The development of early-onset cow’s milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow’s milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow’s milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.

Background: Allergic diseases in early childhood are influenced by genetic predisposition and modifiable early-life exposures, including epigenetic mechanisms. Understanding the interplay between environmental factors and allergy development in children with atopic heredity is critical for prevention strategies. Objective: To investigate the associations between selected early-life environmental exposures and the development of allergic conditions in children with a positive family history of atopy. Methods: A cross-sectional study was conducted among 120 children aged 2 years (±5 months) with atopic heredity, recruited at the Medical University of Varna, Bulgaria (2017–2020). Data on sociodemographic background, prenatal exposures, birth mode, feeding practices, pet contact, daycare attendance, and infectious burden were collected via structured questionnaires and medical records. Allergic outcomes (food allergy and atopic dermatitis) were physician-confirmed. Statistical analyses included t-tests and chi-square tests. Results: Food allergy was diagnosed in 23.3% and atopic dermatitis in 21.7% of participants. Formula feeding was significantly more common in children with food allergy (66.7% vs. 38.1%; p = 0.020). A lower maternal pregnancy experience score was significantly associated with both food allergy (p = 0.021) and overall allergic outcomes (p = 0.004). Indoor smoking was more common in households of non-allergic children (p = 0.034). Children with food allergy had significantly more rhinopharyngitis episodes (p = 0.014) and longer infection duration. Higher gastroenteritis frequency and hospitalization rates were also noted in food-allergic children. Conclusions: In children with atopic heredity, early formula feeding, prenatal maternal stress, and infection burden were associated with increased risk of allergic conditions. This study underscores the importance of early-life psychosocial and environmental influences, possibly mediated by epigenetic mechanisms, in the development of childhood allergies. These findings highlight novel targets for early prevention and warrant further longitudinal research.

Objectives: Early environmental factors have a significant impact on the development of atopic conditions in children. Breastfeeding has been highlighted for its role in enhancing both immune support and cognitive development. Early allergic conditions and maternal behaviors are linked to cognitive and neurodevelopmental challenges. Our study aims to compare children from atopic families focusing on early nutrition and the neuropsychological development of children, especially in the presence of an allergic predisposition. Materials and methods: The study included 120 children with a family history of allergies (55% boys). Children were divided into group A, children breastfed for at least two months, and group B, children breastfed for less than two months or fed with formula. The study measurements and outcomes included demographic and social data, medical data, the smoking status of the parents, breastfeeding and early feeding practices, and anthropometric measurements. The assessment of the neurological development was carried out with a validated Developmental Profile-3 questionnaire. Diagnosis of allergic conditions was carried out with the SCORAD (SCORing Atopic Dermatitis) questionnaire for assessing atopic dermatitis; the CoMiSS (Cow’s Milk-Related Allergy Symptom Score) questionnaire for potential cow’s milk protein allergy and Prick testing and elimination-provocation protocol were used to confirm allergic status in children with atopic conditions. Data were analyzed using Jamovi 2.2.2 software, with statistical significance set at p ≤ 0.05. Results: The age of the examined children was 13 ÷ 31 months, the age of the mothers was 21 ÷ 42 years, and that of the fathers was 22 ÷ 44 years. Educational levels among mothers were 68.35% (n = 54) with higher education in group A and 61.5% (n = 24) in group B, compared to fathers with rates of higher education of, respectively, 54.3% (n = 44) and 38.5% (n = 15). The average gestational age of the children was 38.8 ± 1.08 weeks, and the relative share of cesarean delivery—50.8% (n = 61)—was slightly higher than vaginal delivery. Anthropometric results (HAZ, WAZ, BMIAZ) did not show a statistically significant influence of the type of feeding (breastfeeding, standard formula, or hydrolyzed formula) on growth during the first two months after birth (p > 0.05). During the study period, a significant number of the children developed allergic conditions, which were more common in children from group A—43.2% (n = 35)—compared to group B—38.5% (n = 15). In the families included in the study, mothers smoked more often (53.3%; n = 64) than fathers (43.3%; n = 52), and 13.3% (n = 16) of the women smoked during pregnancy. Children’s neuropsychological development, assessed with the DP-3 questionnaire, according to the duration of breastfeeding, does not show statistically significant differences for the five functional areas (“Physical development”, “Adaptive behavior”, “Social-emotional” Development”, “Cognitive development “, and “Communication”) or the overall development of children from both groups. The neuropsychological development (DP-3) of the group A children showed correlations with the presence of atopic dermatitis, parents’ age, father’s level of education, mother’s smoking during pregnancy, number of cigarettes smoked by the mother per day, and cesarean delivery. Maternal smoking (number of cigarettes per day) had significant negative correlations with all areas of children’s neuropsychological development, which were most pronounced with physical (rho = −0.352; p = 0.001) and overall development (rho = −0.329; p= 0.003). Cesarean delivery moderately correlated with physical development (rho = 0.292; p = 0.008) and adaptive behavior (rho = −0.294; p = 0.008). In group B, neuropsychological development (DP-3) correlates most clearly with allergic conditions (allergy at two years of age and atopic dermatitis), as well as with maternal smoking during pregnancy, with a strong negative correlation with physical development (rho = −0.510; p = 0.001). Conclusions: Our study reinforces the link between early feeding practices, neuropsychological development, and allergic conditions, emphasizing the lasting effects they have on children’s neurological health. However, limitations such as the relatively small sample size and reliance on parental reporting may affect the generalizability of the findings. Future studies with larger cohorts and objective biomarkers for allergic conditions are needed to further validate these results.