Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age Schoetzau A, Filipiak-Pittroff B, Koletzko S, Franke K, von Berg A, Gru¨bl A, Bauer CP, Berdel D, Reinhardt D, Wichmann H-E, for the GINI Study Group. Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. PediatrAllergyImmunol2002:13:234–242. # 2002BlackwellMunksgaard The aim of this study was to assess the preventive effect of exclusive breast-feeding and early solid food avoidance on atopic dermatitis (AD) in infancy in an epidemiological setting. The data are from a dietary clinical trial in a prospective cohort of healthy term newborns at risk of atopy. It was recommended to breast-feed for at least 4 months and to avoid solid food in the same time-period. Eight hundred and sixty-five infants exclusively breast-fed, and 256 infants partially or exclusively formula-fed, were followed-up until the end of the first year following birth. AD and sensitization to milk and egg were considered as study end-points. The 1-year incidence of AD was compared between the two study groups. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. In the breast-fed group, the adjusted OR for AD was 0.47 (95% CI 0.30–0.74). The strongest risk factor was the occurrence of AD in the subject’s core family. The risk of infants with AD to be sensitized to milk was four times higher, and to egg eight times higher, than in infants without AD. Age at first introduction and diversity of solid food did not seem to modify the protective effect of breast-feeding on AD. However, the GINI study was not designed for evaluating the effect of solid food feeding. A preventive effect of delayed solid diet and avoidance of potentially allergenic foods can only be estimated in prospective, well-designed, randomized studies. We conclude that in infants at atopic risk, exclusive breast-feeding for at least 4 months is effective in reducing AD in the first year of life. Angela Schoetzau 1 , Birgit Filipiak-Pittroff 1 , Sibylle Koletzko 2 , Ka ¨the Franke 1 , Andrea von Berg 3 , Armin Gru ¨bl 4 , Carl Peter Bauer 4 , Dietrich Berdel 3 , Dietrich Reinhardt 2 and H.-Erich Wichmann 1,5 , for the GINI Study Group 1 GSF – National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany, 2 Department of Paediatrics and 5 Institute of Medical Data Management, Biometrics and Epidemiology, Ludwig-Maximilians-University, Munich, Germany, 3 Marien-Hospital Wesel, Department of Paediatrics, Wesel, Germany, 4 Technical University, Department of Paediatrics, Munich, Germany Key words: allergy prevention; breast-feeding; atopic dermatitis; infants; solid food Angela Schoetzau, MD, MPH, GSF – National Research Center for Environment and Health, Institute of Epidemiology, Geb. 56, Ingolsta ¨ dter Landstraße 1, 85764 Neuherberg, Germany Tel.:+49-89-3187-4481 Fax: +49-89-3187-3201 Accepted 10 October 2001 Atopic dermatitis (AD) is the most common atopic disease in infancy. Sixty per cent of affected individuals manifest characteristic lesions during the first year of life (1). Sampson (2) assumes that there are two forms of AD – one in which the disease is triggered by allergens with potential immuno- globulin E (IgE) dependency and one in which the disease appears to be IgE independent. In infancy and childhood, 30–40% of children with moderate-to-severe AD have IgE-mediated clin- ical reactivity to food proteins (3–7). In these patients, strict dietary elimination of the offending food results in an improvement of the skin lesions (8,9). In 1936, Grulee & Sandford (10) reported a highly preventive effect of exclusive breast- feeding on infantile eczema compared to cow’s milk in a large cohort of infants. Since then, a great number of studies on this topic have been published, the results of which are contradictory. In a systematic review, Kramer Pediatr Allergy Immunol 2002: 13: 234–242 Printed in UK. All rights reserved Copyright # 2002 Blackwell Munksgaard PEDIATRIC ALLERGY AND IMMUNOLOGY ISSN 0905-6157 234