1. The Introduction of Allergenic Foods and the Development of Reported Wheezing and Eczema in Childhood: The Generation R Study Tromp IIM, Kiefte-de Jong JC, Lebon A, et al. The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the Generation R Study. Arch Pediatr Adolesc Med. Published online June 6, 2011. doi:10.1001/archpediatrics.2011.93. Copyright restrictions may apply

2. Introduction Recommendations for the timing of complementary feeding vary, mostly recommending introduction beyond the age of 4 to 6 months. Whether delayed introduction of allergenic foods could decrease the risk of atopic diseases is controversial. The aim of this study was to examine whether the timing of introduction of select allergenic foods is associated with eczema and wheezing in children up to 4 years of age. –Cow’s milk, hen’s egg, peanuts, tree nuts, soy, and gluten. Copyright restrictions may apply

3. Methods Study Design: Population-based prospective cohort study from fetal life until young adulthood. Participants: A total of 6905 preschool children born between April 2002 and January 2006. Copyright restrictions may apply

4. Methods Data Analysis: Multivariate logistic regression analyses. –Dependent variables: eczema and wheezing (ages 2, 3, and 4 years). –Independent variables: introductions of allergenic foods before or after 6 months of age. –Adjustment for potential confounders. Limitations: –Diagnosis based on parent-reported questionnaires. –Residual confounding. –This study was not able to examine the effect of allergenic food introduction before 4 months of age. Copyright restrictions may apply

5. Results Introduction of cow’s milk, hen’s egg, peanuts, tree nuts, soy, and gluten before the age of 6 months was not significantly associated with eczema or wheezing up to 4 years of age. The results did not alter after stratification according to the child’s history of cow’s milk allergy and parental history of atopy. Copyright restrictions may apply

6. Results Copyright restrictions may apply Association Between the Introduction of Allergenic Foods and Wheezing at Ages 2, 3, and 4 Years in 6905 Preschool Children Participating in the Generation R Study

7. Results Copyright restrictions may apply Association Between the Introduction of Allergenic Foods and Eczema at Ages 2, 3, and 4 Years in 6905 Preschool Children Participating in the Generation R Study

8. Comment This study does not support the recommendation for delayed introduction of allergenic foods beyond age 6 months for the prevention of eczema and wheezing. Copyright restrictions may apply

9. Comment Further studies in this cohort should focus on asthma and eczema at later ages to elucidate whether late introduction of food allergens delays the onset of atopic disease. Delayed introduction of allergenic foods beyond 6 months of age does not prevent the development of atopic diseases eczema and wheezing. Copyright restrictions may apply

10. Contact Information If you have questions, please contact the corresponding author: –Henriëtte A. Moll, MD, PhD, Department of Pediatrics, Erasmus Medical Center, PO Box 2060, 3000 CB Rotterdam, the Netherlands (h.a.moll@erasmusmc.nl). Funding/Support This phase of the Generation R Study was supported by the Erasmus Medical Center, the Erasmus University Rotterdam, the Netherlands, Organization for Health Research and Development (Zon Mw), and Europe Container Terminals B.V. Copyright restrictions may apply