Breastfeeding and allergies: time for a change in paradigm?

For decades, conventional wisdom and much medicalliterature have stated that breastfeeding, in addition toitsnutritionalandsociologicalbenefits,providedanumberofspecifichealthbenefitstotheinfant,includingreductionof the incidence of allergy and childhood wheezing. In2004,KempandKakakios[1]wrote‘Ithasbeenanarticleof faith amongst pediatricians and allergists that breast-feedingisbeneficialforthepreventionofallergicdisease’.Now that paradigm is beingchallenged, as several studiespublished over the last few years suggest, there is nosustained protective effect, or even, that there is anincreased long-term risk of allergy and asthma associatedwith breastfeeding. These reports contrast with studiesdemonstratingreductionofchildhoodwheezingandaller-gic diseases among breastfed children, leading to contro-versy and debate [2,3]. A recent editorial in the BritishMedical Journal concluded ‘...the claim that breastfeed-ingreducestheriskofallergyandasthmaisnotsupportedby evidence’ [4 ]. This review examines reasons for theconflicting reports and suggests an over-arching perspect-ive given recent evidence.Breastfeeding is a natural phenomenon, providingbalanced nutrition and mother–infant bonding, as wellas a number of health benefits. These include reducedincidence of infectious diseases, including diarrheal dis-eases and lower respiratory tract infections, reducedincidence of diabetes and obesity, and improved mentalperformance [5,6]. There are numerous reasons whybreastfeeding should be encouraged wherever possible,with few exceptions such as in the presence of maternalHIV infection [7].