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

Dr. Greene’s take on eczema and 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. 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 like cheese 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.