influencing levels of food antibodies and antigens in breast milk. Acta Paediatrica 1996;85:778‐84.

References to studies excluded from this review

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included studies
additional references
other published versions

Arshad SH, Mathews S, Gant C, Hide DW. Effect of allergen avoidance on development of allergic disorders in infancy. Lancet 1992;339:1493‐7.

Hattevig G, Kjellman B, Sigurs N, Bjorksten B, Kjellman NIM. Effect of maternal avoidance of egg, cow's milk and fish during lactation upon allergic manifestations in infants. Clinical and Experimental Allergy 1989;19:27‐32.

Zeiger RS, Heller S. The development and prediction of atopy in high‐risk children: follow‐up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. Journal of Allergy and Clinical Immunology 1995;95:1179‐90.

Zeiger RS, Heller S, Mellon M, O'Connor R, Hamburger RN. Effectiveness of dietary manipulation in the prevention of food allergy in infants. Journal of Allergy and Clinical Immunology 1986;78:224‐38.

Zeiger RS, Heller S, Mellon MH, Forsythe AB, O'Connor RD, Hamburger RN, et al. Effect of combined maternal and infant food‐allergen avoidance on development of atopy in early infancy; a randomized study. Journal of Allergy and Clinical Immunology 1989;84:72‐89.

Zeiger RS, Heller S, Mellon MH, Halsey JF, Hamburger RN, Sampson HA. Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents: a prospective randomized study of food allergen avoidance. Pediatric Allergy and Immunology 1992;3:110‐27.

Additional references

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included studies
excluded studies
other published versions

Cant AJ, Marsden RA, Kilshaw PJ. Egg and cow's milk hypersensitivity in exclusively breast fed infants with eczema, and detection of egg protein in breast milk. BMJ 1985;291:932‐5.

Clarke MJ, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.2.0 [updated March 2003]. In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software. Updated quarterly.

Falth‐Magnusson K, Kjellman NIM. Allergy prevention by maternal elimination diet during late pregnancy ‐ a 5‐year follow‐up of a randomized study. Journal of Allergy and Clinical Immunology 1992;89:709‐13.

Gerrard JW. Allergy in breast fed babies to ingredients of breast milk. Annals of Allergy 1979;42:69‐72.

Jakobsson I, Lindberg T, Benediktsson B, Hansson BG. Dietary bovine beta‐lactoglobulin is transferred to human milk. Acta Paediatrica Scandinavica 1985;74:342‐5.

O'Keefe ES. The relation of food to infantile eczema. Boston Medical and Surgical Journal 1920;183:569‐73.

Shannon WR. Demonstration of food proteins in human breast milk by anaphylactic experiments on guinea pigs. American Journal of Diseases of Children 1921;22:223‐31.

Stuart CA, Twiselton R, Nicholas MK, Hide DW. Passage of cow's milk protein in breast milk. Clinical Allergy 1984;14:533‐5.

Talbot FB. Eczema in childhood. Medical Clinics of North America 1918;1:985‐96.

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Troncone R, Scarcella A, Donatiello A, Cannataro P, Tarabuso A, Auricchio S. Passage of gliadin into human breast milk. Acta Paediatrica Scandinavica 1987;76:453‐6.

Upton MN, McConnachie A, McSharry C, Hart CL, Davey Smith D, Gillis CR, et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000;321:88‐92.

Vadas P, Wai Y, Burks W, Perelman B. Detection of peanut antigens in breast milk of lactating women. JAMA 2001;285:1746‐8.

Williams HC. Is the prevalence of atopic dermatitis increasing?. Clinical and Experimental Dermatology 1992;17:385‐91.

Woolcock AJ, Peat JK. Evidence for the increase in asthma worldwide. CIBA Foundation Symposium 1997;206:122‐34.

Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003;111:1662‐71.

References to other published versions of this review

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included studies
excluded studies
additional references

Kramer MS. Maternal antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child (Cochrane Review). The Cochrane Library 2003, Issue 3.

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Kramer MS. Maternal antigen avoidance during lactation for preventing atopic eczema in infants (Cochrane Review). The Cochrane Library 2003, Issue 3.

Google Scholar

Kramer MS. Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk (Cochrane Review). The Cochrane Library 2003, Issue 3.

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

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excluded studies

Cant 1986

Methods	Randomized cross‐over trial based on random numbers table, but details of allocation procedure not reported.
Participants	19 US mothers of infants 6 weeks to 6 months of age with atopic eczema.
Interventions	Experimental: Maternal exclusion of cow milk, egg, chocolate, wheat, nuts, fish, beef, chicken, citrus fruits, colorings, and preservatives, with use of soya‐based milk substitute for 4 weeks. Control: Same dietary exclusions for same duration (4 weeks), but substitute contained cow milk and egg. Each of the two interventions allocated to all subjects in randomized order.
Outcomes	Two, continuous‐scale eczema severity scores evaluated after 4 weeks on each diet: area (number of involved body areas from 0 to 20) and "activity" (severity within each area on 0‐3 scale X number of involved areas).
Notes	1) Two poor compliers excluded. 2) No data presented on compliance in the 17 women not excluded. 3) Results in original publication analyzed appropriately for crossover trial; data tables in this review contain group means after exclusion diet (intervention vs control) and common SD for each outcome at the end of the trial. 3) A second, nonrandomized crossover trial reported in the same publication has been excluded from this review, because the sequential treatments were used in the same order in all subjects (i.e., not randomized).
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Chandra 1986

Methods	Randomization based on random number table, but details of method not described.
Participants	121 women with one or more previous children with atopic eczema or asthma, 109 of whom were included in the analysis. Only 38 who formula‐fed their infants are included in considering antigen avoidance during pregnancy, while only the 71 who breastfed their infants are used for antigen avoidance during lactation.
Interventions	Experimental: Maternal avoidance of cow milk and dairy products, egg, fish, beef, and peanut "throughout pregnancy and lactation", but time of onset on gestation not reported. Control: No dietary restriction.
Outcomes	Incidence and severity of atopic eczema in first year.
Notes	1) Allocation procedure not described in detail. 2) Post‐randomization exclusion of poor compliers. 3) Compliance data were collected but not reported. 4) Discrepancy between "complete" (Methods) vs "almost complete" (Abstract) antigen avoidance. 5) No blinding of examiners to treatment. 6) No data reported on gestational weight gain or pregnancy outcomes. 7) Eczema score appears to be based only on infants with eczema.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Chandra 1989

Methods	Randomization based on random number table, but details not reported.
Participants	112 women with atopic family history themselves or in partners (fathers) who were planning to exclusively breastfeed their infants.
Interventions	Experimental: Maternal avoidance of milk and other dairy products, eggs, fish, peanuts, and soybeans for duration of lactation (up to 6 months). Control: No dietary restriction.
Outcomes	Atopic eczema incidence and severity through age 18 months.
Notes	1) Several post‐randomization exclusions in each group. 2) Compliance data collected but not reported. 3) No blinding of outcome for breastfed groups. 4) No difference in maternal weight change, but data not reported. 5) No SDs reported for eczema scores in infants with eczema only.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Falth‐Magnusson 1987

Methods	Randomization based on random numbers assigned in advance, allocation contained in sealed envelope opened only after consent was obtained.
Participants	212 pregnant Swedish women with positive family history of allergy (herself, husband, or previous children).
Interventions	Experimental: Cow milk and egg avoidance diet from 28 weeks of gestation. Control: Normal diet.
Outcomes	Gestational weight gain, cord blood IgE, atopic eczema, asthma, birth weight, and preterm birth.
Notes	1) Birth weight, 5‐year atopic outcomes analyzed by compliance with diet, not by randomized allocation group. 2) SDs for cord blood and maternal IgEs do not add up.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Lilja 1988

Methods	Cluster randomization used in Stockholm/Uppsala, but randomization method not described.
Participants	171 pregnant women in Stockholm/Uppsala with a history of respiratory allergy to pollen and/or dander. 84 pregnant women from Linkoping are also mentioned in the 1988 report, but these appear to be a subset of the women reported in Falth‐Magnusson 1987.
Interventions	Experimental: Low‐milk and low‐egg diet during third trimester. Control: High‐milk and high‐egg diet during third trimester.
Outcomes	Cord blood IgE, total atopy, asthma, atopic eczema, allergic rhinitis, and urticaria.
Notes	1) Analysis based on individual subjects despite cluster randomization. 2) Small number of noncompliers not analyzed. 3) Large differences at baseline in type of allergy in both trials raises question about randomization. 4) Cord blood IgE levels not tabulated; graph only. 5) Cord blood IgE sample sizes do not add up.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

Lovegrove 1994

Methods	Randomization method not described.
Participants	Pregnant English women with atopic histories in themselves or in partners, recruited at 30 weeks' gestation.
Interventions	Experimental: Milk‐free diet from 36 weeks' gestation and during lactation. Control: Unrestricted diet.
Outcomes	Atopic eczema at 6, 12, and 18 months, preterm birth, and birth weight. Atopic outcomes restricted to comparison of antigen avoidance during lactation, while birth outcomes (preterm birth and birth weight) restricted to comparison of antigen avoidance during pregnancy.
Notes	1) Number of women randomized not reported, but 44 original participants included nonatopic women. 2) 6 of 44 total participants (including nonatopic, nonrandomized) not included in analysis. 3) Nonblind mothers may have unblinded examining physicians. 4) Funded by manufacturer of hypoallergenic formula.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

SD: standard deviation
vs: versus

Characteristics of excluded studies [ordered by study ID]

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included studies

Study	Reason for exclusion
Arshad 1992	Experimental intervention included dietary antigen avoidance in infant's diet, as well as the mother's, and also included application of acaricidal powder to reduce exposure to inhaled dust mite antigen.
Hattevig 1989	Experimental and control interventions allocated by site (2 different hospital clinics), not randomized or quasi‐randomized.
Zeiger 1989	Experimental intervention included dietary antigen avoidance in infant's diet, as well as the mother's. In addition, the trial suffered from large and grossly unequal losses to follow up due to noncompliance with dietary restriction.

Data and analyses

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Comparison 1. Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Atopic eczema in first 12‐18 months Show forest plot	3	372	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.67, 1.33]
Open in figure viewer Analysis 1.1 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 1 Atopic eczema in first 12‐18 months.
2 Asthma in first 18 months Show forest plot	2	334	Risk Ratio (M‐H, Random, 95% CI)	2.22 [0.39, 12.67]
Open in figure viewer Analysis 1.2 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 2 Asthma in first 18 months.
3 Allergic rhinitis/conjunctivitis in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
Open in figure viewer Analysis 1.3 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 3 Allergic rhinitis/conjunctivitis in first 18 months.
4 Allergic urticaria in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.21, 4.87]
Open in figure viewer Analysis 1.4 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 4 Allergic urticaria in first 18 months.
5 Any atopic condition in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.42, 1.38]
Open in figure viewer Analysis 1.5 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 5 Any atopic condition in first 18 months.
6 Positive skin prick test to egg at 6 months Show forest plot	2	340	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.32, 1.05]
Open in figure viewer Analysis 1.6 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 6 Positive skin prick test to egg at 6 months.
7 Positive skin prick test to egg at 18 months Show forest plot	2	335	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.52, 1.74]
Open in figure viewer Analysis 1.7 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 7 Positive skin prick test to egg at 18 months.
8 Positive skin prick test to milk at 6 months Show forest plot	2	340	Risk Ratio (M‐H, Random, 95% CI)	1.15 [0.29, 4.51]
Open in figure viewer Analysis 1.8 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 8 Positive skin prick test to milk at 6 months.
9 Positive skin prick test to milk at 18 months Show forest plot	2	335	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.16, 4.59]
Open in figure viewer Analysis 1.9 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 9 Positive skin prick test to milk at 18 months.
10 Detectable cord blood IgE (>= .125 U/ml) Show forest plot	2	287	Risk Ratio (M‐H, Random, 95% CI)	1.16 [0.94, 1.44]
Open in figure viewer Analysis 1.10 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 10 Detectable cord blood IgE (>= .125 U/ml).
11 Cord blood IgE > 1 U/ml Show forest plot	1	91	Risk Ratio (M‐H, Fixed, 95% CI)	2.81 [1.00, 7.90]
Open in figure viewer Analysis 1.11 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 11 Cord blood IgE > 1 U/ml.
12 Preterm birth Show forest plot	2	236	Risk Ratio (M‐H, Random, 95% CI)	10.06 [0.53, 192.26]
Open in figure viewer Analysis 1.12 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 12 Preterm birth.
13 Gestational weight gain (as % of prepregnancy weight) Show forest plot	1	164	Mean Difference (IV, Fixed, 95% CI)	‐3.0 [‐5.21, ‐0.79]
Open in figure viewer Analysis 1.13 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 13 Gestational weight gain (as % of prepregnancy weight).
14 Birth weight (g) Show forest plot	2	236	Mean Difference (IV, Random, 95% CI)	‐83.45 [‐221.87, 54.97]
Open in figure viewer Analysis 1.14 Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 14 Birth weight (g).

Open in table viewer

Comparison 2. Maternal antigen avoidance during lactation in women at high risk for atopic offspring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Incidence of atopic eczema in first 12‐18 months Show forest plot	3	194	Risk Ratio (M‐H, Random, 95% CI)	0.56 [0.36, 0.86]
Open in figure viewer Analysis 2.1 Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 1 Incidence of atopic eczema in first 12‐18 months.
2 Severity of atopic eczema (score) Show forest plot	2	168	Mean Difference (IV, Random, 95% CI)	‐11.05 [‐16.57, ‐5.52]
Open in figure viewer Analysis 2.2 Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 2 Severity of atopic eczema (score).
3 Birth weight (g) Show forest plot	1	26	Mean Difference (IV, Fixed, 95% CI)	‐100.0 [‐485.52, 285.52]
Open in figure viewer Analysis 2.3 Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 3 Birth weight (g).

Open in table viewer

Comparison 3. Maternal antigen avoidance during lactation for treating atopic eczema in infants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema area score Show forest plot	1	34	Mean Difference (IV, Fixed, 95% CI)	‐0.80 [‐4.43, 2.83]
Open in figure viewer Analysis 3.1 Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 1 Eczema area score.
2 Eczema activity score Show forest plot	1	34	Mean Difference (IV, Fixed, 95% CI)	‐1.40 [‐7.18, 4.38]
Open in figure viewer Analysis 3.2 Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 2 Eczema activity score.

Analysis 1.1

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 1 Atopic eczema in first 12‐18 months.

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Analysis 1.2

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 2 Asthma in first 18 months.

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Analysis 1.3

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 3 Allergic rhinitis/conjunctivitis in first 18 months.

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Analysis 1.4

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 4 Allergic urticaria in first 18 months.

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Analysis 1.5

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 5 Any atopic condition in first 18 months.

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Analysis 1.6

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 6 Positive skin prick test to egg at 6 months.

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Analysis 1.7

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 7 Positive skin prick test to egg at 18 months.

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Analysis 1.8

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 8 Positive skin prick test to milk at 6 months.

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Analysis 1.9

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 9 Positive skin prick test to milk at 18 months.

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Analysis 1.10

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 10 Detectable cord blood IgE (>= .125 U/ml).

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Analysis 1.11

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 11 Cord blood IgE > 1 U/ml.

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Analysis 1.12

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 12 Preterm birth.

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Analysis 1.13

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 13 Gestational weight gain (as % of prepregnancy weight).

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Analysis 1.14

Comparison 1 Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring, Outcome 14 Birth weight (g).

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Analysis 2.1

Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 1 Incidence of atopic eczema in first 12‐18 months.

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Analysis 2.2

Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 2 Severity of atopic eczema (score).

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Analysis 2.3

Comparison 2 Maternal antigen avoidance during lactation in women at high risk for atopic offspring, Outcome 3 Birth weight (g).

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Analysis 3.1

Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 1 Eczema area score.

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Analysis 3.2

Comparison 3 Maternal antigen avoidance during lactation for treating atopic eczema in infants, Outcome 2 Eczema activity score.

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Comparison 1. Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Atopic eczema in first 12‐18 months Show forest plot	3	372	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.67, 1.33]

2 Asthma in first 18 months Show forest plot	2	334	Risk Ratio (M‐H, Random, 95% CI)	2.22 [0.39, 12.67]

3 Allergic rhinitis/conjunctivitis in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Allergic urticaria in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.21, 4.87]

5 Any atopic condition in first 18 months Show forest plot	1	163	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.42, 1.38]

6 Positive skin prick test to egg at 6 months Show forest plot	2	340	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.32, 1.05]

7 Positive skin prick test to egg at 18 months Show forest plot	2	335	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.52, 1.74]

8 Positive skin prick test to milk at 6 months Show forest plot	2	340	Risk Ratio (M‐H, Random, 95% CI)	1.15 [0.29, 4.51]

9 Positive skin prick test to milk at 18 months Show forest plot	2	335	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.16, 4.59]

10 Detectable cord blood IgE (>= .125 U/ml) Show forest plot	2	287	Risk Ratio (M‐H, Random, 95% CI)	1.16 [0.94, 1.44]

11 Cord blood IgE > 1 U/ml Show forest plot	1	91	Risk Ratio (M‐H, Fixed, 95% CI)	2.81 [1.00, 7.90]

12 Preterm birth Show forest plot	2	236	Risk Ratio (M‐H, Random, 95% CI)	10.06 [0.53, 192.26]

13 Gestational weight gain (as % of prepregnancy weight) Show forest plot	1	164	Mean Difference (IV, Fixed, 95% CI)	‐3.0 [‐5.21, ‐0.79]

14 Birth weight (g) Show forest plot	2	236	Mean Difference (IV, Random, 95% CI)	‐83.45 [‐221.87, 54.97]

Comparison 1. Maternal antigen avoidance in pregnancy in women at high risk for atopic offspring

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Comparison 2. Maternal antigen avoidance during lactation in women at high risk for atopic offspring

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Incidence of atopic eczema in first 12‐18 months Show forest plot	3	194	Risk Ratio (M‐H, Random, 95% CI)	0.56 [0.36, 0.86]

2 Severity of atopic eczema (score) Show forest plot	2	168	Mean Difference (IV, Random, 95% CI)	‐11.05 [‐16.57, ‐5.52]

3 Birth weight (g) Show forest plot	1	26	Mean Difference (IV, Fixed, 95% CI)	‐100.0 [‐485.52, 285.52]

Comparison 2. Maternal antigen avoidance during lactation in women at high risk for atopic offspring

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Comparison 3. Maternal antigen avoidance during lactation for treating atopic eczema in infants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eczema area score Show forest plot	1	34	Mean Difference (IV, Fixed, 95% CI)	‐0.80 [‐4.43, 2.83]

2 Eczema activity score Show forest plot	1	34	Mean Difference (IV, Fixed, 95% CI)	‐1.40 [‐7.18, 4.38]

Comparison 3. Maternal antigen avoidance during lactation for treating atopic eczema in infants

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References

References to studies included in this review

Cant 1986 {published and unpublished data}

Chandra 1986 {published data only}

Chandra 1989 {published data only}

Falth‐Magnusson 1987 {published and unpublished data}

Lilja 1988 {published and unpublished data}

Lovegrove 1994 {published data only}

References to studies excluded from this review

Arshad 1992 {published data only}

Hattevig 1989 {published data only}

Zeiger 1989 {published data only}

Additional references

Cant 1985

Clarke 2003

Falth‐Magnusson 1992

Gerrard 1979

Jakobsson 1985

O'Keefe 1920

Shannon 1921

Stuart 1984

Talbot 1918

Troncone 1987

Upton 2000

Vadas 2001

Williams 1992

Woolcock 1997

Zeiger 2003

References to other published versions of this review

CDSR 2003a

CDSR 2003b

CDSR 2003c

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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