FPIN's Clinical Inquiries

Atopic Eczema and Early Introduction of Solid Foods


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Am Fam Physician. 2015 Sep 15;92(6):523-524.

Clinical Question

Does early introduction of solid foods (added when breast milk or formula is no longer used exclusively) affect the incidence of atopic eczema in childhood?

Evidence-Based Answer

In most children, solid foods may be introduced before four to six months of age without increasing the risk of atopic eczema. (Strength of Recommendation [SOR]: B, based on prospective cohort trials.) Children with HLA genotypes that predispose them to type 1 diabetes mellitus may be more likely to develop atopic eczema if five or more foods are introduced before six months of age. (SOR: 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

Address correspondence to James M. Lee, MD, at lee.jamesmichael@gmail.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Tromp II, Kiefte-de Jong JC, Lebon A, et al. The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the Generation R Study. Arch Pediatr Adolesc Med. 2011;165(10):933–938....

2. Zutavern A, Brockow I, Schaaf B, et al.; LISA Study Group. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. 2008;121(1):e44–e52.

3. Sariachvili M, Droste J, Dom S, et al. Early exposure to solid foods and the development of eczema in children up to 4 years of age. Pediatr Allergy Immunol. 2010;21(1 pt 1):74–81.

4. Nwaru BI, Takkinen HM, Kaila M, et al. Food diversity in infancy and the risk of childhood asthma and allergies. J Allergy Clin Immunol. 2014;133(4):1084–1091.

5. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183–191.

6. Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29–36.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.


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