Pie in the Face: Eczema and the Surprising Timing of Cheese

Eczema rates are careening upwards in children around the world. It’s now a big slice on the pie chart, affecting up to 1/3 of all kids in Western societies. Is the timetable for starting certain foods a culprit? “Try not to start your baby on solid foods before 6 months,” and, “Hold off on cow’s milk and on milk products,” are common tidbits of advice dispensed to those seeking to keep their babies’ skin free of the scaly rash of eczema. But researchers in the Netherlands couldn’t find good scientific evidence to support this assertion, so they followed more than 2,500 healthy, full-term children until they were two years old to see if there were indeed any measurable differences in developing eczema tied to the arrival schedule for solid foods. Some of their results will seem ho-hum; others like a whipped cream pie in the face of common recommendations.

Longer breastfeeding and clear skin were linked, with nursing beyond 7 months cutting the odds of eczema by half. Score another point for the perfect food! Or 50 points.

Eczema rates are careening upwards in children around the world. It’s now a big slice on the pie chart, affecting up to 1/3 of all kids in Western societies. Is the timetable for starting certain foods a culprit? “Try not to start your baby on solid foods before 6 months,” and, “Hold off on cow’s milk and on milk products,” are common tidbits of advice dispensed to those seeking to keep their babies’ skin free of the scaly rash of eczema. But researchers in the Netherlands couldn’t find good scientific evidence to support this assertion, so they followed more than 2,500 healthy, full-term children until they were two years old to see if there were indeed any measurable differences in developing eczema tied to the arrival schedule for solid foods. Some of their results will seem ho-hum; others like a whipped cream pie in the face of common recommendations.

Longer breastfeeding and clear skin were linked, with nursing beyond 7 months cutting the odds of eczema by half. Score another point for the perfect food! Or 50 points. An earlier study, by the way, showed that mom’s switching from conventional to organic dairy products during nursing (and later for babies themselves), with no other changes, decreased eczema in children by another third.

Delaying cows milk products, though, significantly increased the risk of eczema. Bring on the cheese and yogurt! Delaying other solid foods also increased the risk of eczema, by more than double if the adventure of feeding solid foods is started after 4 to 6 months. The allergic risks didn’t stop there. Delaying solid foods also increased the risk of recurrent wheezing and of positive allergy tests by age 2 – and those odds were even higher than for eczema. Bring on the chow! But keep nursing

These findings are all consistent with the 2008 AAP guidelines that overturned previous recommendations by declaring that there is no evidence that delaying any food beyond 4 to 6 months helps prevent allergies at all -- for healthy term children who are not already allergic.

But this Dutch study dares to go even further.

During the first year of life the immune system is actively calibrating, helping the body to recognize what is normal and what is a potential threat. I wonder if what’s at work here is that starting foods later makes it more likely that they will be judged foreign by the jury of the immune system.

Or not…

This is one large, important study, consistent with some previous, largely-ignored evidence that delaying milk and milk products increases allergic disease. We no longer have solid grounds to say, “Delay,” to help prevent allergies. But even taking all of the studies together we don’t yet have solid grounds to say that starting foods earlier helps. It is enough, though, to make you wonder…

By the way, early pet exposures decrease the risk of developing pet allergies, but once an allergy develops, avoidance is smart. It may be similar with milk. Even if early milk exposure were to decrease eczema, once a child already has eczema stopping milk (or another food trigger) is sometimes the best way to clear it up. Thankfully most milk allergies in babies are soon out grown.


Snijders BEP, Thijs C, van Ree R, and van den Brandt PA. Age at First Introduction of Cow Milk Products and Other Food Products in Relation to Infant Atopic Manifestations in the First 2 Years of Life: The KOALA Birth Cohort Study. Pediatrics July 2008;122;e115-e122.
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Comments

Anonymous's picture

Heather, while this

Heather, while this particular study emphasized the value of breast milk, it didn't look at the foods Mom eats or avoids during nursing. The 2008 AAP guidelines on allergies and feeding did, though. (http://blogs.drgreene.com/blog/2008/01/08/eggs-fish-milk-nuts-and-peanuts-for-babies/) They found that proteins from peanuts, cow's milk, eggs, etc. do show up in breast milk, but that avoiding them does not reduce the odds of peanut allergies, other food allergies or asthma. They suggest that avoiding them may help in reducing eczema, but there is not enough data to really know. A number of foods in Mom's diet during pregnancy and/or nursing appear to help --including foods rich in vitamin E and zinc (http://blogs.drgreene.com/blog/2006/09/20/pregnancy-diet-asthma-and-eczema/), probiotics (http://www.drgreene.com/21_948.html and http://www.drgreene.com/21_1601.html), and the Mediterranean diet (http://blogs.drgreene.com/blog/2008/01/24/mom%e2%80%99s-diet-kid%e2%80%99s-asthma/). Marisela, I agree with you in wanting what's best for our kids. Sometimes grandmas do know best. I'm a big fan of taking time-honored wisdom and the latest science, and seeing how the different perspectives can lead us to a better understanding. Each new study fills in another small piece of the puzzle. Studies from a few years ago suggested that early solids may increase allergies. Allergies were certainly increasing, and it was important to identify what was going on. Newer studies, such as this one, suggest that the problem was not early feeding itself, but other things that may go along with it -- such as decreased breastfeeding, or new chemicals in the foods, or even timing new foods at the same time as antibiotics. Some studies in animals have shown that new food exposures didn't cause allergies in the babies -- unless the babies were taking antibiotics at the time. We don't know if the problem was from destruction of the beneficial bacteria in the gut (would probiotics help?) or perhaps inflammation from the medicines. But it's another piece of the puzzle. I'm glad fewer antibiotics are being used in babies. They were one of the greatest inventions of the last century, but should only be used when really necessary. Oh, and Kathy, you are wise to be noticing wheat. It is certainly one of the most common triggers of eczema and other allergies: http://blogs.drgreene.com/blog/2005/02/01/nuts-allergies-omega-3s-and-yogurt/ For many people with eczema, identifying a food trigger and eliminating it can make all the difference. Taking probiotics and omega-3s are other gentle things that might offer significant help. (http://blogs.drgreene.com/blog/2005/04/15/probiotics-for-baby-eczema/#comment-479)
Anonymous's picture

I grew up with constant itchy

I grew up with constant itchy skin and eczema. Finally after more than 40 years I found out that I'm allergic to wheat. No wheat, itchy skin goes away. Now I'm not suggesting that wheat is the problem for everyone, but I've noticed that it is used in everything often as just a filler or binder. Maybe it's been so overused that it is causing problems.
Anonymous's picture

I believe knowledge is power,

I believe knowledge is power, and one thing I've learned as I look back at the things I did "wrong" as a parent is that I made the best choices I could with the information and circumstances that I had at the time. I can't say for sure, but I think Dr. Greene may have helped me realize that. I am grateful for the constant search of information and updates of what is considered best practice. If only there were a way to let go of the guilt that comes when what is considered the best way to do things changes.
Anonymous's picture

Maybe the docs are wrong and

Maybe the docs are wrong and we should just listen to our grandmas. It seems scientists are toying with us and our kids are suffering... I can't stand it...
Anonymous's picture

Interesting study. I enjoy

Interesting study. I enjoy watching the information on allergies unfold with only occasional twinges of "I wish I had known that when mine were babies" Did they look at foods Mom eats or avoids while she is nursing at all?