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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Adam T, Divaret-Chauveau A, Roduit C, Adel-Patient K, Deschildre A, Raherison C, Charles MA, Nicklaus S, de Lauzon-Guillain B. Complementary feeding practices are related to the risk of food allergy in the ELFE cohort. Allergy 2023; 78:2456-2466. [PMID: 37496192 DOI: 10.1111/all.15828] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Conflicting results have been obtained when analyzing the relationship between complementary feeding (CF) practices and allergic diseases in childhood. This study aims to further explore the association between allergic diseases in early childhood (10.1016/j.jaci.2012.02.036) and the age at CF introduction (10.1016/S0140-6736(15)00149-X), food diversity in the first year of life (10.1016/j.ijporl.2019.109759) and the delayed introduction of major allergenic foods. METHODS This analysis focused on 6662 children from the French nationwide ELFE cohort. Data on feeding practices were collected monthly from 3 to 10 months old. Their age at CF introduction was calculated alongside a diversity score, and the number of major allergenic foods (out of eggs, fish, wheat, and dairy products) not introduced at 8 and 10 months. Their associations with parent-reported allergy-related health events between 1 and 5.5 years were assessed using logistic regressions adjusted for confounding factors. A sensitivity analysis excluding early allergic cases (occurring between 2 months and 1 or 2 years) was conducted. RESULTS Late CF (>6 months) was related to a higher risk of food allergy (OR [95% CI] = 1.35 [1.02; 1.78]), a low diversity score at 8 months to a higher risk of asthma (OR [95% CI] = 1.22 [1.01; 1.48]), and two allergenic foods or more not being introduced at 10 months to a higher risk of rhinoconjunctivitis (OR [95% CI] = 1.20 [1.00; 1.44]) and food allergy (OR [95% CI] = 2.46 [1.77; 3.42]). Only this last association remained significant after the exclusion of early cases. CONCLUSION The delayed introduction of major allergenic foods is related to a higher risk of food allergy, which supports the updated guidelines for allergy prevention.
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Affiliation(s)
- T Adam
- Department of Dermatology and Allergology, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France
- Department of Pediatric Allergology, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France
| | - A Divaret-Chauveau
- Department of Pediatric Allergology, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France
- EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Nancy, France
| | - C Roduit
- Division of Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - K Adel-Patient
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - A Deschildre
- University of Lille, CHU Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France
| | - C Raherison
- Department of Pulmonology, CHU of Guadeloupe, French West Indies University, INSERM UMR 1219 EpiCene Team, Bordeaux, France
| | - M-A Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, CRESS, Paris, France
- Unité Mixte Inserm-Ined-EFS Elfe, Ined, Aubervilliers, France
| | - S Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, Dijon, France
| | - B de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, CRESS, Paris, France
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Lee J, Shin M, Lee B. Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. Clin Exp Pediatr 2021; 64:408-414. [PMID: 33147910 PMCID: PMC8342876 DOI: 10.3345/cep.2020.01382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/12/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Complementary food in infancy is necessary for human growth, neurodevelopment, and health. However, the role of allergen consumption in early infancy and its effects on the development of food allergy or tolerance remain unclear. PURPOSE To investigate the influence of age at the time of complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. METHODS We combined data from the Korea National Health and Nutrition Examination Survey collected from 2010 to 2014 and analyzed 1619 children aged 1-3 years who were included in the survey. Multivariate regression analysis was used to identify associations among type of feeding, age at the time of complementary food introduction, and doctor-diagnosed atopic dermatitis and asthma. RESULTS Age at the time of complementary food introduction was not significantly associated with doctor-diagnosed atopic dermatitis and asthma in children aged 1-3 years. In the univariate analysis, children with asthma showed higher water and sodium intake levels than nonasthmatic children. However, this relationship was not significant in the multivariate regression analysis. CONCLUSION The present study revealed no statistically significant relationship between age at the time of complementary food introduction and the risk of atopic dermatitis and asthma in young Korean children. A national prospective study is needed to clarify the influence of age at the time of complementary food introduction on the development of allergic diseases.
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Affiliation(s)
- Jihyun Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Bora Lee
- Institute of Health & Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
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Samady W, Campbell E, Aktas ON, Jiang J, Bozen A, Fierstein JL, Joyce AH, Gupta RS. Recommendations on Complementary Food Introduction Among Pediatric Practitioners. JAMA Netw Open 2020; 3:e2013070. [PMID: 32804213 PMCID: PMC7431991 DOI: 10.1001/jamanetworkopen.2020.13070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. Objective To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. Design, Setting, and Participants In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. Main Outcomes and Measures The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. Results The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%). Conclusions and Relevance In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary.
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Affiliation(s)
- Waheeda Samady
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Campbell
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ozge Nur Aktas
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Jialing Jiang
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Bozen
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jamie L. Fierstein
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alanna Higgins Joyce
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruchi S. Gupta
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Fialkowski MK, Ng-Osorio J, Kai J, Swafford K, Langfelder G, Young CG, Chen JJ, Zhu FM, Boushey CJ. Type, Timing, and Diversity of Complementary Foods Among Native Hawaiian, Pacific Islander, and Filipino Infants. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:127-134. [PMID: 32490400 PMCID: PMC7260875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prevention is the recommended strategy for addressing childhood obesity and may be particularly important for minority groups such as Native Hawaiians, Pacific Islanders, and Filipinos (NHPIF) who display poorer health outcomes than other race/ethnic groups. Complementary feeding is a critical milestone in the first 1,000 days of life and plays a critical role in growth and eating habit formation. This cross-sectional study recruited NHPIF infants between 3 - 12 months of age residing on O'ahu, Hawai'i to examine timing and types of complementary foods introduced first as well as the dietary diversity of those infants 6 - 12 months of age. Basic demographic information and early feeding practices were assessed via online questionnaire. Diet was evaluated using the image-based mobile food record completed over 4-days. Images were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) score. Data were analyzed using descriptive statistics and linear regressions. Seventy participants completed the study with a majority being between the ages of 6 - 12 months (n=56). About half of the participants were provided a complementary food prior to 6 months of age with the most common first complementary food being poi (steamed, mashed taro). Grains were the most commonly reported food group while the high protein food groups was the least commonly reported. Approximately 25% of infants 6 - 12 months of age met MDD all four days. Meeting MDD was significantly associated with age. Findings illuminate opportunities for improvement (eg, delayed introduction) and for promotion (eg, cultural foods) in NHPIF complementary feeding.
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Affiliation(s)
- Marie K. Fialkowski
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Jacqueline Ng-Osorio
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Jessie Kai
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Keala Swafford
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Gemady Langfelder
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Christina G. Young
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - John J. Chen
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Fengqing Maggie Zhu
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
| | - Carol J. Boushey
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai‘i at Mānoa, Honolulu, HI (MKF, JK, KS, GL,CGY)
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rafieyan-Kopaei Z, Fathian-Dastgerdi Z, Tarrahi MJ, Zamani-Alavijeh F. Effectiveness of message-framing intervention on complementary feeding related behaviors among mothers with infants aged 4-8 months: a 3-arm randomized controlled trial. Ital J Pediatr 2019; 45:158. [PMID: 31801605 PMCID: PMC6894219 DOI: 10.1186/s13052-019-0749-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
Objective Complementary feeding from the age of 6 months along with breastfeeding is essential for the health of infants. The effect of educational interventions on preventing the early or late onset of complementary feeding and correcting other relevant behaviors depends on the framing of educational messages. This study aimed to compare different types of message framing on maternal behaviors in complementary feeding of infants. Materials and methods This randomized controlled trial was performed on 96 mothers in three groups of 32 subjects with four-month-old infants in Isfahan (central Iran) during May–September 2018. Data were collected through self-report using a valid researcher-made questionnaire including demographic factors, knowledge, attitude, self-efficacy, and the complementary feeding related behaviors of mothers. For 4 months, the mothers received gain-framed messages in the GF group and loss-framed messages in the LF group from two different channels. The control group only received routine education. Data analysis was performed in SPSS20 using paired t-test, ANOVA, and Chi-square at the significance level of below 0.05. Results In this study, all three groups were matched in terms of demographic characteristics and mean scores of attitude, knowledge, and self-efficacy regarding the complementary feeding of their infants. Following the intervention, the mean knowledge score increased in all three groups and was more favorable in the intervention groups compared to the control group. However, no difference was observed between the GF and LF groups regarding their knowledge. In addition, the GF and LF groups were similar in terms of self-efficacy and behavior of mothers concerning the appropriate onset of complementary feeding. Meanwhile, the mean scores of attitude and behavior of mothers regarding the timely onset, diversity, and appropriateness of continuing complementary feeding were higher in the LF group compared with the GF group. Conclusion Framing messages changes the attitude and knowledge and improves behaviors related to complementary feeding. The interesting point is the different impacts of different types of framing on psychological and behavioral variables. In general, loss-framed messages have more effects on the attitude and certain parts of maternal behaviors. Trial registration IRCT, IRCT20180901040919N1. Registered 29 October 2018, https://en.irct.ir/trial/33782
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Affiliation(s)
- Ziba Rafieyan-Kopaei
- Health Education and Health Promotion. Student Research Committee, School of Heath, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Fathian-Dastgerdi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Hezar Jarib, Avenue, Postal Code, Isfahan, 81676-36954, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Heath, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Hezar Jarib, Avenue, Postal Code, Isfahan, 81676-36954, Iran.
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to discuss the recent literature around methods of prevention of food allergies other than peanut allergy. RECENT FINDINGS While the most robust data to date exists for peanut, there are emerging studies suggesting a beneficial effect to early introduction of cooked egg, and cow's milk as well. While the literature is sparse for other allergens such as tree nuts, finned fish, and shellfish, the mechanism of sensitization is thought to be the same and no study to date has demonstrated a harm with allergenic introduction in the 4-6 months of age window (nor has there been level 1 evidence of benefit to delay of such allergens). This strategy is safe, and pre-emptive testing is not required prior to allergenic solid introduction. All allergenic solids should be introduced at around 6, but not before 4, months of age in infants at high risk.
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Affiliation(s)
- Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. .,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
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Mathias JG, Zhang H, Soto-Ramirez N, Karmaus W. The association of infant feeding patterns with food allergy symptoms and food allergy in early childhood. Int Breastfeed J 2019; 14:43. [PMID: 31666803 PMCID: PMC6813109 DOI: 10.1186/s13006-019-0241-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children. Methods The Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors’ diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2–3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders. Results Of the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors’ diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors’ diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79). Conclusions Analysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.
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Affiliation(s)
- Joacy G Mathias
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
| | - Hongmei Zhang
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
| | | | - Wilfried Karmaus
- 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN USA
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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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Abrams EM, Chan ES. It's Not Mom's Fault: Prenatal and Early Life Exposures that Do and Do Not Contribute to Food Allergy Development. Immunol Allergy Clin North Am 2019; 39:447-457. [PMID: 31563180 DOI: 10.1016/j.iac.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Thus far, the most effective strategy for the prevention of food allergy is early introduction of allergenic solids to at-risk infants. Early skin moisturization may have a role in food allergy prevention. There is insufficient evidence for hydrolyzed formula as a means of allergy prevention. Studies on vitamin D, omega 3, and probiotic supplementation; breastfeeding; early infant dietary diversity; and maternal peanut ingestion during pregnancy and breastfeeding are inconsistent.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, Manitoba R2A 5L9, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
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Wheat Allergy in Children: A Comprehensive Update. ACTA ACUST UNITED AC 2019; 55:medicina55070400. [PMID: 31340608 PMCID: PMC6681225 DOI: 10.3390/medicina55070400] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
Gluten-related disorders are very common in pediatric patients. Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism; its prevalence varies according to the age and region, and in Europe has been estimated to be lower than 1%. Many studies investigated the potential role of several external factors that can influence the risk to developing wheat allergy, but results are still inconclusive. It can be responsible for several clinical manifestations depending on the route of allergen exposure: food-dependent exercise-induced anaphylaxis (FDEIA), occupational rhinitis or asthma (also known as baker’s asthma), and contact urticaria. The prognosis of IgE-mediated wheat allergy in children is generally favorable, with the majority of children becoming tolerant by school age. Patients who experienced an anaphylactic reaction prior to 3 years of age and patients with higher level of wheat- or ω-5 gliadin-specific IgE antibodies seem to be at higher risk of persistent wheat allergy. The current management of patients is dietary avoidance. Nowadays, oral immunotherapy has been proposed for wheat allergy with promising results, even if further studies are necessary to establish the best protocol in order to promote tolerance in wheat-allergic children.
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Burgess JA, Dharmage SC, Allen K, Koplin J, Garcia-Larsen V, Boyle R, Waidyatillake N, Lodge CJ. Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:754-769. [PMID: 30861244 DOI: 10.1111/cea.13383] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/11/2018] [Accepted: 02/11/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. METHODS Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-analysis. RESULTS Cohort studies-Introducing complementary solids at age ≥ 4 months vs <4 months was not associated with food allergy (OR 1.22; 95% CI, 0.76-1.96) but was associated with food sensitization (OR 1.93; 95% CI 1.57-2.38). First exposure from age 4 to 6 months vs <4 months was not associated with food allergy (OR 1.01; 95% CI, 0.64-1.60) but was associated with food sensitization (OR 2.46; 95% CI 1.55-3.86). Randomized controlled trials-Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95% CI, 0.44-0.90) and sensitization (OR 0.76, 95% CI, 0.51-0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95% CI 0.14-0.57). CONCLUSIONS We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4 to 6 months and peanut from 4 to 11 months reduced the risk of egg allergy, peanut allergy and egg sensitization. PROSPERO systematic review registry (CRD42016033473).
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Affiliation(s)
- John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina Allen
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert Boyle
- Department of Paediatric Allergy, Imperial College London, London, UK
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Agyemang A, Sicherer S. The importance of early peanut ingestion in the prevention of peanut allergy. Expert Rev Clin Immunol 2019; 15:487-495. [DOI: 10.1080/1744666x.2019.1582331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Amanda Agyemang
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Sicherer
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr 2019; 109:890S-934S. [PMID: 30982864 DOI: 10.1093/ajcn/nqy220] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.
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Affiliation(s)
| | | | | | - Nancy F Butte
- USDA-Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
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Bedolla-Barajas M, Morales-Romero J, Gaxiola-Arredondo BY, Alcalá-Padilla G, Romero-Velarde E. Prolonged breastfeeding and delayed introduction of whole cow's milk into the diet are factors associated with egg sensitization: A matched case-control study. Allergol Immunopathol (Madr) 2018; 46:539-545. [PMID: 29739686 DOI: 10.1016/j.aller.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Both breastfeeding and the moment at which introduction to solid food occurs have been associated with food allergy. OBJECTIVE To evaluate whether prolonged breastfeeding and the delayed introduction of whole cow's milk into an infant's diet are factors that can be associated with egg sensitization. METHODS This was a hospital-based case-control study, matched by age and sex: each study group comprised 97 atopic children. Additionally, logistic regression was used to identify the factors associated with egg protein sensitization. RESULTS The most common type of allergic disease among both groups was allergic rhinitis. After adjusting for possible confounding variables, a delayed introduction to whole cow's milk decreased the odds of egg protein sensitization; OR=0.16 (95% CI: 0.07-0.36, p<0.0001). Notably, breastfeeding during the first six months of life, regardless of whether it was the only milk an infant drank, increased the risk for sensitization to chicken eggs; OR=5.54 (95% CI: 2.41-12.7, p<0.0001). CONCLUSION Prolonged breastfeeding, regardless of whether it was the only milk an infant drank, greatly increased the risk of egg sensitization. Interestingly, a delayed introduction to whole cow's milk was associated with a reduced possibility of becoming sensitized to eggs. Further studies are required to elucidate these findings.
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Affiliation(s)
- M Bedolla-Barajas
- Servicio de Alergia e Inmunología Clínica, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador de Quevedo y Zubieta No. 750, Colonia La Perla, C. P. 44340, Guadalajara, Jalisco, Mexico.
| | - J Morales-Romero
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n., Colonia Industrial Ánimas, C. P. 91190, Xalapa, Veracruz, Mexico
| | - B Y Gaxiola-Arredondo
- Servicio de Alergología e Inmunología Clínica, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Coronel Calderón No. 777, Colonia El Retiro, C. P. 44280, Guadalajara, Jalisco, Mexico
| | - G Alcalá-Padilla
- Servicio de Alergología e Inmunología Clínica, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Coronel Calderón No. 777, Colonia El Retiro, C. P. 44280, Guadalajara, Jalisco, Mexico
| | - E Romero-Velarde
- División de Pediatría, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Salvador de Quevedo y Zubieta No. 750, Colonia La Perla, C. P. 44340, Guadalajara, Jalisco, Mexico
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Chan ES, Abrams EM, Hildebrand KJ, Watson W. Early introduction of foods to prevent food allergy. Allergy Asthma Clin Immunol 2018; 14:57. [PMID: 30275847 PMCID: PMC6157280 DOI: 10.1186/s13223-018-0286-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Food allergy is a growing public health problem, and in many affected individuals, the food allergy begins early in life and persists as a lifelong condition (e.g., peanut allergy). Although early clinical practice guidelines recommended delaying the introduction of peanut and other allergenic foods in children, this may have in fact contributed to the dramatic increase in the prevalence of food allergy in recent decades. In January 2017, new guidelines on peanut allergy prevention were released which represented a significant paradigm shift in early food introduction. Development of these guidelines was prompted by findings from the Learning Early About Peanut Allergy study—the first randomized trial to investigate early allergen introduction as a strategy to prevent peanut allergy. This article will review and compare the new guidelines with previous guidelines on food introduction, and will also review recent evidence that has led to the paradigm shift in early food introduction.
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Affiliation(s)
- Edmond S Chan
- 1Division of Allergy & Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Elissa M Abrams
- 2Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB Canada
| | - Kyla J Hildebrand
- 1Division of Allergy & Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC Canada
| | - Wade Watson
- 3Division of Allergy, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS Canada
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Introduction of various allergenic foods during infancy reduces risk of IgE sensitization at 12 months of age: a birth cohort study. Pediatr Res 2017; 82:733-740. [PMID: 29040259 DOI: 10.1038/pr.2017.174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
BackgroundIn this study, we aimed to determine whether introducing various allergenic foods during infancy is associated with IgE sensitization at 12 months of age.MethodsDetailed information on feeding practices regarding six possible allergenic foods (fruits, egg white, egg yolk, fish, shellfish, and peanuts) was obtained by administering age-specific questionnaires to parents of infants at ages 6 and 12 months. Fecal secretory IgA (sIgA), fecal eosinophil cationic protein (ECP), and serum levels of total IgE and IgE specific to 20 foods, and IgE specific to 20 inhalant allergens were also quantified at 12 months of age.ResultsAt 12 months of age, infants with IgE sensitization had been introduced to fewer allergenic food items during infancy (3.2±1.4 vs. 3.7±1.3 items). Compared with infants who were given 0-2 allergenic food items, infants introduced to 3-4 or ≥5 allergenic food items showed a significantly lower risk of IgE sensitization (odds ratios (ORs) 0.62 and 0.61, respectively) and lower total IgE levels. In addition, non-introduction of egg white or egg yolk was significantly related to IgE sensitization (ORs 1.41 and 1.26, respectively).ConclusionIncreasing the diversity of allergenic foods in infancy, including fruits, egg white, egg yolk, fish, shellfish, and peanuts, may protect infants from IgE sensitization at 12 months of age.
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19
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Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6–23 months in Southern Benin. Food Secur 2017. [DOI: 10.1007/s12571-017-0722-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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20
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Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction. J Allergy Clin Immunol 2017; 141:620-625.e1. [PMID: 28916221 DOI: 10.1016/j.jaci.2017.06.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent trials have shown that avoiding peanuts during infancy increases the risk of peanut allergy; however, these studies did not address maternal peanut consumption. OBJECTIVE We sought to investigate the relationship between maternal peanut consumption while breast-feeding, timing of direct peanut introduction, and peanut sensitization at age 7 years. METHODS Secondary analysis of a nested cohort within the 1995 Canadian Asthma Primary Prevention Study intervention study was performed. Breast-feeding and maternal and infant peanut consumption were captured by repeated questionnaires during infancy. Skin prick testing for peanut sensitization was performed at age 7 years. RESULTS Overall, 58.2% of mothers consumed peanuts while breast-feeding and 22.5% directly introduced peanuts to their infant by 12 months. At 7 years, 9.4% of children were sensitized to peanuts. The lowest incidence (1.7%) was observed among children whose mothers consumed peanuts while breast-feeding and directly introduced peanuts before 12 months. Incidence was significantly higher (P < .05) if mothers consumed peanuts while breast-feeding but delayed introducing peanuts to their infant beyond 12 months (15.1%), or if mothers avoided peanuts themselves but directly introduced peanuts by 12 months (17.6%). Interaction analyses controlling for study group and maternal atopy confirmed that maternal peanut consumption while breast-feeding and infant peanut consumption by 12 months were protective in combination, whereas either exposure in isolation was associated with an increased risk of sensitization (P interaction = .003). CONCLUSIONS In this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.
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Larson K, McLaughlin J, Stonehouse M, Young B, Haglund K. Introducing Allergenic Food into Infants' Diets: Systematic Review. MCN Am J Matern Child Nurs 2017; 42:72-80. [PMID: 27879501 DOI: 10.1097/nmc.0000000000000313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to explore the association between timing of introduction of potentially allergenic foods to infants and development of food allergies. METHODS CINAHL, Medline, PubMed, Science Direct, and Web of Science were searched using the terms solid food, complementary food, or infant feeding combined with allergy or hypersensitivity for articles published in English in 2000 or later. Inclusion criteria were 1) primary research articles with 2) a focus on association between introduction of complementary foods including potentially allergenic foods into diets of infants less than 12 months of age and development of food allergies. Articles were excluded if they were 1) not primary research, 2) about complementary foods only (without specificity of allergenic foods), or 3) on allergic conditions other than food allergy (such as asthma or eczema). RESULTS The initial literature search yielded 533 articles; 14 articles met inclusion criteria. Level of evidence of each study was determined with the SORT criteria. Results found that delayed introduction of solid foods in general and allergenic foods in particular was not associated with decreased risk for allergic diseases among high and low-risk infants. Later introduction was associated with increased risk for allergy development. CLINICAL IMPLICATIONS For infants at low risk for development of food allergies, providers should advise caregivers to introduce potentially allergenic foods with other solid foods between 4 and 6 months of age when children show an interest in eating solids. Infants at high risk for peanut allergy, should be evaluated by an allergy specialist prior to introduction of peanuts and work with providers to create an individualized plan for introduction of peanuts and other allergenic foods as needed.
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Affiliation(s)
- Katelin Larson
- Katelin Larson is a Pediatric Nurse Practitioner, Olympia Pediatrics, Olympia, WA. Jessica McLaughlin is a Pediatric Nurse Practitioner, School Health Clinics of Santa Clara County, San Jose, CA. Mallory Stonehouse is a Graduate Student, Marquette University College of Nursing, Milwaukee, WI. Brittany Young is a Graduate Student, Marquette University College of Nursing, Milwaukee, WI. Kristin Haglund is an Associate Professor, Pediatric Nurse Practitioner, Marquette University College of Nursing, Milwaukee, WI. She can be reached at
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Human Milk and Allergic Diseases: An Unsolved Puzzle. Nutrients 2017; 9:nu9080894. [PMID: 28817095 PMCID: PMC5579687 DOI: 10.3390/nu9080894] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
There is conflicting evidence on the protective role of breastfeeding in relation to the development of allergic sensitisation and allergic disease. Studies vary in methodology and definition of outcomes, which lead to considerable heterogeneity. Human milk composition varies both within and between individuals, which may partially explain conflicting data. It is known that human milk composition is very complex and contains variable levels of immune active molecules, oligosaccharides, metabolites, vitamins and other nutrients and microbial content. Existing evidence suggests that modulation of human breast milk composition has potential for preventing allergic diseases in early life. In this review, we discuss associations between breastfeeding/human milk composition and allergy development.
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Bunning BJ, DeKruyff RH, Nadeau KC. Epigenetic Changes During Food-Specific Immunotherapy. Curr Allergy Asthma Rep 2017; 16:87. [PMID: 27943047 DOI: 10.1007/s11882-016-0665-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The prevalence and severity of IgE-mediated food allergy has increased dramatically over the last 15 years and is becoming a global health problem. Multiple lines of evidence suggest that epigenetic modifications of the genome resulting from gene-environment interactions have a key role in the increased prevalence of atopic disease. In this review, we describe the recent evidence suggesting how epigenetic changes mediate susceptibility to food allergies, and discuss how immunotherapy (IT) may reverse these effects. We discuss the areas of the epigenome as yet unexplored in terms of food allergy and IT such as histone modification and chromatin accessibility, and new techniques that may be utilized in future studies. RECENT FINDINGS Recent findings provide strong evidence that DNA methylation of certain promoter regions such as Forkhead box protein 3 is associated with clinical reactivity, and further, can be changed during IT treatment. Reports on other epigenetic changes are limited but also show evidence of significant change based on both disease status and treatment. In comparison to epigenetic studies focusing on asthma and allergic rhinitis, food allergy remains understudied. However, within the next decade, it is likely that epigenetic modifications may be used as biomarkers to aid in diagnosis and treatment of food-allergic patients. DNA methylation at specific loci has shown associations between food challenge outcomes, successful desensitization treatment, and overall phenotype compared to healthy controls.
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Affiliation(s)
- Bryan J Bunning
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosemarie H DeKruyff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Kari C Nadeau
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA. .,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA. .,Sean N. Parker Center for Allergy and Asthma Research, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA, 94305-5101, USA.
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Tran MM, Lefebvre DL, Dai D, Dharma C, Subbarao P, Lou W, Azad MB, Becker AB, Mandhane PJ, Turvey SE, Sears MR. Timing of food introduction and development of food sensitization in a prospective birth cohort. Pediatr Allergy Immunol 2017; 28:471-477. [PMID: 28557044 DOI: 10.1111/pai.12739] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effect of infant feeding practices on the development of food allergy remains controversial. We examined the relationship between timing and patterns of food introduction and sensitization to foods at age 1 year in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study. METHODS Nutrition questionnaire data prospectively collected at age 3, 6, 12, 18, and 24 months were used to determine timing of introduction of cow's milk products, egg, and peanut. At age 1 year, infants underwent skin prick testing to cow's milk, egg white, and peanut. Logistic regression models were fitted to assess the impact of timing of food exposures on sensitization outcomes, and latent class analysis was used to study patterns of food introduction within the cohort. RESULTS Among 2124 children with sufficient data, delaying introduction of cow's milk products, egg, and peanut beyond the first year of life significantly increased the odds of sensitization to that food (cow's milk adjOR 3.69, 95% CI 1.37-9.08; egg adjOR 1.89, 95% CI 1.25-2.80; peanut adjOR 1.76, 95% CI 1.07-3.01). Latent class analysis produced a three-class model: early, usual, and delayed introduction. A pattern of delayed introduction, characterized by avoidance of egg and peanut during the first year of life, increased the odds of sensitization to any of the three tested foods (adjOR 1.78, 95% CI 1.26-2.49). CONCLUSIONS Avoidance of potentially allergenic foods during the first year of life significantly increased the odds of sensitization to the corresponding foods.
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Affiliation(s)
- Maxwell M Tran
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Dai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Meghan B Azad
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B Becker
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Tham EH, Lee BW, Chan YH, Loo EXL, Toh JY, Goh A, Teoh OH, Yap F, Tan KH, Godfrey KM, Chong MFF, Van Bever HPS, Chong YS, Shek LPC. Low Food Allergy Prevalence Despite Delayed Introduction of Allergenic Foods-Data from the GUSTO Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:466-475.e1. [PMID: 28734861 DOI: 10.1016/j.jaip.2017.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/18/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is mounting evidence that early introduction of allergenic food decreases the risk of food allergy development, especially in high-risk infants with eczema. However, there is a lack of data to suggest whether this association holds true in Asian populations. OBJECTIVE To investigate the relationship between the timing of introduction of allergenic foods and food allergy outcomes in infants in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. METHODS The GUSTO cohort recruited 1152 mothers of Chinese, Malay, and Indian ethnicity who had singleton, naturally conceived pregnancies and followed their offspring prospectively. Information on demographic characteristics, child health, infant feeding practices, and a convincing history of IgE-mediated food allergy was obtained from interviewer-administered questionnaires at multiple time points. Corroborative skin prick tests to food allergens were performed at 18 and 36 months. RESULTS Most of the infants were introduced to egg (49.6%), peanut (88.7%), and shellfish (90.2%) after age 10 months. Food allergy prevalence was, however, very low between age 12 and 48 months: egg, 0.35% to 1.8%; peanut allergy, 0.1% to 0.3%; and shellfish, 0.2% to 0.9%. There were no significant associations between the timing of introduction of allergenic foods and the development of food allergy, adjusted for confounders including breast-feeding and eczema. CONCLUSIONS Food allergy rates in Singapore are low despite delayed introduction of allergenic foods. Early introduction of allergenic foods may thus not be necessary in populations in which overall food allergy prevalence is low, and thus infant feeding recommendations should be carefully tailored to individual populations.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Respiratory Service Medicine, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Fabian Yap
- Department of Endocrinology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Mary Foong Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Hugo P S Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol 2017; 139:29-44. [PMID: 28065278 DOI: 10.1016/j.jaci.2016.10.010] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/18/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy. OBJECTIVES Prompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy. RESULTS The addendum provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation. CONCLUSIONS Guidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.
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Abstract
Food allergy is estimated to affect approximately 8% of children in the USA. This is a disease without any known treatment or cure and, for some, a disease that can be quite severe, even life-threatening. While recent advances in potential treatment have made remarkable strides, with two food-targeted immunotherapy products now in phase III trials, perhaps the biggest gains in the field have come in the advent of potential preventative strategies to avoid the development of food allergy in high-risk individuals. There have been multiple, randomized, controlled trials (RCTs) performed in the past 5 years that have demonstrated significant risk reduction from early allergen introduction. These include two trials for early peanut introduction and five trials for early egg introduction in the first year of life. The results indicate that primary prevention of food allergy through early allergen introduction may represent a strategy that could potentially avert tens of thousands of children from becoming food allergic. In support of the data for peanut, the National Institute of Allergy and Infectious Diseases recently sponsored an addendum to the 2010 food allergy guidelines, specifically recommending peanut be introduced in both high- and standard-risk infants to reduce the risk of developing peanut allergy. To date, no formal recommendations have been made for egg, however. This review will focus on the latest evidence supporting early introduction as a strategy to prevent food allergy, as well as on practical aspects for its successful implementation.
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Hildebrand KJ, Abrams EM, Vander Leek TK, Upton JEM, Mack DP, Kirste L, McCusker C, Kapur S. Primum non nocere-first do no harm. And then feed peanut. Allergy Asthma Clin Immunol 2017; 13:7. [PMID: 28194188 PMCID: PMC5299733 DOI: 10.1186/s13223-017-0180-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/18/2017] [Indexed: 01/15/2023] Open
Abstract
The Addendum Guidelines for the Prevention of Peanut Allergy in the United States—Report of the NIAID-Sponsored Expert Panel were developed to build on previous food allergy guidelines after several key studies demonstrated the benefit of early introduction of allergenic foods. These landmark studies including the Learning Early about Peanut (LEAP), LEAP-On and Enquiring about Tolerance trials created a paradigm shift in food allergy prevention. The “take home” messages of this guideline include that peanut should be introduced early in the first year of life, and for the majority of infants, peanut can be introduced at home. The only group of infants for which medical assessment is recommended is those with severe eczema, egg allergy or both. Here we summarize the Guideline recommendations, endorsed by the Canadian Society of Allergy and Clinical Immunology, and highlight important aspects relevant to Canadian practitioners.
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Affiliation(s)
- Kyla Jade Hildebrand
- Program Director Clinical Immunology & Allergy Training Program, Faculty of Medicine, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, 4480 Oak Street, Room 1C31B, Vancouver, BC V6H 3V4 Canada
| | | | | | | | - Douglas P Mack
- McMaster University, Joseph Brant Hospital, 1230 North Shore Blvd, Burlington, ON L7S 1W7 Canada
| | - Linda Kirste
- Government of British Columbia, Dietitian & Physical Activity Services, HealthLink BC, Burnaby, Canada
| | - Christine McCusker
- McGill University, Meakins-Christie Laboratories RI-MUHC, Block E, Office EM3.2230,2155 Decarie Blvd, Montreal, QC H4A 3J1 Canada
| | - Sandeep Kapur
- Dalhousie University, 503-5657 Spring Garden Road, Halifax, NS B3J 3R4 Canada
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Liang Y, Chang C, Lu Q. The Genetics and Epigenetics of Atopic Dermatitis-Filaggrin and Other Polymorphisms. Clin Rev Allergy Immunol 2017; 51:315-328. [PMID: 26385242 DOI: 10.1007/s12016-015-8508-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease caused by a combination of genetic and environmental factors. Genetic evidences depict a complex network comprising by epidermal barrier dysfunctions and dysregulation of innate and adaptive immunity in the pathogenesis of AD. Mutations in the human filaggrin gene (FLG) are the most significant and well-replicated genetic mutation associated with AD, and other mutations associated with epidermal barriers such as SPINK5, FLG-2, SPRR3, and CLDN1 have all been linked to AD. Gene variants may also contribute to the abnormal innate and adaptive responses found in AD, including mutations in PRRs and AMPs, TSLP and TSLPR, IL-1 family cytokines and receptors genes, vitamin D pathway genes, FCER1A, and Th2 and other cytokines genes. GWAS and Immunochip analysis have identified a total of 19 susceptibility loci for AD. Candidate genes at these susceptibility loci identified by GWAS and Immunochip analysis also suggest roles for epidermal barrier functions, innate and adaptive immunity, interleukin-1 family signaling, regulatory T cells, the vitamin D pathway, and the nerve growth factor pathway in the pathogenesis of AD. Increasing evidences show the modern lifestyle (i.e., the hygiene hypothesis, Western diet) and other environmental factors such as pollution and environmental tobacco smoke (ETS) lead to the increasing prevalence of AD with the development of industrialization. Epigenetic alterations in response to these environmental factors, including DNA methylation and microRNA related to immune system and skin barriers, have been found to contribute to the pathogenesis of AD. Genetic variants and epigenetic alteration might be the key tools for the molecular taxonomy of AD and provide the background for the personalized management.
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Affiliation(s)
- Yunsheng Liang
- Hunan Key Laboratory of Medical Epigenomics & Department of Dermatology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Rd, Changsha, Hunan, 410011, China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, 95616, USA
| | - Qianjin Lu
- Hunan Key Laboratory of Medical Epigenomics & Department of Dermatology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Rd, Changsha, Hunan, 410011, China.
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Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR, Beck LA, Block J, Byrd-Bredbenner C, Chan ES, Eichenfield LF, Fleischer DM, Fuchs GJ, Furuta GT, Greenhawt MJ, Gupta RS, Habich M, Jones SM, Keaton K, Muraro A, Plaut M, Rosenwasser LJ, Rotrosen D, Sampson HA, Schneider LC, Sicherer SH, Sidbury R, Spergel J, Stukus DR, Venter C, Boyce JA. Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel. Pediatr Dermatol 2017; 34:e1-e21. [PMID: 28054723 DOI: 10.1111/pde.13093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Food allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy. OBJECTIVES Prompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy. RESULTS The addendum provides three separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation. CONCLUSIONS Guidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.
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Affiliation(s)
- Alkis Togias
- The National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Susan F Cooper
- The National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Maria L Acebal
- The Board of Directors, Food Allergy Research & Education, McLean, Virginia
| | - Amal Assa'ad
- The Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - James R Baker
- Food Allergy Research & Education, McLean and the Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lisa A Beck
- The Department of Dermatology, University of Rochester Medical Center, San Rafael and San Diego, California
| | - Julie Block
- The National Eczema Association, San Rafael, California
| | - Carol Byrd-Bredbenner
- The Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey
| | - Edmond S Chan
- The Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence F Eichenfield
- The Departments of Dermatology and Pediatrics, San Diego School of Medicine, Rady Children's Hospital, University of California, San Diego, California
| | - David M Fleischer
- The Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Columbia
| | - George J Fuchs
- The Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Glenn T Furuta
- The Digestive Health Institute, Children's Hospital Colorado, Aurora, Columbia.,The Section of Pediatric Gastroenterology, University of Colorado Denver School of Medicine, Aurora, Columbia
| | - Matthew J Greenhawt
- The Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Columbia
| | - Ruchi S Gupta
- The Division of Academic General Pediatrics and Primary Care, Department of Pediatrics and the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michele Habich
- Northwestern Medicine, Central DuPage Hospital, Winfield, Illinois
| | - Stacie M Jones
- The Division of Allergy and Immunology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kari Keaton
- Metro DC Food Allergy Support Group, Rockville, Maryland
| | - Antonella Muraro
- The Food Allergy Referral Centre, Department of Women and Child Health, Padua University Hospital, Padua, Italy
| | - Marshall Plaut
- The National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Lanny J Rosenwasser
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Daniel Rotrosen
- The National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Hugh A Sampson
- The Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynda C Schneider
- The Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott H Sicherer
- The Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert Sidbury
- The Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan Spergel
- The Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Stukus
- The Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Carina Venter
- The Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua A Boyce
- The Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
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Palmer DJ. Timing of Introduction of Solids and Early-Onset Allergic Disease. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greenhawt MJ, Fleischer DM, Atkins D, Chan ES. The Complexities of Early Peanut Introduction for the Practicing Allergist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:221-5. [DOI: 10.1016/j.jaip.2015.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
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Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:648S-78S. [PMID: 26791182 PMCID: PMC6459074 DOI: 10.3945/ajcn.115.117309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | | | | | | | - Sandra Robins
- Fairfax Neonatal Associates at Inova Children's Hospital, Fairfax, VA
| | - Josef Neu
- University of Florida, Gainesville, FL
| | | | - Sharon Groh-Wargo
- Case Western Reserve University-School of Medicine, Cleveland, OH; and
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Abstract
PURPOSE OF REVIEW The paradigm for the primary prevention of peanut allergy was, until recently, strict avoidance of peanut during pregnancy, infancy, and early childhood. However, in countries that had these dietary guidelines, the prevalence of peanut allergy greatly increased in contrast to low prevalence rates of peanut allergy in countries where infant diets included peanut at an early age, suggesting the hypothesis that early introduction of peanut is superior to delayed introduction of peanut as a strategy for the primary prevention of food allergy. This review examines recent high-quality studies that support this hypothesis. RECENT FINDINGS Publication of the Learning Early about Allergy to Peanut interventional trial showed that 17% of children avoiding peanut until 5 years of age developed peanut allergy compared with 3% of children who started eating peanut at ages of 4-11 months. Two birth cohort studies demonstrated that high maternal consumption of peanut during the pregnancy period reduced the risk of peanut allergy in offspring by 50-75%. SUMMARY Recent studies indicate that early introduction of peanut enhances the development of tolerance to peanut, reducing the risk of childhood peanut allergy.
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Greenhawt M. The Learning Early About Peanut Allergy Study: The Benefits of Early Peanut Introduction, and a New Horizon in Fighting the Food Allergy Epidemic. Pediatr Clin North Am 2015; 62:1509-21. [PMID: 26456447 DOI: 10.1016/j.pcl.2015.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Observational studies have explored associations between timing of peanut, egg, and milk introduction and food allergy development, noting significant associations with reduced respective rates of milk, egg, and peanut allergy associated with earlier timing of introduction. Interventional studies developed to more definitively explore these outcomes have been published for egg and peanut, and are ongoing for multiple other allergens. This review focuses on the recent publication regarding the LEAP (Learning Early About Peanut Allergy) study, its highly favorable results, the policy implications of its findings, and the horizon for primary prevention as a realistic strategy to prevent food allergy.
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Affiliation(s)
- Matthew Greenhawt
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby H-2100, Box 442, Ann Arbor, MI 48106, USA; Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby H-2100, Box 442, Ann Arbor, MI 48106, USA.
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Rueter K, Haynes A, Prescott SL. Developing Primary Intervention Strategies to Prevent Allergic Disease. Curr Allergy Asthma Rep 2015; 15:40. [PMID: 26143389 DOI: 10.1007/s11882-015-0537-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Allergic diseases are a major cause of morbidity in the developed world, now affecting up to 40 % of the population with no evidence that this is abating. If anything, the prevalence of early onset allergic diseases such as eczema and food allergy appears to be still increasing. This is almost certainly due to the changing modern environment and lifestyle factors, acting to promote immune dysfunction through early perturbations in immune maturation, immune tolerance and regulation. This early propensity to inflammation may also have implications for the rising risk of other inflammatory non-communicable diseases (NCDs) later in life. Identifying risk factors and pathways for preventing early onset immune disease like allergy is likely to have benefits for many aspects of human health, particularly as many NCDs share similar risk factors. This review focuses on recent advances in primary intervention strategies for promoting early immune health and preventing allergic disease, highlighting the current evidence-based guidelines where applicable and areas requiring further investigation.
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Affiliation(s)
- Kristina Rueter
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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The role of epigenetic mediation and the future of food allergy research. Semin Cell Dev Biol 2015; 43:125-130. [PMID: 26150170 DOI: 10.1016/j.semcdb.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 11/22/2022]
Abstract
IgE-mediated food allergy is a developing global health problem with prevalence rising at alarmingly fast rates. In this review, we discuss the interplay between genetics, epigenetics, and environmental exposures in the pathogenesis of food allergies. We aim to highlight the most recent evidence that suggests how epigenetic control may mediate genetic susceptibility of food allergies. We also examine how epigenetic modifications may be the key in explaining how environmental factors modulate and modify gene expression, leading to the dysregulation of immune tolerance and consequently, the development of food allergies. The emerging epigenetic paradigm in food allergies is likely to provide new mechanistic insight into food allergy risk and development as well as shape our therapeutic and preventive strategies.
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McKean M, Caughey AB, Leong RE, Wong A, Cabana MD. The Timing of Infant Food Introduction in Families With a History of Atopy. Clin Pediatr (Phila) 2015; 54:745-51. [PMID: 25976525 DOI: 10.1177/0009922815584927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the timing of introduction and type of food introduced to infants with a family history of atopy. METHODS We conducted a secondary analysis of foods introduced each month to an interventional birth cohort of 149 infants at risk for atopy. RESULTS Seven percent of infants received solid food prior to 4 months of age; 13% after 6 months of age. Hyperallergenic foods were introduced on average in the following order: wheat (8.7 months); eggs (11.2 months); soy (13.0 months); fish (13.4 months); peanut (20.2 months); tree nuts (21.8 months); and other seafood (21.8 months). Asian race (odds ratio 3.94; 95% CI 1.14-13.58) and maternal history of food allergy (odds ratio 3.86; 95% CI 1.29-11.56) were associated with late food introduction. CONCLUSION Variation in timing of food introduction may reflect cultural preferences and/or previous experience with food allergy, as well as the ambiguous state of current recommendations.
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Affiliation(s)
| | | | | | - Angela Wong
- Kaiser Permanente, San Francisco Medical Center, San Francisco, CA, USA
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Houghteling PD, Walker WA. Why is initial bacterial colonization of the intestine important to infants' and children's health? J Pediatr Gastroenterol Nutr 2015; 60:294-307. [PMID: 25313849 PMCID: PMC4340742 DOI: 10.1097/mpg.0000000000000597] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microbial colonization of the infant occurs during a critical time window for immune and gastrointestinal development. Infant colonization sets the stage for the adult microbiome. This review is a broad survey of the factors affecting infant colonization and the downstream effects on gastrointestinal health and disease. Major topics affecting colonization include initial inoculation dependent on birth mode, the impact of breast-feeding, and inside-out modulation of the developing microbiome by the immune system. Major outcomes of colonization include the timing-dependent education of the neonatal immune system, which is interconnected with barrier function and metabolism. These all engage in further continuing cross-talk with the microbiome, genetics, and nutrition. This review also briefly examines mechanisms of disease resulting from disrupted colonization as well as nutritional and microbial therapies.
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Affiliation(s)
- Pearl D. Houghteling
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, 114 16th Street (114-3505), Charlestown, MA02129-4404, USA
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - W. Allan Walker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, 114 16th Street (114-3505), Charlestown, MA02129-4404, USA
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Wegienka G, Zoratti E, Johnson CC. The role of the early-life environment in the development of allergic disease. Immunol Allergy Clin North Am 2015; 35:1-17. [PMID: 25459574 PMCID: PMC4427897 DOI: 10.1016/j.iac.2014.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A consensus has been reached that the development of allergic disorders is strongly influenced by early life exposures. An overview of several prenatal and early life factors that have been investigated for their associations with development of childhood allergy is presented. Delivery mode, the gut microbiome, vitamin D, folate, breastfeeding, pets, antibiotics, environmental tobacco smoke, and airborne traffic pollutants are discussed. Although many studies suggest an effect, overall, no risk factors clearly increase or reduce the risk of allergic outcomes.
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Affiliation(s)
- Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA.
| | - Edward Zoratti
- Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
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Dutau G, Lavaud F. Existe-t-il réellement une fenêtre d’opportunité pour la diversification alimentaire ? L’exemple de la maladie cœliaque à la lumière de publications récentes. REVUE FRANCAISE D ALLERGOLOGIE 2015. [DOI: 10.1016/j.reval.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Diversification alimentaire et risque allergique. Arch Pediatr 2014; 21:1392-5. [DOI: 10.1016/j.arcped.2014.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/27/2014] [Accepted: 07/04/2014] [Indexed: 11/21/2022]
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Havstad S, Johnson CC, Kim H, Levin AM, Zoratti EM, Joseph CLM, Ownby DR, Wegienka G. Atopic phenotypes identified with latent class analyses at age 2 years. J Allergy Clin Immunol 2014; 134:722-727.e2. [PMID: 24636082 PMCID: PMC4149949 DOI: 10.1016/j.jaci.2014.01.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/16/2014] [Accepted: 01/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic sensitization (ie, atopy) is the most commonly reported risk factor for asthma. Recent studies have begun to suggest that atopy, as conventionally defined, might be an umbrella term that obfuscates more specific allergic disease types. OBJECTIVE We sought to determine whether distinct and meaningful atopic phenotypes exist within a racially diverse birth cohort using 10 allergen-specific serum IgE (sIgE) measurements from children aged 2 years. METHODS Using the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort (62% black), we analyzed sIgE data on 10 allergens (Dermatophagoides farinae, dog, cat, timothy grass, ragweed, Alternaria alternata, egg, peanut, milk, and German cockroach) obtained from 594 children at age 2 years. Conventional atopy was defined as at least 1 sIgE level of 0.35 IU/mL or greater. RESULTS A 4-class solution (latent class model) was the best fit. Class types were labeled "low to no sensitization" (76.9% of sample), "highly sensitized" (2.7%), "milk and egg dominated" (15.3%), and "peanut and inhalant(s)" (5.1%). Almost one third (32.2%) of the low to no sensitization group met the criteria for conventional atopy. The highly sensitized group was significantly associated with a doctor's diagnosis of asthma after age 4 years (odds ratio [OR], 5.3; 95% CI, 1.6-17.4), whereas the milk and egg dominated and peanut and inhalant(s) groups were not (ORs of 1.6 [95% CI, 0.8-3.0] and 1.8 [95% CI, 0.6-4.9], respectively). Children of black race were more likely to be in the 3 multisensitized groups (P = .04). CONCLUSION Classification by sIgE patterns defined groups whose membership is more strongly associated with atopic dermatitis, wheeze, and asthma compared with conventional atopy.
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Affiliation(s)
- Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich.
| | | | - Haejin Kim
- Department of Internal Medicine, Division of Allergy, Henry Ford Hospital, Detroit, Mich
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Edward M Zoratti
- Department of Internal Medicine, Division of Allergy, Henry Ford Hospital, Detroit, Mich
| | | | - Dennis R Ownby
- Department of Pediatrics, Georgia Regents University, Augusta, Ga
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
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Liao SL, Lai SH, Yeh KW, Huang YL, Yao TC, Tsai MH, Hua MC, Huang JL. Exclusive breastfeeding is associated with reduced cow's milk sensitization in early childhood. Pediatr Allergy Immunol 2014; 25:456-61. [PMID: 25171739 DOI: 10.1111/pai.12247] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although breastfed infants have consistently been reported as having fewer infections and respiratory morbidity during infancy, none have reached a definitive conclusion as to whether breastfeeding is an effective strategy to prevent allergic diseases. This study aims to investigate the relationship between exclusive breastfeeding and sequential changes of several biomarkers of allergy, such as absolute eosinophil count, total IgE level, and specific IgE level during the first 3 yrs of life. METHODS This is an unselected, population-based study that is part of a prospective birth cohort called the PATCH (Prediction of Allergy in Taiwanese Children). Blood analysis was performed at ages 6, 12, 18, 24, and 36 months. Clinical records of breastfeeding and detailed questionnaires regarding to allergic diseases were also obtained. RESULTS Analysis comparing exclusive breastfeeding ≥4 months with those <4 months and those partially breastfed showed a decreased risk of sensitization toward cow's milk protein up to the age of 2 yr (adjusted OR for cow's milk sensitization at 12 months was 0.2 [95% CI, 0.07-0.5]), at 18 months of age it was 0.2 [95% CI, 0.07-0.5], and at 24 months of age it was 0.2 [95% CI, 0.04-0.7]). In addition, although not significant, children of the exclusive breastfeeding group showed a trend of lower absolute eosinophil counts than their counterparts at all ages, and a lower total IgE level at the age of 3 yr. CONCLUSIONS Results of this study suggest that exclusive breastfeeding is associated with a reduced risk of cow's milk protein sensitization during early childhood.
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Affiliation(s)
- Sui-Ling Liao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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Ezell JM, Ownby DR, Zoratti EM, Havstad S, Nicholas C, Nageotte C, Misiak R, Enberg R, Johnson CC, Joseph CLM. Using a physician panel to estimate food allergy prevalence in a longitudinal birth cohort. Ann Epidemiol 2014; 24:551-3. [PMID: 24854182 PMCID: PMC4104510 DOI: 10.1016/j.annepidem.2014.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Jerel M Ezell
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI; Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI
| | - Dennis R Ownby
- Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI; Division of Allergy and Immunology, Department of Pediatrics, Georgia Regents University, Augusta
| | - Edward M Zoratti
- Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI; Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI; Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI
| | - Charlotte Nicholas
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI; Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI
| | - Christian Nageotte
- Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI; Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Rana Misiak
- Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI; Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Robert Enberg
- Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI; Division of Allergy and Immunology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI
| | - Christine Cole Johnson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI; Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI
| | - Christine L M Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI; Center for Allergy, Asthma and Immunology Research, Henry Ford Health System, Detroit, MI.
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Nwaru BI, Craig LCA, Allan K, Prabhu N, Turner SW, McNeill G, Erkkola M, Seaton A, Devereux G. Breastfeeding and introduction of complementary foods during infancy in relation to the risk of asthma and atopic diseases up to 10 years. Clin Exp Allergy 2014; 43:1263-73. [PMID: 24152159 DOI: 10.1111/cea.12180] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/04/2013] [Accepted: 07/18/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND It has been hypothesized that changes in diet during early life may have contributed to the increase in childhood asthma and atopy. The long-term effect of the timing and content of infant feeding on the incidence of asthma and atopic diseases in children is unclear. OBJECTIVE To investigate the associations between duration of breastfeeding and the timing of introduction of complementary foods during the first 6 months and parental-reported asthma, wheeze and atopic eczema up to 10 years of age. METHODS Infant feeding practices (breastfeeding and introduction of complementary foods) of 1924 singleton children participating in the Study of Eczema and Asthma To Observe the influence of Nutrition (SEATON) birth cohort were prospectively collected up to 6 months with outcomes (wheeze, atopic eczema and asthma) being assessed at 1, 2, 5 and 10 years. Data were analysed using generalized estimating equations and discrete hazards models with adjustment for confounders. RESULTS By 6 months, 59% and 35% of mothers had stopped exclusive and total breastfeeding, respectively. Although formula feeding was adversely associated with wheeze in the past 12 months (adjusted OR for no formula feeding: 070, 95% CI 0.50-0.97), and the introduction of biscuits/bread after 5 months of age adversely associated with atopic eczema (adjusted OR 1.34, 95% CI 1.06-1.69), these results lost their statistical significance after adjustment for multiple testing. Stratification of the results by the presence of eczema by 6 months of age and family atopic history did not substantially differ from the results of the whole study population. CONCLUSION AND CLINICAL RELEVANCE Our results suggest that the nature of infant feeding during the first 6 months seems not to substantially influence the long-term risk of asthma and atopic diseases in children, nor in children at high risk of atopic disease because of a family history of atopic disease.
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Affiliation(s)
- B I Nwaru
- School of Health Sciences, University of Tampere, Tampere, Finland
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Robison RG. Food allergy: diagnosis, management & emerging therapies. Indian J Med Res 2014; 139:805-13. [PMID: 25109714 PMCID: PMC4164992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IgE-mediated food allergy is an important health concern with increasing prevalence worldwide. Manifestations of IgE-mediated food allergy include urticaria, angioedema, pruritus, difficulty in breathing, laryngeal oedema, vomiting, diarrhoea and/or hypotension within minutes to two hours of the offending food's ingestion. Diagnosis requires both a careful history and supportive testing with laboratory studies and possibly oral food challenges. Current treatment of food allergy focuses on avoidance of the allergen and prompt emergency management of reactions. Epinephrine autoinjectors are provided to patients for the treatment of severe reactions. More research is needed to determine the optimal timing with which to introduce common allergens into a child's diet to possibly prevent the development of food allergy. Novel therapies are under investigation given the difficulty of allergen avoidance and the potentially fatal nature of reactions. Both allergen specific therapies such as oral, sublingual and epicutaneous immunotherapy and allergen non-specific therapies such the Chinese herbal formula FAHF-2 and omalizumab show promise though more data on efficacy and long-term safety are needed before these therapies become mainstream.
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Affiliation(s)
- Rachel Glick Robison
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Reprint requests: Dr Rachel Glick Robison, Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Allergy & Immunology, 225 East Chicago Ave, Box 60, Chicago, IL 60611, USA e-mail:
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