Systematic review: Early infant feeding practices and the risk of wheat allergy.

AIM: Wheat is a common allergen. Early feeding practices (breastfeeding, potentially allergenic foods) might affect the risk of allergy. To systematically evaluate the association between early feeding practices and the risk of wheat allergy and sensitisation.

METHODS: Five databases were searched for studies of any design up to July 2015.

RESULTS: We included seven studies (five observational, low to moderate quality, two randomised controlled trials (RCTs), high quality). The results come from observational studies unless stated otherwise. Longer breastfeeding was associated with wheat allergy (two studies, n = 1847) and sensitisation (one study, n = 3781). Evidence for exclusive breastfeeding was contradictory; longer exclusive breastfeeding was associated with either lower (one study, n = 408) or higher (one study, n = 3781) risk of wheat sensitisation. Breastfeeding at gluten introduction did not affect the risk of wheat allergy (two studies, n = 2581). Introducing cereal ≥7 months of age increased the risk of wheat allergy (one study, n = 1612), but results from an RCT (n = 1303) showed no effect. Early introduction of gluten was associated with a reduced risk of wheat sensitisation up to 5 years in one observational study (n = 3781) but not in RCTs (n = 1303).

CONCLUSIONS: Based on limited evidence, the influence of breastfeeding and an early exposure to gluten on the risk of wheat allergy remain uncertain. There is no evidence supporting breastfeeding at gluten introduction as modifying the risk. Early introduction of gluten might reduce the risk of sensitisation, but currently, no evidence exists that it affects the risk of wheat allergy.