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Beth A. Tarini, MD; Aaron E. Carroll, MD, MS; Colin M. Sox, MD, MS; Dimitri A. Christakis, MD, MPH

Arch Pediatr Adolesc Med. 2006;160:502-507.

Objective  To assess the evidence that early solid feeding (before age 4 months) increases the risk of allergic disease.

Data Sources  MEDLINE, the Cochrane Library, and the Drugs and Pharmacology section of EMBASE with key words "infant," "food," and "allergy."

Study Selection  We found 2719 article citations and reviewed references of relevant articles. We critically evaluated the methods and results of articles that met inclusion criteria. We identified 13 studies that met inclusion criteria. There was only 1 controlled trial.

Data Extraction  Allergic disease.

Data Synthesis  Five studies found a positive association between early solid feeding and eczema, with a persistence of the association for 10 years in 1 study. Four studies found no association. One study found an association between early solid feeding and pollen allergy. We found no strong evidence to support the association between early solid feeding and the development of persistent asthma, persistent food allergy, allergic rhinitis, or animal dander allergy.

Conclusions  Systematic review of available evidence suggests that early solid feeding may increase the risk of eczema. However, there are little data supporting an association between early solid feeding and other allergic conditions. Since many studies had problematic methods, additional controlled trials are needed to help guide physicians as they advise parents about the allergic risks of early introduction of solids.

Author Affiliations: Robert Wood Johnson Clinical Scholars Program (Drs Tarini and Christakis); Department of Pediatrics, University of Washington (Drs Tarini and Christakis), and Child Health Institute and Children's Hospital and Regional Medical Center (Dr Christakis), Seattle; Children's Health Services Research, Indiana University School of Medicine, and Regenstrief Institute for Health Care, Indianapolis (Dr Carroll); Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Healthcare, Boston, Mass (Dr Sox).

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