Food allergy in atopic eczema I. The effect of maternal diet on breast-fed babies with eczema

Eczema in infants solely breast fed may be caused by food proteins transmitted through mother's milk (Warner, 1980). By radioimmunoassay we identified traces of cow's milk and egg proteins in human milk 2–4 h after oral challenge. Sixty-nine exclusively breast-fed infants with eczema and 36 controls were then studied. The infants' rashes were classified as 'definite atopic eczema' (DAE), 'possible atopic eczema' (PAE) and 'atopic eczema unlikely' (AEU). All were skin prick-tested against 12 common antigens including six foods. Thirty-five mothers who were breast feeding eczematous infants then completed controlled trials of cows' milk and egg exclusion diets.
Sixty-nine per cent of infants with DAE, 37% with PAE, 25% with AEU and 8% of controls gave positive skin tests to food antigens, in all but three cases to egg and cows' milk. Thirty of 35 (86%) infants did not benefit from a maternal cow's milk and egg exclusion diet. In five, however, exclusion appeared to be effective and double-blind challenge provoked eczema in all five and diarrhoea and colitis in one.
Although half of exclusively breast-fed infants with eczema (DAE and PAE) show cutaneous hypersensitivity to cows' milk or egg protein, only a minority improve if mothers avoid these foods.