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Pagano F, Gaeta E, Morlino F, Riccio MT, Giordano M, De Bernardo G. Long-term benefits of exclusive human milk diet in small for gestational age neonates: a systematic review of the literature. Ital J Pediatr 2024; 50:88. [PMID: 38679716 PMCID: PMC11057117 DOI: 10.1186/s13052-024-01648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Evidence about feeding practices' consequences in small for gestational age newborns is not well established because they are less likely to initiate and continue breastfeeding than other newborns. Our aim was to study current knowledge about the benefits of exclusive human milk diet after 2 years of age in small for gestational age newborns. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria. Pubmed and Scopus were searched for studies published from databases inception until June 2, 2023. Included articles were analysed and synthesised. Risk of bias and level of evidence assessments were performed. They were enrolled small for gestational age newborns fed by breastfeeding, breast milk or donor milk. The systematic review included 9 articles which were related to 4 health domains: neurodevelopment, cardiovascular, somatic growth and bone mineralization and atopy. Extracted data support a beneficial effect of breastfeeding on these outcomes. Better quality of evidence and longer follow-up are needed.
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Affiliation(s)
- Federica Pagano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emanuele Gaeta
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Francesca Morlino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Riccio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy.
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Abstract
Atopic dermatitis, a common chronic and pruritic inflammatory skin disorder, can create significant disruptions in sleep and quality of life. Atopic dermatitis is especially common in infants and children; therefore, safe and natural therapeutic options have considerable appeal. Over the past several decades, there has been an increase in the prevalence of atopic dermatitis in industrialized nations. Also, there is variability in the prevalence of atopic dermatitis in the United States, both across and within states. Environmental factors including diet are believed to be associated with this increased risk. Dietary interventions continue to be an area of keen interest and have been studied extensively, albeit with variable results. Maternal dietary restrictions during pregnancy and lactation, hydrolyzed or partially hydrolyzed formulas, delaying the introduction of solid foods, and omega-3 or omega-6 fatty acids supplementation do not appear to have a beneficial effect on the treatment and prevention of atopic dermatitis. Exclusive breastfeeding for 3 to 4 months, a diet high in fruits and vegetables, and prebiotics might have a beneficial effect. Because environmental triggers, including dietary exposures, are thought to play a role in the pathogenesis of atopic dermatitis, we herein review the current literature on the role of dietary habits, vitamin and mineral supplementation, and probiotics on the treatment and prevention of atopic dermatitis.
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Kong WS, Tsuyama N, Inoue H, Guo Y, Mokuda S, Nobukiyo A, Nakatani N, Yamaide F, Nakano T, Kohno Y, Ikeda K, Nakanishi Y, Ohno H, Arita M, Shimojo N, Kanno M. Long-chain saturated fatty acids in breast milk are associated with the pathogenesis of atopic dermatitis via induction of inflammatory ILC3s. Sci Rep 2021; 11:13109. [PMID: 34162906 PMCID: PMC8222289 DOI: 10.1038/s41598-021-92282-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
Breastfeeding influences the immune system development in infants and may even affect various immunological responses later in life. Breast milk provides a rich source of early nutrition for infant growth and development. However, the presence of certain compounds in breast milk, related to an unhealthy lifestyle or the diet of lactating mothers, may negatively impact infants. Based on a cohort study of atopic dermatitis (AD), we find the presence of damage-associated molecular patterns (DAMPs) activity in the mother's milk. By non-targeted metabolomic analysis, we identify the long-chain saturated fatty acids (LCSFA) as a biomarker DAMPs (+) breast milk samples. Similarly, a mouse model in which breastfed offspring are fed milk high in LCSFA show AD onset later in life. We prove that LCSFA are a type of damage-associated molecular patterns, which initiate a series of inflammatory events in the gut involving type 3 innate lymphoid cells (ILC3s). A remarkable increase in inflammatory ILC3s is observed in the gut, and the migration of these ILC3s to the skin may be potential triggers of AD. Gene expression analysis of ILC3s isolated from the gut reveal upregulation of genes that increase ILC3s and chemokines/chemokine receptors, which may play a role in ILC migration to the skin. Even in the absence of adaptive immunity, Rag1 knockout mice fed a high-LCSFA milk diet develop eczema, accompanied by increased gut ILC3s. We also present that gut microbiota of AD-prone PA milk-fed mice is different from non-AD OA/ND milk-fed mice. Here, we propose that early exposure to LCSFAs in infants may affect the balance of intestinal innate immunity, inducing a highly inflammatory environment with the proliferation of ILC3s and production of interleukin-17 and interleukin-22, these factors may be potential triggers or worsening factors of AD.
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Affiliation(s)
- Weng Sheng Kong
- Department of Immunology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naohiro Tsuyama
- Analytical Molecular Medicine and Devices Laboratory, Hiroshima University, Hiroshima, Japan
- Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
- Department of Radiation Life Sciences, Fukushima Medical University, Fukushima, Japan
| | - Hiroko Inoue
- Department of Immunology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yun Guo
- Department of Immunology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Asako Nobukiyo
- Natural Science Centre for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | | | - Fumiya Yamaide
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Taiji Nakano
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoichi Kohno
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Chiba Rosai Hospital, Chiba, Japan
| | - Kazutaka Ikeda
- Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
- Laboratory of Medical Omics Research, Kazusa DNA Research Institute, Chiba, Japan
| | - Yumiko Nakanishi
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
- Intestinal Microbiota Project, Kanagawa Institute of Industrial Science and Technology, Kawasaki, Japan
- Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan
| | - Hiroshi Ohno
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
- Intestinal Microbiota Project, Kanagawa Institute of Industrial Science and Technology, Kawasaki, Japan
- Immunobiology Laboratory, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan
- AMED-CREST Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Makoto Arita
- Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
- AMED-CREST Japan Agency for Medical Research and Development, Tokyo, Japan
- Center for Preventive Medicine, Chiba University, Chiba, Japan
| | - Masamoto Kanno
- Department of Immunology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
- AMED-SENTAN, Tokyo, Japan.
- AMED-CREST Japan Agency for Medical Research and Development, Tokyo, Japan.
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Han SM, Binia A, Godfrey KM, El-Heis S, Cutfield WS. Do Human Milk Oligosaccharides Protect Against Infant Atopic Disorders and Food Allergy? Nutrients 2020; 12:nu12103212. [PMID: 33096669 PMCID: PMC7589050 DOI: 10.3390/nu12103212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/28/2022] Open
Abstract
Atopic disorders (AD), often coexistent with food allergy (FA), start developing in early life and have lifelong health consequences. Breastfeeding is thought to be protective against AD and FA, but the data are controversial, and mechanisms are not well understood. Human milk oligosaccharides (HMOs) are complex carbohydrates that are abundant in human milk. These are thought to contribute to the development of the infant immune system by (i) promoting healthy microbiome, (ii) inhibiting pathogen binding to gut mucosa and (iii) modulating the immune system. Differences in microbiome composition between allergic and healthy infants have been observed, regardless of breastfeeding history. To date, limited studies have examined the preventive effects of HMOs on AD and FA in infants and current data relies on observation studies as trials of varying HMO intake through randomising individuals to breastfeeding are unethical. There is evidence for beneficial effects of breastfeeding on lowering the risks of FA, eczema and asthma but there are inconsistencies amongst studies in the duration of breastfeeding, diagnostic criteria for AD and the age at which the outcome was assessed. Furthermore, current analytical methods primarily used today only allow detection of 16-20 major HMOs while more than 100 types have been identified. More large-scale longitudinal studies are required to investigate the role of HMO composition and the impact of changes over the lactation period in preventing AD and FA later in life.
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Affiliation(s)
- Soo Min Han
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
| | - Aristea Binia
- Nestlé Research, Société des Produits Nestlé SA, 1000 Lausanne, Switzerland;
| | - Keith M. Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO17 1BJ, UK;
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO17 1BJ, UK;
| | - Sarah El-Heis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO17 1BJ, UK;
| | - Wayne S. Cutfield
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
- A Better Start—National Science Challenge, Liggins Institute, The University of Auckland, Auckland 1023, New Zealand
- Correspondence: ; Tel.: +64-9-923-4476
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Logan K, Du Toit G, Giovannini M, Turcanu V, Lack G. Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance. Annu Rev Cell Dev Biol 2020; 36:511-528. [PMID: 32634325 DOI: 10.1146/annurev-cellbio-100818-125346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
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Affiliation(s)
- Kirsty Logan
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - George Du Toit
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - Mattia Giovannini
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom; .,Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Victor Turcanu
- School of Immunology and Microbial Sciences and School of Life Course Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
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Gorlanova O, Appenzeller R, Mahmoud YS, Ramsey KA, Usemann J, Decrue F, Kuehni CE, Röösli M, Latzin P, Fuchs O, Soti A, Frey U, On Behalf Of The Bild Study Group. Effect of breastfeeding duration on lung function, respiratory symptoms and allergic diseases in school-age children. Pediatr Pulmonol 2020; 55:1448-1455. [PMID: 32181595 DOI: 10.1002/ppul.24733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/06/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A positive effect of breastfeeding on lung function has been demonstrated in cohorts of children with asthma or risk for asthma. We assessed the impact of breastfeeding on lung function and symptoms at the age of 6 years in an unselected, healthy birth cohort. METHODS We prospectively studied healthy term infants from the Bern-Basel Infant Lung Development (BILD) cohort from birth up to 6 years. Any breastfeeding was assessed by weekly phone calls during the first year of life. Risk factors (eg, smoking exposure, parental history of allergic conditions, and education) were obtained using standardized questionnaires. The primary outcomes were lung function parameters measured at 6 years of age by spirometry forced expiratory volume in 1 second, body plethysmography (functional residual capacity [FRCpleth ], the total lung capacity [TLCpleth ], and the effective respiratory airway resistance [Reff ]) and fractional exhaled nitric oxide (FeNO). Secondary outcomes included ever wheeze (between birth and 6 years), wheeze in the past 12 months, asthma, presence of allergic conditions, atopic dermatitis, rhinitis, and positive skin prick test at the age of 6 years. RESULTS In 377 children the mean breastfeeding duration was 36 weeks (SD 14.4). We found no association of breastfeeding duration with obstructive or restrictive lung function and FeNO. After adjustment for confounders, we found no associations of breastfeeding duration with respiratory symptoms or the presence of allergic conditions. CONCLUSION This study found no evidence of an association between breastfeeding and comprehensive lung function in unselected healthy children with long-term breastfeeding. Our findings do not support the hypothesis that the duration of breastfeeding has a direct impact on lung function in a healthy population with low asthmatic risk.
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Affiliation(s)
- Olga Gorlanova
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rhea Appenzeller
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasmin S Mahmoud
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathryn A Ramsey
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jakob Usemann
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Fabienne Decrue
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute for Social and Preventive Medicine, Pediatric Respiratory Epidemiology Group, University of Bern, Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute Basel, Environmental Exposures and Health Unit, Basel, Switzerland
| | - Philipp Latzin
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Fuchs
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andras Soti
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- Pediatric Pulmonology, University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Sestito S, D'Auria E, Baldassarre ME, Salvatore S, Tallarico V, Stefanelli E, Tarsitano F, Concolino D, Pensabene L. The Role of Prebiotics and Probiotics in Prevention of Allergic Diseases in Infants. Front Pediatr 2020; 8:583946. [PMID: 33415087 PMCID: PMC7783417 DOI: 10.3389/fped.2020.583946] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Allergic diseases have been linked to genetic and/or environmental factors, such as antibiotic use, westernized high fat and low fiber diet, which lead to early intestinal dysbiosis, and account for the rise in allergy prevalence, especially in western countries. Allergic diseases have shown reduced microbial diversity, including fewer lactobacilli and bifidobacteria, within the neonatal microbiota, before the onset of atopic diseases. Raised interest in microbiota manipulating strategies to restore the microbial balance for atopic disease prevention, through prebiotics, probiotics, or synbiotics supplementation, has been reported. We reviewed and discussed the role of prebiotics and/or probiotics supplementation for allergy prevention in infants. We searched PubMed and the Cochrane Database using keywords relating to "allergy" OR "allergic disorders," "prevention" AND "prebiotics" OR "probiotics" OR "synbiotics." We limited our evaluation to papers of English language including children aged 0-2 years old. Different products or strains used, different period of intervention, duration of supplementation, has hampered the draw of definitive conclusions on the clinical impact of probiotics and/or prebiotics for prevention of allergic diseases in infants, except for atopic dermatitis in infants at high-risk. This preventive effect on eczema in high-risk infants is supported by clear evidence for probiotics but only moderate evidence for prebiotic supplementation. However, the optimal prebiotic or strain of probiotic, dose, duration, and timing of intervention remains uncertain. Particularly, a combined pre- and post-natal intervention appeared of stronger benefit, although the definition of the optimal intervention starting time during gestation, the timing, and duration in the post-natal period, as well as the best target population, are still an unmet need.
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Affiliation(s)
- Simona Sestito
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Enza D'Auria
- Department of Pediatrics, Vittore Buzzi Children's Hospital-University of Milan, Milan, Italy
| | - Maria Elisabetta Baldassarre
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, Bari, Italy
| | - Silvia Salvatore
- Department of Pediatrics, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Valeria Tallarico
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ettore Stefanelli
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Flora Tarsitano
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Daniela Concolino
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.,Department of Health Sciences, School of Medicine and Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Ravn NH, Halling AS, Berkowitz AG, Rinnov MR, Silverberg JI, Egeberg A, Thyssen JP. How does parental history of atopic disease predict the risk of atopic dermatitis in a child? A systematic review and meta-analysis. J Allergy Clin Immunol 2019; 145:1182-1193. [PMID: 31887393 DOI: 10.1016/j.jaci.2019.12.899] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 12/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear. OBJECTIVE We sought to determine the association of parental history of atopic disease with AD in offspring. METHODS We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models. RESULTS A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81). CONCLUSIONS This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children's risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level.
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Affiliation(s)
- Nina H Ravn
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Maria R Rinnov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; National Allergy Research Centre, Herlev and Gentofte Hospital, Hellerup, Denmark.
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9
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Lin B, Dai R, Lu L, Fan X, Yu Y. Breastfeeding and Atopic Dermatitis Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Dermatology 2019; 236:345-360. [PMID: 31694017 DOI: 10.1159/000503781] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The effect of breastfeeding on atopic dermatitis (AD) remains controversial. To determine the association -between breastfeeding and AD, we conducted an updated meta-analysis of prospective cohort studies. METHODS A comprehensive search of PubMed, EMBASE, MEDLINE and Cochrane Library was conducted. Studies meeting the predetermined criteria were evaluated by 2 authors independently. The pooled relative risk (RR) adjusted for confounders with its 95% CI was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis and meta-regression. RESULTS A total of 27 studies were included for meta-analysis. The pooled estimates for the effect of total and exclusive breastfeeding on AD were 1.01 (95% CI 0.93-1.10) and 0.99 (95% CI 0.88-1.11), respectively. Heterogeneity was substantial across studies (total: p < 0.01 or I2 = 65.2%; exclusive: p < 0.01 or I2 = 72.3%). There was a weak evidence for a protective effect of breastfeeding against AD in cohorts with atopic heredity (total: RR 0.85, 95% CI 0.74-0.98; exclusive: RR 0.83, 95% CI 0.70-0.97). In cohorts without atopic heredity, the effect shifted to the risk side when limited to exclusive breastfeeding (RR 1.19, 95% CI 1.02-1.40) while it dropped towards null when limited to total breastfeeding (RR 1.11, 95% CI 0.94-1.31). CONCLUSIONS There is no association between AD and breastfeeding, regardless of total or exclusive breastfeeding patterns. There is some evidence for a protective function of exclusive and total breastfeeding in a cohort with atopic heredity. The effect shifts to the risk side in cohorts without atopic heredity. However, these findings should be interpreted with caution because heterogeneity is evident.
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Affiliation(s)
- Bingjiang Lin
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Ru Dai
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Ningbo, China,
| | - Lingyi Lu
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Xin Fan
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Yingzhe Yu
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Ningbo, China
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Roth R, Lynch K, Hyöty H, Lönnrot M, Driscoll KA, Johnson SB. The association between stressful life events and respiratory infections during the first 4 years of life: The Environmental Determinants of Diabetes in the Young study. Stress Health 2019; 35:289-303. [PMID: 30768831 PMCID: PMC6697245 DOI: 10.1002/smi.2861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/15/2022]
Abstract
The aim of this study was to conduct a prospective analysis of the association between negative life events (NLEs) and respiratory infections in children genetically at risk for islet autoimmunity (IA) and type 1 diabetes (T1D). Long- and short-term temporal associations between NLEs and rate of respiratory infection episodes (RIEs) in 5,618 children in The Environmental Determinants of Diabetes in the Young study for at least 1 up to 4 years were analysed. All models were adjusted for demographic, day care, season of infection, and psychosocial factors associated with the rate of child RIEs between study visits. The rate of child RIEs was 26% higher in Europe (Sweden, Finland, Germany) than in the United States (rate ratio [RR] = 1.26, p < 0.001). However, the percentage of child NLEs (odds ratio [OR] = 1.18, p < 0.001) and mother NLEs (OR = 1.83, p < 0.001) was higher in the United States compared with Europe. In both continents (Europe, RR = 1.12, p < 0.001; United States, RR = 1.07, p = 0.006), high child cumulative NLEs (>1 NLE per year since study inception) was significantly associated with an increased rate of child RIEs. This large-scale prospective study confirms observations that stress may increase the susceptibility for infections in paediatric populations and suggests at least one mechanism by which stress could increase risk for IA and T1D in genetically at risk children.
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Affiliation(s)
- Roswith Roth
- Roswith Roth, Ph.D., Forschergruppe Diabetes e.V Helmholtz Zentrum München Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- University of Graz, Institute of Psychology Graz, Universitätsplatz 2/III, Austria, Tel: +43-316-380-5119, Fax: +43-316-380-9808,
| | - Kristian Lynch
- Kristian Lynch, Ph.D., Data Coordinating Center, University of South Florida, FL, USA
| | - Heikki Hyöty
- Heikki Hyöty, M.D., Ph.D., School of Medicine, University of Tampere, Tampere, Finland
- Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Maria Lönnrot
- Maria Lönnrot, M.D., Ph.D., University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kimberly A. Driscoll
- Kimberly A. Driscoll, Ph.D., University of Colorado Denver Barbara Davis Center for Childhood Diabetes, CO, USA
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11
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Parizkova P, Dankova N, Frühauf P, Jireckova J, Zeman J, Magner M. Associations between breastfeeding rates and infant disease: A survey of 2338 Czech children. Nutr Diet 2019; 77:310-314. [DOI: 10.1111/1747-0080.12532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 12/20/2018] [Accepted: 02/24/2019] [Indexed: 01/07/2023]
Affiliation(s)
| | - Nika Dankova
- Czech Society of Midwives Czech Republic
- Department of Obstetrics and GynaecologyCharles University and General University Hospital in Prague Czech Republic
| | - Pavel Frühauf
- Department of Paediatrics and Adolescent Medicine, First Faculty of MedicineCharles University and General University Hospital in Prague Czech Republic
| | - Jitka Jireckova
- Department of Paediatrics and Adolescent Medicine, First Faculty of MedicineCharles University and General University Hospital in Prague Czech Republic
| | - Jiri Zeman
- Department of Paediatrics and Adolescent Medicine, First Faculty of MedicineCharles University and General University Hospital in Prague Czech Republic
| | - Martin Magner
- Department of Paediatrics and Adolescent Medicine, First Faculty of MedicineCharles University and General University Hospital in Prague Czech Republic
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12
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Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the life span: a systematic review. Am J Clin Nutr 2019; 109:772S-799S. [PMID: 30982870 PMCID: PMC6500928 DOI: 10.1093/ajcn/nqy283] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the USDA and Department of Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding prior to infant formula introduction, 4) feeding a lower versus higher intensity of human milk to mixed-fed infants, and 5) feeding a higher intensity of human milk by bottle versus breast with food allergies, allergic rhinitis, atopic dermatitis, and asthma. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published between January 1980 and March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS The systematic reviews numbered 1-5 above included 44, 35, 1, 0, and 0 articles, respectively. Moderate, mostly observational, evidence suggests that 1) never versus ever being fed human milk is associated with higher risk of childhood asthma, and 2) among children and adolescents who were fed human milk as infants, shorter versus longer durations of any human milk feeding are associated with higher risk of asthma. Limited evidence does not suggest associations between 1) never versus ever being fed human milk and atopic dermatitis in childhood or 2) the duration of any human milk feeding and allergic rhinitis and atopic dermatitis in childhood. CONCLUSIONS Moderate evidence suggests that feeding human milk for short durations or not at all is associated with higher childhood asthma risk. Evidence on food allergies, allergic rhinitis, and atopic dermatitis is limited.
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Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA,Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Ekhard E Ziegler
- Panum Group, Bethesda, MD,Department of Pediatrics, The University of Iowa, Iowa City, IA
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13
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The influence of breastfeeding in breast-fed infants with atopic dermatitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:132-140. [DOI: 10.1016/j.jmii.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/09/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023]
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14
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Lau S, Matricardi PM, Wahn U, Lee YA, Keil T. Allergy and atopy from infancy to adulthood. Ann Allergy Asthma Immunol 2019; 122:25-32. [DOI: 10.1016/j.anai.2018.05.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
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15
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Goedicke-Fritz S, Härtel C, Krasteva-Christ G, Kopp MV, Meyer S, Zemlin M. Preterm Birth Affects the Risk of Developing Immune-Mediated Diseases. Front Immunol 2017; 8:1266. [PMID: 29062316 PMCID: PMC5640887 DOI: 10.3389/fimmu.2017.01266] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022] Open
Abstract
Prematurity affects approximately 10% of all children, resulting in drastically altered antigen exposure due to premature confrontation with microbes, nutritional antigens, and other environmental factors. During the last trimester of pregnancy, the fetal immune system adapts to tolerate maternal and self-antigens, while also preparing for postnatal immune defense by acquiring passive immunity from the mother. Since the perinatal period is regarded as the most important “window of opportunity” for imprinting metabolism and immunity, preterm birth may have long-term consequences for the development of immune-mediated diseases. Intriguingly, preterm neonates appear to develop bronchial asthma more frequently, but atopic dermatitis less frequently in comparison to term neonates. The longitudinal study of preterm neonates could offer important insights into the process of imprinting for immune-mediated diseases. On the one hand, preterm birth may interrupt influences of the intrauterine environment on the fetus that increase or decrease the risk of later immune disease (e.g., maternal antibodies and placenta-derived factors), whereas on the other hand, it may lead to the premature exposure to protective or harmful extrauterine factors such as microbiota and nutritional antigen. Solving this puzzle may help unravel new preventive and therapeutic approaches for immune diseases.
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Affiliation(s)
- Sybelle Goedicke-Fritz
- Laboratory of Neonatology and Pediatric Immunology, Department of Pediatrics, Philipps University Marburg, Marburg, Germany.,Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | | | | | - Matthias V Kopp
- Department of Pediatric Allergy and Pulmonology, University of Lübeck, Airway Research-Center North (ARCN), Lübeck, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
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16
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Wang J, Ramette A, Jurca M, Goutaki M, Beardsmore CS, Kuehni CE. Association between breastfeeding and eczema during childhood and adolescence: A cohort study. PLoS One 2017; 12:e0185066. [PMID: 28945812 PMCID: PMC5612686 DOI: 10.1371/journal.pone.0185066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022] Open
Abstract
Background Breastfeeding is said to protect children from eczema (atopic dermatitis), but the available evidence is conflicting and subject to the influences of parental atopy and reverse causation (when mothers extended duration of breastfeeding because their children had eczema). Methods In the prospective, population-based Leicester Respiratory Cohort study, we assessed duration of breastfeeding in children aged 1–4 years. Prevalence of eczema was determined by questionnaire surveys that were repeated until the children were 17 years old. We investigated the association between having been breastfed and current eczema using generalized estimating equations, adjusting for potential confounders, and tested for effect modification by parental atopy. We also assessed the association between having been breastfed and incident eczema at ages 2, 4, and 6 years using multivariable logistic regression. Results Among the 5,676 children in the study, 2,284 (40%) had never been breastfed, while 1,610 (28%), 705 (12%), and 1,077 (19%) had been breastfed for 0–3, 4–6, and >6 months, respectively. Prevalence of current eczema decreased from 36% in 1-year-olds to 18% in children aged 10–17 years. Breastfeeding was not associated with current eczema. Compared with children who had never been breastfed, the adjusted odds ratios for current eczema at any age were 1.02 (95% confidence interval 0.90–1.15) for children who had been breastfed for 0–3 months, 0.97 (0.82–1.13) for children breastfed for 4–6 months, and 0.98 (0.85–1.14) for children breastfed for >6 months. There was no strong evidence for an effect modification by parental atopy (p-value for interaction term was 0.061) and no association between having been breastfed and incident eczema later in childhood. Conclusions This population-based cohort study found no evidence for protection of breastfeeding against childhood eczema at any age, from infancy through adolescence.
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Affiliation(s)
- Jingying Wang
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alban Ramette
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Maja Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, Bern, Switzerland
| | - Caroline S. Beardsmore
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
- Leicester Respiratory Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, Bern, Switzerland
- * E-mail:
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17
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Vaughn AR, Tannhauser P, Sivamani RK, Shi VY. Mother Nature in Eczema: Maternal Factors Influencing Atopic Dermatitis. Pediatr Dermatol 2017; 34:240-246. [PMID: 28523877 DOI: 10.1111/pde.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin disease. Current knowledge about the etiology of AD suggests that it is multifactorial and involves the interaction of several factors, including environmental triggers, genetics, immunologic factors, and skin barrier dysfunction. The prenatal environment has a significant influence on fetal development, including the maturation of skin barrier function. This review summarizes maternal factors that have been reported to influence the development of AD in offspring, including maternal genetics, nutrition, breastfeeding, environment, and behaviors.
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Affiliation(s)
- Alexandra R Vaughn
- College of Medicine, Drexel University, Philadelphia, Pennsylvania.,Department of Dermatology, University of California at Davis, Sacramento, California
| | - Paige Tannhauser
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Raja K Sivamani
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Vivian Y Shi
- Department of Medicine, Dermatology Division, University of Arizona, Tucson, Arizona
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18
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Kim JH. Role of Breast-feeding in the Development of Atopic Dermatitis in Early Childhood. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:285-287. [PMID: 28497914 PMCID: PMC5446942 DOI: 10.4168/aair.2017.9.4.285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jeong Hee Kim
- Department of Pediatrics, School of Medicine, Inha University Hospital, Incheon, Korea.,Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Ministry of Environment, Incheon, Korea.
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19
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Wold A. Why is there still confusion about the impact of breast-feeding on the risk of allergy development? SCANDINAVIAN JOURNAL OF FOOD & NUTRITION 2016. [DOI: 10.1080/11026480600617774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Agnes Wold
- Department of Clinical Bacteriology, Go¨ teborg University, Sweden
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20
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Soto-Ramírez N, Boyd K, Zhang H, Gangur V, Goetzl L, Karmaus W. Maternal serum but not breast milk IL-5, IL-6, and IL-13 immune markers are associated with scratching among infants. Allergy Asthma Clin Immunol 2016; 12:25. [PMID: 27222655 PMCID: PMC4878041 DOI: 10.1186/s13223-016-0129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scratching in infants is considered to be related to early development of eczema. Little is known about the effects of maternal immune markers on scratching among infants. The objective is to compare the risks related to maternal serum immune markers (IMs) during pregnancy and IMs in breast milk for the occurrence of scratching in infants at 6 and 12 months of age. METHODS Pregnant women were recruited in Columbia and Charleston, South Carolina. Blood (median 3 weeks prepartum) and breast milk (3 weeks postpartum) samples were collected. The concentrations of interferon (IFN)-γ, IFN gamma-induced protein 10 (IP-10) (or CXCL10), CCL11, interleukin (IL) 1β, IL-4, IL-5, IL-6, IL-8 (CXCL8), IL-10, IL-12 (p70), IL-13, transforming growth factor (TGF)-β1, and immunoglobulin (Ig) A in both maternal serum and whey were assayed using optimized immunoassays. Scratching and skin manifestations were ascertained at 6 and 12 months. Generalized estimating equations were used to estimate relative risks (RRs) of IMs for repeated measurements of scratching, considering intra-individual correlations and adjusting for confounders. RESULTS Of 178 women, 161 provided blood and 115 breast milk samples. IL-1β, IL-4, IL-10, IL-12, and CCL11 in maternal serum and whey were not analyzed due to a large proportion of non-detectable values. Infants in the highest tertile of IL-6 and IL-13 in maternal serum were at higher risk of scratching (RR 1.73 and 1.84, respectively; p ≤ 0.002) compared to infants in the first tertile; similarly, infants born to mothers with high (versus low) levels of serum IL-5 were also at increased risk (RR 1.60, p = 0.002). None of the breast milk IMs studied were associated with scratching. CONCLUSIONS Scratching but not doctors diagnosed eczema was associated with higher levels of maternal IL-5, IL-6, and IL-13 during pregnancy. Further investigations are necessary to determine how maternal serum IMs influence infants scratching.
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Affiliation(s)
- Nelís Soto-Ramírez
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152 USA
| | - Keith Boyd
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152 USA
| | - Venugopal Gangur
- Food Allergy and Immunology Laboratory, Michigan State University, East Lansing, MI USA
| | - Laura Goetzl
- Department of Obstetrics and Gynecology, School of Medicine, Temple University, Philadelphia, USA
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152 USA
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21
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Chiu CY, Liao SL, Su KW, Tsai MH, Hua MC, Lai SH, Chen LC, Yao TC, Yeh KW, Huang JL. Exclusive or Partial Breastfeeding for 6 Months Is Associated With Reduced Milk Sensitization and Risk of Eczema in Early Childhood: The PATCH Birth Cohort Study. Medicine (Baltimore) 2016; 95:e3391. [PMID: 27082611 PMCID: PMC4839855 DOI: 10.1097/md.0000000000003391] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
There is insufficient evidence to confirm the association between breastfeeding and allergic outcomes later in life. This study aimed to determine the relationships between different breastfeeding patterns and allergen sensitizations and risk of developing atopic diseases in early childhood. A total of 186 children from a birth cohort in the Prediction of Allergies in Taiwanese Children study for a 4-year follow-up period were enrolled. Total serum immunoglobulin E (IgE) levels and specific IgE antibodies against food and inhalant allergens were measured sequentially at 6 months as well as at 1, 1.5, 2, 3, and 4 years of age. A significantly lower prevalence of milk sensitization was found in children at ages 1 and 1.5 years who were exclusively or partially breastfed for ≥6 months. Breastfeeding ≥6 months was significantly associated with a reduced risk of developing eczema but not allergic rhinitis and asthma at ages 1 and 2 years. Compared with exclusive breastfeeding ≥6 months, partial breastfeeding <6 months was significantly associated with an increased risk of developing eczema at ages 1 and 2 years. As with exclusive breastfeeding, partial breastfeeding for at least 6 months appears to be associated with a reduced prevalence of milk sensitization as well as a reduced risk of developing eczema in early childhood.
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Affiliation(s)
- Chih-Yung Chiu
- From the Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine (C-YC, S-LL, K-WS, M-HT, M-CH); and Division of Pediatric Pulmonology (C-YC, S-HL) and Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics (L-CC, T-CY, K-WY, J-LH), Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen R, Tang X, Fan B, Liu J, Jia X, Yang X. IgG Expression upon Oral Sensitization in Association with Maternal Exposure to Ovalbumin. PLoS One 2016; 11:e0148251. [PMID: 26844775 PMCID: PMC4742080 DOI: 10.1371/journal.pone.0148251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 01/16/2016] [Indexed: 11/18/2022] Open
Abstract
The role of maternal allergen exposure in the allergenicity of the offspring remains controversial. Some studies have shown that maternal exposure is a risk factor for allergy in the offspring, whereas other studies have shown that maternal exposure induces immune tolerance and protects offspring from allergy disease. Therefore, we utilized maternal rat allergen exposure model to evaluate the offspring immune reactions to ovalbumin protein and to determine whether the Brown Norway (BN) rat model is a suitable animal model for studying the allergenicity of food proteins. For three generations, rats received an allergens or non-allergens by gavage during the pregnancy and lactation periods. After weaning, the offspring rats were used for oral sensitization experiment. In the sensitization experiment, the control rat, which had maternal exposure to phosphate-buffered saline (PBS), exhibited full response of IgG to oral exposure to OVA. The IgG level was significantly lower in F1 rats that were sensitized by maternal exposure to ovalbumin(OVA). Moreover, the lowest IgG level was found for the F3b sensitized by maternal rats exposed to OVA allergen for three continuous generations. Compared with maternal OVA exposure prior to postnatal sensitization, the sensitization via maternal PBS led to a higher serum level of OVA-specific IgG. However, the OVA-specific IgG levels for the two generations of maternal PBS exposure prior to postnatal sensitization was not higher than that for the one generation of maternal rats exposed to PBS prior to postnatal sensitization. Our studies demonstrate that maternal OVA exposure during the pregnancy and lactation can affect the results of oral sensitization studies using ovalbumin protein. BN rats must be bred in non-allergen conditions for at least one generation to avoid problems in rat models for studying the allergenicity of food proteins.
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Affiliation(s)
- Rucheng Chen
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China, 430079
- College of Basic Medical Science, Zhejiang Chinese Medical School, Hangzhou, Zhejiang, China, 310053
| | - Xiaoqiao Tang
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China, 430079
| | - Bolin Fan
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China, 430079
- * E-mail: (BF); (JL)
| | - Jiafa Liu
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, China, 430079
- * E-mail: (BF); (JL)
| | - Xudong Jia
- China National Center for Food Safety Risk Assessment, Beijing, China, 100021
| | - Xiaoguang Yang
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China, 100021
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23
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Neonatal adiposity increases the risk of atopic dermatitis during the first year of life. J Allergy Clin Immunol 2016; 137:108-117. [DOI: 10.1016/j.jaci.2015.05.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
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24
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Kotenko KV, Khan MA, Lyan NA, Vakhova EL, Novikova EV. [The medical rehabilitation of the children presenting with atopic dermatitis (a literature review)]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2016. [PMID: 28635707 DOI: 10.17116/kurort2016566-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atopic dermatitis takes the predominant position in the structure of skin pathologies in the children of various age. Both the scientifically based forecasts and the data of numerous investigations give evidence not only of the significant increase in the number of patients presenting with this condition but also of the growing severity of this disease. Taken together, these facts account for the serious medico-social importance of the problems arising in connection with this pathology. The introduction of the eliminative actions, a hypoallergenic diet, local and systemic pharmacotherapeutic modalities do not always allow to prevent or arrest the inflammatory process and achieve the long-standing remission. The high frequency of undesirable reactions to the pharmacological products turns the attention of many clinicians to the application of the non-pharmacological factors and methods for the treatment of atopic dermatitis in the children. The main objectives of physical therapy in the case of atopic dermatitis include the normalization of the state of the central and vegetative nervous system, the achievement of hyposensitization, sedative, anti-toxic, and anti-inflammatory effects, as well as the application of the dissolving, trophic, and antipruritogenic agents, strengthening of the general health status of the children.
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Affiliation(s)
- K V Kotenko
- Central Medical Facility, General Management Department of Presidential Administration of the Russian Federation, Moscow, Russia
| | - M A Khan
- Federal state budgetary institution 'Moscow Research Centre of Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russia; State budgetary educational institution of higher professional education 'I.M. Sechenov First Moscow State Medical University', Russian Ministry of Health, Moscow, Russia
| | - N A Lyan
- Federal state budgetary institution 'Moscow Research Centre of Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russia; State budgetary educational institution of higher professional education 'I.M. Sechenov First Moscow State Medical University', Russian Ministry of Health, Moscow, Russia
| | - E L Vakhova
- Federal state budgetary institution 'Moscow Research Centre of Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russia; State budgetary educational institution of higher professional education 'I.M. Sechenov First Moscow State Medical University', Russian Ministry of Health, Moscow, Russia
| | - E V Novikova
- Federal state budgetary institution 'Moscow Research Centre of Medical Rehabilitation, Restorative and Sports Medicine', Moscow Health Department, Moscow, Russia; State budgetary educational institution of higher professional education 'I.M. Sechenov First Moscow State Medical University', Russian Ministry of Health, Moscow, Russia
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Allergenkarenz und Klimatherapie. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Role of primary and secondary prevention in atopic dermatitis. Postepy Dermatol Alergol 2015; 32:409-20. [PMID: 26755903 PMCID: PMC4697018 DOI: 10.5114/pdia.2014.44017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/03/2014] [Indexed: 11/21/2022] Open
Abstract
Atopic dermatitis (AD) is a serious epidemiological problem in industrialized countries. The incidence of AD has increased considerably over the last 30 years. Atopic dermatitis is a chronic, recurrent, inflammatory skin disease accompanied by strong itching. It is characterized by typical features depending on age. The parents of children suffering from AD must be prepared to change their lifestyle. They should avoid factors which can promote skin lesions and apply appropriate, regular skin care. The article describes primary prevention of AD as well as prophylactic measures to avoid skin eczema. It presents the role of infections, vaccinations, breastfeeding and the influence of domestic animals, house renovation and moulds on development of AD. The article also describes the significance of the epidermal barrier, skin colonization by microbial agents, pruritus, stress, food and inhalant allergy among people who suffer from AD.
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Affiliation(s)
- Elissa M Abrams
- Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man.
| | - Allan B Becker
- Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man
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Yung J, Yuen JWM, Ou Y, Loke AY. Factors associated with atopy in toddlers: a case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2501-20. [PMID: 25723646 PMCID: PMC4377914 DOI: 10.3390/ijerph120302501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/08/2015] [Accepted: 02/17/2015] [Indexed: 01/04/2023]
Abstract
In this case-control study the association between the approaches used to feed infants, together with known family and environmental factors, and the occurrence of atopic illness in toddlers between the ages of 4 months to 3 years in Hong Kong was examined. A total of 206 subjects were recruited from April to June of 2014. The results obtained by binary logistic regression indicated that atopy is associated with boys (OR 2.072, CI 1.089-3.941), the maternal use of antibiotics in utero or while breast feeding (OR 2.276, CI 1.151-4.504), the later commencement of mixed feeding (OR 2.497, CI 1.025-6.082), breast feeding exclusively for 3 months (OR 1.972, CI 1.009-3.857), and having a mother who was diagnosed with eczema (OR 4.510, CI 1.764-11.530). Although an exclusive reliance on breast feeding has been shown to be predictive of atopy among toddlers, the positive qualities of breast milk cannot be ignored. A further study of the contents and nutritional values of breast milk is warranted.
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Affiliation(s)
- Jolene Yung
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - John W M Yuen
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
| | - Yvonne Ou
- Central Health Medical Practice, Hong Kong, China.
| | - Alice Yuen Loke
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China.
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McGowan EC, Bloomberg GR, Gergen PJ, Visness CM, Jaffee KF, Sandel M, O'Connor G, Kattan M, Gern J, Wood RA. Influence of early-life exposures on food sensitization and food allergy in an inner-city birth cohort. J Allergy Clin Immunol 2014; 135:171-8. [PMID: 25129677 DOI: 10.1016/j.jaci.2014.06.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/04/2014] [Accepted: 06/30/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Previous data suggest that food allergy (FA) might be more common in inner-city children; however, these studies have not collected data on both sensitization and clinical reactivity or early-life exposures. METHODS Children in the Urban Environment and Childhood Asthma birth cohort were followed through age 5 years. Household exposures, diet, clinical history, and physical examinations were assessed yearly; levels of specific IgE to milk, egg, and peanut were measured at 1, 2, 3, and 5 years of age. On the basis of sensitization (IgE ≥0.35 kU/L) and clinical history over the 5-year period, children were classified as having FA or being possibly allergic, sensitized but tolerant, or not allergic/not sensitized. RESULTS Five hundred sixteen children were included. Overall, 55.4% were sensitized (milk, 46.7%; egg, 31.0%; and peanut, 20.9%), whereas 9.9% were categorized as having FA (peanut, 6.0%; egg, 4.3%; and milk, 2.7%; 2.5% to >1 food). The remaining children were categorized as possibly allergic (17.0%), sensitized but tolerant (28.5%), and not sensitized (44.6%). Eighteen (3.5%) reported reactions to foods for which IgE levels were not measured. Food-specific IgE levels were similar in children with FA versus sensitized but tolerant children, except for egg, levels of which were higher in patients with FA at ages 1 and 2 years. FA was associated with recurrent wheeze, eczema, aeroallergen sensitization, male sex, breast-feeding, and lower endotoxin exposure in year 1 but not with race/ethnicity, income, tobacco exposure, maternal stress, or early introduction of solid foods. CONCLUSIONS Even given that this was designed to be a high-risk cohort, the cumulative incidence of FA is extremely high, especially considering the strict definition of FA that was applied and that only 3 common allergens were included.
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Affiliation(s)
- Emily C McGowan
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Gordon R Bloomberg
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Peter J Gergen
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | | | - Megan Sandel
- Department of Medicine, Division of Pediatric Primary Care, Boston University School of Medicine, Boston, Mass
| | - George O'Connor
- Department of Medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Mass
| | - Meyer Kattan
- Department of Pediatrics, Division of Pediatric Pulmonology, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - James Gern
- Department of Pediatrics, Division of Allergy and Immunology, University of Wisconsin School of Medicine, Madison, Wis
| | - Robert A Wood
- Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Md.
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Saulyte J, Regueira C, Montes-Martínez A, Khudyakov P, Takkouche B. Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001611. [PMID: 24618794 PMCID: PMC3949681 DOI: 10.1371/journal.pmed.1001611] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 01/22/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Allergic rhinitis, allergic dermatitis, and food allergy are extremely common diseases, especially among children, and are frequently associated to each other and to asthma. Smoking is a potential risk factor for these conditions, but so far, results from individual studies have been conflicting. The objective of this study was to examine the evidence for an association between active smoking (AS) or passive exposure to secondhand smoke and allergic conditions. METHODS AND FINDINGS We retrieved studies published in any language up to June 30th, 2013 by systematically searching Medline, Embase, the five regional bibliographic databases of the World Health Organization, and ISI-Proceedings databases, by manually examining the references of the original articles and reviews retrieved, and by establishing personal contact with clinical researchers. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk (RR) estimates and confidence intervals of smoking and allergic conditions, first among the general population and then among children. We retrieved 97 studies on allergic rhinitis, 91 on allergic dermatitis, and eight on food allergy published in 139 different articles. When all studies were analyzed together (showing random effects model results and pooled ORs expressed as RR), allergic rhinitis was not associated with active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated with passive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis was associated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passive smoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent, allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis was associated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking (pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43 [1.12-1.83]) when cohort studies only were examined, but not when all studies were combined. The findings are limited by the potential for confounding and bias given that most of the individual studies used a cross-sectional design. Furthermore, the studies showed a high degree of heterogeneity and the exposure and outcome measures were assessed by self-report, which may increase the potential for misclassification. CONCLUSIONS We observed very modest associations between smoking and some allergic diseases among adults. Among children and adolescents, both active and passive exposure to SHS were associated with a modest increased risk for allergic diseases, and passive smoking was associated with an increased risk for food allergy. Additional studies with detailed measurement of exposure and better case definition are needed to further explore the role of smoking in allergic diseases.
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Affiliation(s)
- Jurgita Saulyte
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Carlos Regueira
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Agustín Montes-Martínez
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Polyna Khudyakov
- Departments of Epidemiology and Biostatistics,
Harvard School of Public Health, Boston, Massachusetts, United States of
America
| | - Bahi Takkouche
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
- * E-mail:
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32
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Kroumpouzos G. Specific dermatoses of pregnancy: advances and controversies. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ito J, Fujiwara T. Breastfeeding and risk of atopic dermatitis up to the age 42 months: a birth cohort study in Japan. Ann Epidemiol 2013; 24:267-72. [PMID: 24342028 DOI: 10.1016/j.annepidem.2013.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association between breastfeeding and atopic dermatitis (AD) up to the age 42 months. METHODS Data from a nationally representative population-based birth cohort study in Japan were used (N = 38,757). Feeding pattern and breastfeeding duration were investigated via questionnaires when infants were aged 6 months. Physician-diagnosed AD during the previous 1 year was ascertained via questionnaires when the children were aged 18, 30, and 42 months. The associations between feeding patterns or breastfeeding duration and physician-diagnosed AD from the age 6 to 42 months, categorized by AD status (no history of AD, episodic AD, and persistent AD), were analyzed using ordered logistic regression adjusted for covariates. RESULTS Breastfeeding was positively associated with AD, with dose-response association (P for trend < .001). Exclusively breastfed infants were 1.26 times more likely to have AD (95% confidence interval, 1.12-1.41) than infants fed formula alone. Furthermore, children with a longer breastfeeding duration were also significantly more likely to have AD (P for trend < .001). CONCLUSIONS Breastfeeding is associated with an increased risk of AD up to the age 42 months. Further study is needed to elucidate the mechanism underlying the association between breastfeeding and AD.
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Affiliation(s)
- Jun Ito
- Department of Social Medicine, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan; Division of Developmental Social Medicine, Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan; Division of Developmental Social Medicine, Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
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Abstract
PURPOSE OF REVIEW Increasing understanding of mechanisms and influencing factors in the development of uncontrolled inflammatory responses in atopy and asthma should serve for the introduction of new preventive measures. This review tries to present the current state of the art and resumes that until now, no really effective concept can be offered to families at risk. RECENT FINDINGS In addition to modified feeding regimes (hydrolysed formula feeding in infancy), timing of the introduction of solids (avoidance of allergens versus early induction of tolerance), immune modulation using prebiotics or probiotics, a new target of potential intervention could be the human microbiome as a key player in the development of inflammatory diseases such as allergy and asthma. However, during the last 5 years, this concept could not yet be verified in interventional trials. There are new trials ongoing, studying the effect of microbial compounds in early infancy, vitamin D and polyunsaturated fatty acid supplementation during late pregnancy and the effect of azithromycin in children with recurrent wheeze. Results are to be expected within the next couple of years. SUMMARY New data on multifaceted intervention and the analysis of the human microbiome are to be expected. The recommendation for atopy and asthma prevention still focuses on avoidance of tobacco smoke exposure and food allergens during the first 4 months of life and feeding of hydrolysed formula if breast-feeding is not possible in high-risk infants, potentially early feeding of prebiotic sugars and/or certain strains of probiotic bacteria or bacterial compounds in certain subpopulations.
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Affiliation(s)
- Susanne Lau
- Department of Pediatric Pneumology and Immunology, Charité Campus Virchow, Charité Medical University, Berlin, Germany.
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37
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Hörnell A, Lagström H, Lande B, Thorsdottir I. Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res 2013; 57:20823. [PMID: 23589711 PMCID: PMC3625706 DOI: 10.3402/fnr.v57i0.20823] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 01/01/2023] Open
Abstract
The present systematic literature review is part of the 5th revision of the Nordic Nutrition Recommendations. The overall aim was to review recent scientific data valid in a Nordic setting on the short- and long-term health effects of breastfeeding (duration of both any and exclusive breastfeeding) and introduction of foods other than breast milk. The initial literature search resulted in 2,011 abstracts; 416 identified as potentially relevant. Full paper review resulted in 60 quality assessed papers (6A, 48B, and 6C). A complementary search found some additional papers. The grade of evidence was classified as convincing, probable, limited-suggestive, and limited-no conclusion. The evidence was convincing of a protective dose/duration effect of breastfeeding against overweight and obesity in childhood and adolescence, overall infections, acute otitis media, and gastrointestinal and respiratory tract infections. The evidence was probable that exclusive breastfeeding for longer than 4 months is associated with slower weight gain during the second half of the first year which could be part of the reason behind the reduced risk of later overweight or obesity. There was also probable evidence that breastfeeding is a protective factor against inflammatory bowel disease, celiac disease, and diabetes (type 1 and 2), provides beneficial effects on IQ and developmental scores of children as well as a small reductive effect on blood pressure and blood cholesterol levels in adulthood. Other associations explored were limited-suggestive or inconclusive. In conclusion, convincing and probable evidence was found for benefits of breastfeeding on several outcomes. The recommendation in NNR2004 about exclusive breastfeeding for 6 months and continued partial breastfeeding thereafter can stand unchanged. The relatively low proportion of infants in the Nordic countries following this recommendation indicates that strategies that protect, support and promote breastfeeding should be enhanced, and should also recognize the benefits for long-term health.
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Affiliation(s)
- Agneta Hörnell
- Department of Food and Nutrition, Umeå, University, Umeå Sweden
| | - Hanna Lagström
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Britt Lande
- Division of Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Inga Thorsdottir
- Unit for Nutrition Research, School of Health Sciences, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland
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38
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Matheson MC, Allen KJ, Tang MLK. Understanding the evidence for and against the role of breastfeeding in allergy prevention. Clin Exp Allergy 2013; 42:827-51. [PMID: 22276526 DOI: 10.1111/j.1365-2222.2011.03925.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between breastfeeding and allergic disease risk has been controversial. This article reviews the current evidence for the role of breastfeeding in the prevention of allergic disease. We found considerable methodological limitations inherent in most studies evaluating the effect of breastfeeding in allergic disease. Nevertheless, since randomized control trials in breast feeding research would be considered unethical, the evidence remains limited to poorer quality observational studies where participation and recall bias can severely affect the objectivity of the data collected. Furthermore, reporting of type of breastfeeding (exclusive, full or partial) may be biased by a participant's inherent belief system of what they think they should be doing. Current evidence is inconclusive regarding the effect of breastfeeding on the development of eczema, with the most recent systemic review reporting no protective effect. There is insufficient data regarding the effects of breastfeeding on objective measures of food allergy at any age. Studies show a paradoxical effect of breastfeeding on the prevention of asthma, with an apparent protective effect against early wheezing illness in the first years of life yet an increased risk of asthma in later life; however, these findings must be interpreted with caution. Existing studies fail to adequately adjust for confounders, including the critical issues of protection against early life respiratory illnesses and reverse causation. Therefore, it is possible that the effect of breastfeeding on early wheezing illness reflects protection against respiratory infection, the predominant trigger of wheezing in early childhood, rather than a true reduction in risk of asthma. In summary, future research that takes into account the potential contribution of confounding factors and effect modifiers is needed to clarify the role of breastfeeding in development of allergic disease and to inform current clinical guidelines on the prevention of allergic disease.
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Affiliation(s)
- M C Matheson
- Centre for MEGA Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia
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39
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Abstract
Breast-feeding provides protection against infections and contains numerous factors that modulate and promote the development of the infant immune system. These factors include secretory IgA, antimicrobial proteins like CD14, cytokines, and fatty acids. Studies examining the role of breast-feeding in the development of allergic disease in infants demonstrate potentially protective as well as neutral or nonprotective effects, likely due to the heterogeneity in their study design. In this overview, we explore the potential role of immune factors in the breast milk, as well as selected probiotics, in the development of allergy.
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Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2012; 1:29-36. [PMID: 24229819 DOI: 10.1016/j.jaip.2012.09.003] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/17/2012] [Accepted: 09/20/2012] [Indexed: 01/23/2023]
Abstract
With the rising prevalence of atopic disease, primary prevention may play a role in reducing its burden, especially in high-risk infants. With this in mind, the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was charged with the task of developing recommendations for primary care physicians and specialists about the primary prevention of allergic disease through nutritional interventions according to current available literature and expert opinion. Recommendations that are supported by data are as follows. Avoidance diets during pregnancy and lactation are not recommended at this time, but more research is necessary for peanut. Exclusive breast-feeding for at least 4 and up to 6 months is endorsed. For high-risk infants who cannot be exclusively breast-fed, hydrolyzed formula appears to offer advantages to prevent allergic disease and cow's milk allergy. Complementary foods can be introduced between 4 and 6 months of age. Because no formal recommendations have been previously provided about how and when to introduce the main allergenic foods (cow's milk, egg, soy, wheat, peanut, tree nuts, fish, shellfish), these are now provided, and reasons to consider allergy consultation for development of a personalized plan for food introduction are also presented.
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Affiliation(s)
- David M Fleischer
- National Jewish Health, University of Colorado Denver School of Medicine, Denver, Colo.
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Immunological programming by breast milk creates an anti-inflammatory cytokine milieu in breast-fed infants compared to formula-fed infants. Br J Nutr 2012; 109:1962-70. [PMID: 23110822 DOI: 10.1017/s0007114512004229] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Breast milk provides important maturational stimuli to an infant's developing immune system. However, data concerning the role of breast-feeding in reducing the risk of allergic disease remain contradictory. Previous studies have centred on comparative analyses of breast milk and formula compositions. We chose a slightly different angle, whereby we focused on the effects of the chosen diet on the infant himself, comparing the immune development of formula-fed and breast-fed children. The objective of the present study was to determine how the mode of feeding affects infant immunology. Altogether, eighteen formula-fed infants with limited breast-feeding for ,3 months and twenty-nine infants who were exclusively breast-fed for .3 months were included in the study. Concentrations of interferon g, TNF-a IL-10, IL-5, IL-4 and IL-2 were measured simultaneously from the same serum sample through use of a multiplexed flow cytometric assay at the ages of 1, 3, 6 and 12 months. Transforming growth factor β2 (TGF-β2) was measured using ELISA at the same time points. Serum TNF-a and IL-2 concentrations were significantly higher in formula-fed than in breast-fed infants during the first year of life (ANOVA, P=0·002). The serum concentrations of TGF-b were significantly lower in formula-fed than in breast-fed infants throughout the first year of life (ANOVA, P≤0·0001). Exclusive breast-feeding promotes an anti-inflammatory cytokine milieu, which is maintained throughout infancy. Such an immunological environment limits hyper-responsiveness and promotes tolerisation, possibly prohibiting the onset of allergic disease.
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Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012; 129:1187-97. [DOI: 10.1016/j.jaci.2012.02.036] [Citation(s) in RCA: 304] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 12/11/2022]
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Morales E, García-Esteban R, Guxens M, Guerra S, Mendez M, Moltó-Puigmartí C, Lopez-Sabater MC, Sunyer J. Effects of prolonged breastfeeding and colostrum fatty acids on allergic manifestations and infections in infancy. Clin Exp Allergy 2012; 42:918-28. [DOI: 10.1111/j.1365-2222.2012.03969.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Morales
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
| | - R. García-Esteban
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
| | - M. Guxens
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
| | - S. Guerra
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
- Arizona Respiratory Center; Tucson AZ USA
| | - M. Mendez
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
| | - C. Moltó-Puigmartí
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
- Department of Nutrition and Food Science; Faculty of Pharmacy; University of Barcelona; Barcelona Catalonia Spain
| | - M. C. Lopez-Sabater
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
- Department of Nutrition and Food Science; Faculty of Pharmacy; University of Barcelona; Barcelona Catalonia Spain
| | - J. Sunyer
- Center for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública; Barcelona Catalonia Spain
- Department of Experimental and Health Sciences; Pompeu Fabra University; Barcelona Catalonia Spain
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Flohr C, Nagel G, Weinmayr G, Kleiner A, Strachan DP, Williams HC. Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. Br J Dermatol 2011; 165:1280-9. [PMID: 21883137 DOI: 10.1111/j.1365-2133.2011.10588.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease. OBJECTIVES To investigate whether exclusive breastfeeding protects against childhood eczema. METHODS Study subjects comprised 51,119 randomly selected 8- to 12-year-old schoolchildren in 21 countries. Information on eczema and breastfeeding was gathered by parental questionnaire. Children were also examined for flexural eczema and underwent skin prick testing. Odds ratios (ORs) were calculated for each study centre and then pooled across populations. RESULTS There was a small increase in the risk of reported 'eczema ever' in association with 'breastfeeding ever' and breastfeeding < 6 months [pooled adjusted OR 1·11, 95% confidence interval (CI) 1·00-1·22 and OR 1·10, 95% CI 1·02-1·20, respectively]. There was no significant association between reported 'eczema ever' and breastfeeding > 6 months (pooled adjusted OR 1·09, 95% CI 0·94-1·26). Risk estimates were very similar for exclusive breastfeeding < 2 months, 2-4 months and > 4 months and for eczema symptoms in the past 12 months and eczema on skin examination. As for more severe eczema, breastfeeding per se conveyed a risk reduction on sleep disturbed eczema (pooled adjusted OR 0·71, 95% CI 0·53-0·96), but this effect was lost where children had been exclusively breastfed for > 4 months (pooled adjusted OR 1·02, 95% CI 0·67-1·54). Allergic sensitization and a history of maternal allergic disease did not modify any of these findings. CONCLUSIONS Although there was a protective effect of ever having been breastfed on more severe disease, we found no evidence that exclusive breastfeeding for 4 months or longer protects against eczema. Our results are consistent with findings from a recent systematic review of prospective studies. The U.K. breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.
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Affiliation(s)
- C Flohr
- Department of Paediatric Allergy & Dermatology, St John's Institute of Dermatology, St Thomas' Hospital and King's College London, London, UK.
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Flohr C. Recent perspectives on the global epidemiology of childhood eczema. Allergol Immunopathol (Madr) 2011; 39:174-82. [PMID: 21601133 DOI: 10.1016/j.aller.2011.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/28/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest epidemiological study ever performed and the only truly global allergy study. This review summarises the childhood eczema-related findings from ISAAC and discusses how these fit into our current understanding of eczema aetiology, with particular emphasis on worldwide time trends in eczema prevalence, climatic and dietary risk factors, breastfeeding, the role of skin barrier impairment and allergic sensitisation.
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Abstract
Food allergy is a recognized public health concern, for which preventative strategies are required. Although an intervention that adequately protects against the development of food allergy has still to be identified, limited benefits have been shown for the prevention of related allergic conditions such as eczema, and to a lesser extent asthma and rhinitis; these benefits are usually limited to at-risk populations. Prevention strategies need to be tested using randomized controlled study designs that account for the numerous methodological challenges, safety concerns, and necessary ethical limitations.
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Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' National Health Service Foundation Trust, Medical Research Council, London, UK.
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Apfelbacher CJ, Diepgen TL, Schmitt J. Determinants of eczema: population-based cross-sectional study in Germany. Allergy 2011; 66:206-13. [PMID: 20804468 DOI: 10.1111/j.1398-9995.2010.02464.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eczema is a chronic inflammatory skin disease and is among the most frequent chronic conditions in childhood and adolescence. It is the aim of this study to investigate determinants of eczema in German children and adolescents. METHODS Data were drawn from the public use files of the German Interview and Examination Survey for Children and Adolescents (KIGGS), a nationwide cross-sectional representative survey conducted between 2003 and 2006, including 17,641 children aged 0-17 (response rate: 66.6%). We investigated the association of a broad set of environmental and lifestyle exposures with ever physician-diagnosed eczema by means of univariable analyses and multivariable logistic regression modelling. RESULTS The weighted prevalence of ever physician-diagnosed eczema was 13.2% [95% confidence interval (CI) 12.5-13.9%]. In multivariable analysis, significant positive associations of parental allergies (OR 1.94, 95% CI 1.72-2.19), parent-reported infection after birth (OR 1.45, 95% CI 1.05-2.00) and parent-reported jaundice after birth (OR 1.27, 95% CI 1.04-1.54) were revealed. Being a migrant (OR 0.63, 95% CI 0.49-0.80) and keeping a dog (OR 0.78, 95% CI 0.64-0.96) showed significant inverse associations with eczema. Other lifestyle (alcohol consumption during pregnancy) and environmental factors (mould on the walls, pets, origin from East/West Germany) were not significantly related to eczema. CONCLUSIONS This study suggests that a family history of allergies is the strongest determinant of eczema. Perinatal health problems were associated with eczema, pointing to the importance of early life factors in the manifestation of eczema.
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Affiliation(s)
- C J Apfelbacher
- Department of Clinical Social Medicine, University Hospital Heidelberg, Thibautstrasse 3, Heidelberg, Germany.
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Chuang CH, Hsieh WS, Chen YC, Chang PJ, Hurng BS, Lin SJ, Chen PC. Infant feeding practices and physician diagnosed atopic dermatitis: a prospective cohort study in Taiwan. Pediatr Allergy Immunol 2011; 22:43-9. [PMID: 20573037 DOI: 10.1111/j.1399-3038.2010.01007.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is common to recommend breastfeeding and a delayed introduction of solids to prevent atopic dermatitis (AD). However, the scientific evidence for this is inconclusive. The aim of this study was to explore the effect of breastfeeding and solids on AD, when taking account of reverse causality. This on-going birth cohort study was designed to sample 24,200 representative post-partum women and their babies from the Taiwan National Birth Registration database. Using two home interviews at 6 and 18 months after birth, with structured questionnaires about diet and physician's diagnosis of AD by parental reports, a total of 20,172 pairs (83.4%) were reviewed completely. Considering reverse causality, we excluded 2399 children with AD in the first 6 months of life and 18,733 were finally recruited. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. After adjustment for potential confounders, the overall results showed that the increased duration of breastfeeding seemed to increase the risk of AD at 18 months in children. However, no significant effect was found for the delayed introduction of solids on the risk of AD. There is no evidence of a protective effect of prolonged breastfeeding and a delayed introduction of solids against AD among children at age 18 months, and may even be a risk factor of AD.
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Affiliation(s)
- Chao-Hua Chuang
- Department of Nursing, Chang Jung Christian University, 396 Sec.1 Chang Jung Road, Kway Jen, Tainan, Taiwan.
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Sandini U, Kukkonen AK, Poussa T, Sandini L, Savilahti E, Kuitunen M. Protective and Risk Factors for Allergic Diseases in High-Risk Children at the Ages of Two and Five Years. Int Arch Allergy Immunol 2011; 156:339-48. [DOI: 10.1159/000323907] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 12/27/2010] [Indexed: 11/19/2022] Open
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