To investigate the association between cesarean delivery and physician-diagnosed food allergy and atopic dermatitis during the first 3 years of life.

A prospective birth cohort study of children born at ≥34 weeks’ gestation at the University Hospital of Patras, Greece, between August 2009 and March 2011.

Four hundred fifty-nine children born in the same tertiary maternity unit were examined at birth and followed up at 1, 6, 12, 18, 24, 30, and 36 months of age. Those with symptoms suggestive of food allergy or atopic dermatitis were evaluated by a pediatric allergy specialist to confirm the diagnosis.

Food allergy was diagnosed in 5.2% and atopic dermatitis in 13.5% of study participants. Cesarean delivery (odds ratio [OR] 3.15; 95% confidence interval [CI] 1.14–8.70), atopic dermatitis (OR 3.01; 95% CI 1.18–7.80), parental atopy (OR 4.33; 95% CI 1.72–12.1), and gestational age (OR 1.57; 95% CI 1.07–2.37) were significant and independent predictors of food allergies. Children with at least 1 allergic parent delivered by cesarean delivery had higher odds of developing food allergy compared with vaginally delivered children of nonallergic parents (OR 10.0; 95% CI 3.06–32.7). The effect of cesarean delivery on atopic dermatitis was not significant (OR 1.35; 95% CI 0.74–2.47). Antibiotic use and prolonged rupture of membranes did not have a significant effect on food allergy or atopic dermatitis.

Children born by cesarean delivery had threefold higher odds of food allergy, independent of a range of confounding factors, including gestational age, birth weight, smoking, family history of atopy, breastfeeding, and others. Those delivered by cesarean delivery with at least 1 allergic parent had 10-fold higher odds of developing food allergy compared with children who were born vaginally to nonallergic parents. Parental atopy, atopic dermatitis, and gestational age were independent predictors of food allergies as well. Cesarean delivery was not related to the development of atopic dermatitis.

In this study, the authors provide data for a homogeneous birth cohort in Greece. The strengths of this study include the 3-year follow-up period, the similarities between those who remained in the study and those who were lost to follow-up, physician diagnosis of food allergy rather than self-report, and the ability to control for multiple factors, such as atopy, breastfeeding, and family history.