1
|
Wang S, Yin P, Yu L, Tian F, Chen W, Zhai Q. Effects of Early Diet on the Prevalence of Allergic Disease in Children: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100128. [PMID: 37827490 PMCID: PMC10831899 DOI: 10.1016/j.advnut.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
Recent evidence suggests that the timing of introduction, types, and amounts of complementary foods/allergenic foods may influence the risk of allergic disease. However, the evidence has not been updated and comprehensively synthesized. The Cochrane Library, EMBASE, Web of Science, and PubMed databases were searched from the inception of each database up to 31 May 2023 (articles prior to 2000 were excluded manually). Statistical analyses were performed using RevMan 5. The GRADE approach was followed to rate the certainty of evidence. Compared with >6 mo, early introduction of eggs (≤6 mo of age) might reduce the risk of food allergies in preschoolers aged <6 y (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53, 0.81), but had no effect on asthma or atopic dermatitis (AD). Consumption of fish at 6-12 mo might reduce the risk of asthma in children (aged 5-17 y) compared with late introduction after 12 mo (OR, 0.61; 95% CI: 0.52, 0.72). Introduction of allergenic foods for ≤6 mo of age, compared with >6 mos, was a protective factor for the future risk (children aged ≤10 y) of AD (OR, 0.93; 95% CI: 0.89, 0.97). Probiotic intervention for infants at high risk of allergic disease significantly reduced the risk of food allergy at ages 0-3 y (OR, 0.72; 95% CI: 0.56, 0.94), asthma at 6-12 y (OR, 0.61; 95% CI: 0.41, 0.90), and AD at aged <6 y (3-6 y: OR, 0.70; 95% CI: 0.52, 0.94; 0-3 y: OR, 0.73; 95% CI: 0.59, 0.91). Early introduction of complementary foods or the high-dose vitamin D supplementation in infancy was not associated with the risk of developing food allergies, asthma, or AD during childhood. Early introduction to potential allergen foods for normal infants or probiotics for infants at high risk of allergies may protect against development of allergic disease. This study was registered at PROSPERO as CRD42022379264.
Collapse
Affiliation(s)
- Shumin Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Pingping Yin
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Leilei Yu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Fengwei Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu, China
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
| |
Collapse
|
2
|
Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
Collapse
Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Singh S, Behl T, Sharma N, Zahoor I, Chigurupati S, Yadav S, Rachamalla M, Sehgal A, Naved T, Arora S, Bhatia S, Al-Harrasi A, Mohan S, Aleya L, Bungau S. Targeting therapeutic approaches and highlighting the potential role of nanotechnology in atopic dermatitis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:32605-32630. [PMID: 35195869 DOI: 10.1007/s11356-021-18429-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Atopic dermatitis is a chronic as well as widespread skin disease which has significant influence on the life attributes of affected people and their families. Systemic immunosuppressive drugs can be utilised for effective care of disease, although they are often prescribed for rigorous disruption or disease that is complicated to manage. Therefore, topical applications of corticosteroids are considered the primary pharmacologic therapies for atopic dermatitis, and research recommends that these medications might be helpful in preventing disease flare-ups. However, topical medicine administration to deeper layers of skin is challenging because of the skin anatomic barrier that restricts deeper drug permeation, and also due to barrier function abnormalities in atopic dermatitis skin, which might result in systemic drug absorption, provoking systemic consequences. Hence, effective management of atopic dermatitis needs new, effective, safe and targeted treatments. Therefore, nanotechnology-based topical therapeutics have attracted much interest nowadays because of their tendency to increase drug diffusion and bioavailability along with enormous drug targeting potential to affected cells, and, thereby, reducing the adverse effects of medications. In this review, we mention different symptoms of atopic dermatitis, and provide an overview of the different triggering factors causing atopic dermatitis, with emphasis on its epidemiology, pathophysiology, clinical features and diagnostic, and preventive measures. This review discusses existing therapeutics for treating atopic dermatitis, and the newer approaches as well as the current classical pharmacotherapy of atopic dermatitis against new nanoparticle skin delivery systems. This review has also briefly summarised the recent patents and clinical status of therapeutic modalities for atopic dermatitis.
Collapse
Affiliation(s)
- Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sridevi Chigurupati
- Department of Medicine Chemistry and Pharmacognosy, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Shivam Yadav
- Yashraj Institute of Pharmacy, Noida, Uttar Pradesh, India
| | - Mahesh Rachamalla
- Department of Biology, University of Saskatchewan, 112 Science Place, Saskatoon, Canada
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tanveer Naved
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Sandeep Arora
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
- School of Health Science, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
| | - Lotfi Aleya
- School of Health Science, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| |
Collapse
|
4
|
The Association between the Occurrence of Asthma and Antecedents of Exposure to Environmental Tobacco Smoke in the Previous Year in Children: An Incidence-Density Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052888. [PMID: 35270580 PMCID: PMC8910034 DOI: 10.3390/ijerph19052888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 12/04/2022]
Abstract
In previous studies, the strength of the association between childhood asthma and environmental tobacco smoke (ETS) differed depending on the way ETS was assessed and the type of study conducted. We investigated the relationship between asthma occurrence in children and recent exposure to ETS based on an incidence-density study driven by the explicit formulation of a theoretical design. Additionally, we assessed whether the relationship is modified by perinatal ETS exposure and parental inhalation atopy. The event was conceptualized as 'first doctor's diagnosis of asthma'. Population time was probed by sampling population moments. Exposure to ETS was conceptualized as recent exposure (1 year prior to diagnosis or at sampling) and perinatal exposure (in utero and/or during the first year of life). Thirty-nine events and 117 population moments were included. There was no indication for effect modification by perinatal exposure to ETS or parental inhalation atopy. After adjustment for confounding, an association was observed between occurrence of a first asthma diagnosis and recent ETS exposure: incidence-density ratio 4.94 (95% confidence interval 1.21, 20.13). Asthma occurrence in children is associated with recent exposure to ETS, and this association seems not to be modified by perinatal ETS exposure or parental inhalation atopy.
Collapse
|
5
|
Lee J, Shin M, Lee B. Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. Clin Exp Pediatr 2021; 64:408-414. [PMID: 33147910 PMCID: PMC8342876 DOI: 10.3345/cep.2020.01382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/12/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Complementary food in infancy is necessary for human growth, neurodevelopment, and health. However, the role of allergen consumption in early infancy and its effects on the development of food allergy or tolerance remain unclear. PURPOSE To investigate the influence of age at the time of complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. METHODS We combined data from the Korea National Health and Nutrition Examination Survey collected from 2010 to 2014 and analyzed 1619 children aged 1-3 years who were included in the survey. Multivariate regression analysis was used to identify associations among type of feeding, age at the time of complementary food introduction, and doctor-diagnosed atopic dermatitis and asthma. RESULTS Age at the time of complementary food introduction was not significantly associated with doctor-diagnosed atopic dermatitis and asthma in children aged 1-3 years. In the univariate analysis, children with asthma showed higher water and sodium intake levels than nonasthmatic children. However, this relationship was not significant in the multivariate regression analysis. CONCLUSION The present study revealed no statistically significant relationship between age at the time of complementary food introduction and the risk of atopic dermatitis and asthma in young Korean children. A national prospective study is needed to clarify the influence of age at the time of complementary food introduction on the development of allergic diseases.
Collapse
Affiliation(s)
- Jihyun Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Bora Lee
- Institute of Health & Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
| |
Collapse
|
6
|
Yuan M, Tan M, Moore D, Shen S, Qiu X, Thomas GN, Cheng K. Timing of Cow's Milk or Cow's Milk Formula Introduction to the Infant Diet and Atopic Risk in Children: a Systematic Review and Meta-analysis. Clin Rev Allergy Immunol 2021; 59:46-60. [PMID: 31768874 DOI: 10.1007/s12016-019-08770-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infant feeding is an important early-life exposure that may influence the development of atopic disease. The optimal timing of introduction of food allergens, including cow's milk (CM), is not known. This study aims to systematically review the evidence describing the effects of timing of CM or cow's milk formula (CMF) introduction to the infant diet on the development of atopic diseases during childhood. Pubmed, Embase, CINAHL, Cochrane CENTRAL, and CNKI were searched through May 30, 2019. Study screening and data extraction by two reviewers followed the PRISMA statement. Data were extracted independently in duplicate, and meta-analyses were performed by pooling unadjusted and adjusted odds ratio (OR) separately. Heterogeneity was explored using I2 and publication bias by funnel plots and Begg's tests. In total, 45 studies from 20 countries were included. Meta-analyses using adjusted data showed that no associations were observed between early introduction of CM or CMF and the risk of asthma (< 4 vs. ≥ 4 months: OR 1.16, 95% confidence interval (CI) 0.89, 1.51), wheeze (< 6 vs. ≥ 6 months: OR 1.15, 95% CI 0.85, 1.56), and eczema or atopic dermatitis (< 6 vs. ≥ 6 months: OR 0.96, 95% CI 0.65, 1.41). Overall, quite little high-quality evidence was identified to allow for definitive conclusions on the association between early CM or CMF introduction and risk of allergic diseases. Our meta-analysis on this topic highlights the specific gaps in information for public recommendations regarding CM or CMF feeding practice in an early stage of life, particularly before 3 months of age.
Collapse
Affiliation(s)
- Mingyang Yuan
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miaoyu Tan
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kar Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| |
Collapse
|
7
|
Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr 2019; 109:890S-934S. [PMID: 30982864 DOI: 10.1093/ajcn/nqy220] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.
Collapse
Affiliation(s)
| | | | | | - Nancy F Butte
- USDA-Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
| |
Collapse
|
10
|
Waidyatillake NT, Dharmage SC, Allen KJ, Bowatte G, Boyle RJ, Burgess JA, Koplin JJ, Garcia-Larsen V, Lowe AJ, Lodge CJ. Association between the age of solid food introduction and eczema: A systematic review and a meta-analysis. Clin Exp Allergy 2018; 48:1000-1015. [PMID: 29570230 DOI: 10.1111/cea.13140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/25/2018] [Accepted: 03/03/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed. METHODS PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure. RESULTS A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, 2 case-controls, 1 cross-sectional study and 2 randomized controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema. CONCLUSIONS The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema.
Collapse
Affiliation(s)
- N T Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - K J Allen
- Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - G Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - R J Boyle
- Section of Paediatrics, Imperial College London, London, UK
| | - J A Burgess
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J J Koplin
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - V Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - C J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| |
Collapse
|
11
|
Fortson EA, Li B, Bhayana M. Introduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1027:1-10. [PMID: 29063426 DOI: 10.1007/978-3-319-64804-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing condition that is characterized by itching and redness of the skin. Our modern usage of atopic dermatitis dates back to 1933, when Wise and Sulzberger first coined the term to signify the disease's close association with other respiratory atopy, such as bronchial asthma and allergic rhinitis. A recent systematic review of 69 cross-sectional and cohort studies has confirmed that AD is now a worldwide phenomenon with lifetime AD prevalences of well over 20% in many affluent country settings. Although there is no obvious consistent overall global trend in the prevalence of AD, studies have shown that climate, urbanization, lifestyle, and socioeconomic class influence the prevalence of atopic dermatitis. Despite the pervasiveness of the disease, an understanding of atopic dermatitis has been hampered by a number of factors. Data suggests that extrinsic environmental factors work in concert with intrinsic immune mechanism and genetic factors to drive disease progression. With such a complex etiology, management of atopic dermatitis currently at best achieves symptomatic control rather than cure. This approach poses a significant burden on healthcare resources, as well as patients' quality of life. Current management methods of AD often involves a combination of non-pharmacologic modalities and prescription medications. Though they can be effective when employed, there are significant barriers to treatment for patients including time, costs, and medication side effects. Our aim, throughout this text, is to explore the complexities of AD, providing the healthcare provider with tips and tricks to improve patient care and satisfaction and the most current trends and treatment approaches on the horizon.
Collapse
Affiliation(s)
- Erica A Fortson
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Becky Li
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Mahima Bhayana
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| |
Collapse
|
12
|
Jonsson K, Barman M, Brekke HK, Hesselmar B, Johansen S, Sandberg AS, Wold AE. Late introduction of fish and eggs is associated with increased risk of allergy development - results from the FARMFLORA birth cohort. Food Nutr Res 2017; 61:1393306. [PMID: 29151834 PMCID: PMC5678428 DOI: 10.1080/16546628.2017.1393306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/12/2017] [Indexed: 01/16/2023] Open
Abstract
The prevalence of allergy is markedly low in children growing up on farms. An increasing number of studies indicate that the timing of food introduction may affect allergy development. We aimed to investigate if protection against allergy in farm environments may be mediated through differences in food-introduction practices between farm and non-farm families, using an explorative approach. Twenty-eight farm and 37 non-farm children were included in the FARMFLORA birth cohort. Practices of breastfeeding and introduction of formulas and complementary foods were collected by questionnaires at 6, 12, and 18 months of age. Allergy was diagnosed by pediatricians at 3 years of age. The only difference in food-introduction practices observed between farm and non-farm children was an earlier introduction of nuts in farmers (median month: 11 [IQR: 8–6] in farmers, 15 [12–19] in non-farmers). One farm child (4%) and 10 non-farm children (27%) were allergic at 3 years of age. Lower risk of allergy development was associated with early exclusive breastfeeding (continuous variable; OR = 0.59, 95% CI: 0.39–0.89), but also having received eggs (OR = 0.08, 95% CI: 0.13–0.54) and fish (logistic regression not applicable, P = 0.01 in likelihood ratio testing [χ2]) at 10 months of age or earlier compared to later. Our results were not affected by reverse causation, as judged by a questionnaire sent to the families in retrospect. Timing of introduction of complementary foods is unlikely to contribute to the lower risk of allergy among farm children. Although early exclusive breastfeeding was associated with a lower rate of allergy development, postponed introduction of complementary foods might increase the risk of developing allergy. Owing to the limited sample size, our results are only indicative, but support prior findings.
Collapse
Affiliation(s)
- K Jonsson
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - M Barman
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - H K Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - B Hesselmar
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - S Johansen
- Paediatric Clinic, Skaraborg Hospital, Lidköping, Sweden
| | - A-S Sandberg
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - A E Wold
- Clinical Bacteriology Section, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
13
|
Turati F, Bertuccio P, Galeone C, Pelucchi C, Naldi L, Bach JF, La Vecchia C, Chatenoud L. Early weaning is beneficial to prevent atopic dermatitis occurrence in young children. Allergy 2016; 71:878-88. [PMID: 26893011 DOI: 10.1111/all.12864] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epidemiological data on infant feeding practices and allergic diseases are controversial. The purpose of this study was to explore the association of early weaning with the occurrence of atopic dermatitis (AD). METHODS We conducted a matched case-control study on incident physician-diagnosed AD in early childhood including 451 cases and 451 controls. Data on several factors, including feeding practices, were collected through an interviewer-administered questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated through logistic regression models, conditioned on study center, age, sex, and period of interview, and adjusted for potential confounders. RESULTS Early weaning, defined as the introduction of solid foods at 4 or 5 months of age, was inversely related to the risk of AD, with children weaned at 4 months having lower AD risk (OR = 0.41, 95% CI, 0.20-0.87) compared to those exclusively breastfed. Similar results were observed for weaning started at 5 months of age (OR = 0.39, 95% CI, 0.18-0.83). This association persisted when children with and without family history of allergy were considered separately. Prolonged partial breastfeeding (breastmilk plus milk formulas) was not associated with AD. Consistently, the introduction of a high number of different solid foods reduced the risk of AD (P trend = 0.02 at 4 months of age and P trend = 0.04 at 5 months). CONCLUSION Our data provide evidence against the preventing role of prolonged exclusive (but not partial) breastfeeding in AD occurrence and confirm recent results indicating a beneficial role of early weaning in AD.
Collapse
Affiliation(s)
- F. Turati
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - P. Bertuccio
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - C. Galeone
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - C. Pelucchi
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - L. Naldi
- Department of Dermatology; Azienda Ospedaliera Papa Giovanni XXIII; Centro Studi GISED; Bergamo Italy
| | - J.-F. Bach
- Université Paris Descartes; 75015 Paris France
- INSERM, Unité 1151; Paris France
| | - C. La Vecchia
- Department of Clinical Sciences and Community Health; Università degli Studi di Milano; Milan Italy
| | - L. Chatenoud
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | | |
Collapse
|
14
|
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]
|
15
|
McKean M, Caughey AB, Leong RE, Wong A, Cabana MD. The Timing of Infant Food Introduction in Families With a History of Atopy. Clin Pediatr (Phila) 2015; 54:745-51. [PMID: 25976525 DOI: 10.1177/0009922815584927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the timing of introduction and type of food introduced to infants with a family history of atopy. METHODS We conducted a secondary analysis of foods introduced each month to an interventional birth cohort of 149 infants at risk for atopy. RESULTS Seven percent of infants received solid food prior to 4 months of age; 13% after 6 months of age. Hyperallergenic foods were introduced on average in the following order: wheat (8.7 months); eggs (11.2 months); soy (13.0 months); fish (13.4 months); peanut (20.2 months); tree nuts (21.8 months); and other seafood (21.8 months). Asian race (odds ratio 3.94; 95% CI 1.14-13.58) and maternal history of food allergy (odds ratio 3.86; 95% CI 1.29-11.56) were associated with late food introduction. CONCLUSION Variation in timing of food introduction may reflect cultural preferences and/or previous experience with food allergy, as well as the ambiguous state of current recommendations.
Collapse
Affiliation(s)
| | | | | | - Angela Wong
- Kaiser Permanente, San Francisco Medical Center, San Francisco, CA, USA
| | | |
Collapse
|
16
|
Can Atopic Dermatitis Be Prevented? ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Nutten S. Atopic dermatitis: global epidemiology and risk factors. ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 1:8-16. [PMID: 25925336 DOI: 10.1159/000370220] [Citation(s) in RCA: 650] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease posing a significant burden on health-care resources and patients' quality of life. It is a complex disease with a wide spectrum of clinical presentations and combinations of symptoms. AD affects up to 20% of children and up to 3% of adults; recent data show that its prevalence is still increasing, especially in low-income countries. First manifestations of AD usually appear early in life and often precede other allergic diseases such as asthma or allergic rhinitis. Individuals affected by AD usually have genetically determined risk factors affecting the skin barrier function or the immune system. However, genetic mutations alone might not be enough to cause clinical manifestations of AD, and it is merely the interaction of a dysfunctional epidermal barrier in genetically predisposed individuals with harmful effects of environmental agents which leads to the development of the disease. AD has been described as an allergic skin disease, but today, the contribution of allergic reactions to the initiation of AD is challenged, and it is proposed that allergy is rather a consequence of AD in subjects with a concomitant underlying atopic constitution. Treatment at best achieves symptom control rather than cure; there is thus a strong need to identify alternatives for disease prevention.
Collapse
Affiliation(s)
- Sophie Nutten
- Nutrition and Health Department, Nestlé Research Center, Lausanne, Switzerland
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Gómez-de la Fuente E. Can atopic dermatitis be prevented? ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:278-84. [PMID: 25708653 DOI: 10.1016/j.ad.2014.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/23/2014] [Accepted: 12/14/2014] [Indexed: 11/28/2022] Open
Abstract
Atopic dermatitis has become a health problem in our setting due to its rising prevalence, impact on quality of life, associated costs, and role in the progression to other atopic diseases. Furthermore, atopic dermatitis has no definitive cure and therefore preventive measures are important. In this article, we review the latest advances in both primary prevention (reduction of the incidence of atopic dermatitis) and secondary prevention (reduction of associated morbidity and reduction of the atopic march). We analyze the different preventive strategies available, including modification of the immune system through microbial exposure, induction of immune tolerance through antigen exposure, and restoration of skin barrier function to halt the atopic march. Dermatologists need to be familiar with these strategies in order to apply them where necessary and to accurately inform patients and their relatives to prevent misguided or inappropriate actions.
Collapse
Affiliation(s)
- E Gómez-de la Fuente
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, España.
| |
Collapse
|
20
|
Heinrich J, Koletzko B, Koletzko S. Timing and diversity of complementary food introduction for prevention of allergic diseases. How early and how much? Expert Rev Clin Immunol 2014; 10:701-4. [DOI: 10.1586/1744666x.2014.917049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Suárez-Medina R, Venero-Fernández SJ, de la Mora-Faife E, García-García G, Del Valle-Infante I, Gómez-Marrero L, Fabré-Ortiz D, Fundora-Hernández H, Venn A, Britton J, Fogarty AW. Risk factors for eczema in infants born in Cuba: a population-based cross-sectional study. BMC DERMATOLOGY 2014; 14:6. [PMID: 24666750 PMCID: PMC3987161 DOI: 10.1186/1471-5945-14-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
Background There is a concern that allergic disease in childhood is higher than expected in Cuba. The aim of this study was to determine the risk factors for eczema of infants aged 12–15 months living in Havana. Methods We used a cross-sectional epidemiological study design. Data on eczema symptoms and a wide range of lifestyle factors were collected by researcher administered questionnaires. Results Data were collected on 1956 children (96% response rate), of whom 672 (34%) were reported as having had eczema. Independent risk factors for eczema included young maternal age (adjusted odds ratio (OR) 0.98 per additional year of age; 95% confidence interval (CI) 0.97-0.99), child’s weight (OR 1.13 per additional kg; 95% CI: 1.03-1.25), insect sting allergy (OR 2.11; 95% CI: 1.33-3.35), rodents in the home (OR 1.39; 95% CI: 1.10-1.76), attendance at childcare facilities (OR 1.34: 95% CI: 1.05-1.70) and self-reported mould in the home (OR 1.23; 95% CI: 1.07-1.41). Infant exposure to paracetamol was associated with an increased risk of eczema even after adjustment for wheeze (OR 1.22; 95% CI: 1.03-1.46). Conclusion Despite a very different culture and environment, the consistency of these findings with those from more economically developed countries suggests potential causal associations. The association with paracetamol, even after adjustment for wheeze, suggests that intervention studies are required in young infants, to ascertain if this commonly used anti-pyretic medication increases allergic disease.
Collapse
Affiliation(s)
- Ramón Suárez-Medina
- Instituto Nacional de Higiene, Epidemiología y Microbiología, Infanta No 1158 e/ Llinásy Clavel, Código Postal 10300 La Habana, Cuba.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Roduit C, Frei R, Depner M, Schaub B, Loss G, Genuneit J, Pfefferle P, Hyvärinen A, Karvonen AM, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R. Increased food diversity in the first year of life is inversely associated with allergic diseases. J Allergy Clin Immunol 2014; 133:1056-64. [PMID: 24508301 DOI: 10.1016/j.jaci.2013.12.1044] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The role of dietary factors in the development of allergies is a topic of debate, especially the potential associations between infant feeding practices and allergic diseases. Previously, we reported that increased food diversity introduced during the first year of life reduced the risk of atopic dermatitis. OBJECTIVE In this study we investigated the association between the introduction of food during the first year of life and the development of asthma, allergic rhinitis, food allergy, or atopic sensitization, taking precautions to address reverse causality. We further analyzed the association between food diversity and gene expression of T-cell markers and of Cε germline transcript, reflecting antibody isotype switching to IgE, measured at 6 years of age. METHODS Eight hundred fifty-six children who participated in a birth cohort study, Protection Against Allergy Study in Rural Environments/EFRAIM, were included. Feeding practices were reported by parents in monthly diaries during the first year of life. Data on environmental factors and allergic diseases were collected from questionnaires administered from birth up to 6 years of age. RESULTS An increased diversity of complementary food introduced in the first year of life was inversely associated with asthma with a dose-response effect (adjusted odds ratio with each additional food item introduced, 0.74 [95% CI, 0.61-0.89]). A similar effect was observed for food allergy and food sensitization. Furthermore, increased food diversity was significantly associated with an increased expression of forkhead box protein 3 and a decreased expression of Cε germline transcript. CONCLUSION An increased diversity of food within the first year of life might have a protective effect on asthma, food allergy, and food sensitization and is associated with increased expression of a marker for regulatory T cells.
Collapse
Affiliation(s)
- Caroline Roduit
- University of Zurich, Children's Hospital, and Christine Kühne-Center for Allergy Research and Education, Zurich, Switzerland.
| | - Remo Frei
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich and Christine Kühne-Center for Allergy Research and Education, Zurich, Switzerland
| | - Martin Depner
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Bianca Schaub
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Georg Loss
- Swiss Tropical and Public Health Institute and the University of Basel, Basel, Switzerland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Petra Pfefferle
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Anne Hyvärinen
- Department of Environment Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Anne M Karvonen
- Department of Environment Health, National Institute for Health and Welfare, Kuopio, Finland
| | | | - Jean-Charles Dalphin
- Department of Respiratory Disease, UMR/CNRS 6249 Chrono-environment, University Hospital of Besançon, Besançon, France
| | - Juha Pekkanen
- Department of Environment Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Charlotte Braun-Fahrländer
- Swiss Tropical and Public Health Institute and the University of Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Roger Lauener
- Children's Hospital of Eastern Switzerland St Gallen and the Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | |
Collapse
|
23
|
Flohr C, Mann J. New approaches to the prevention of childhood atopic dermatitis. Allergy 2014; 69:56-61. [PMID: 24372089 DOI: 10.1111/all.12343] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 02/04/2023]
Abstract
There has been a steep rise in the burden of atopic dermatitis (AD), and up to 20% of children in developed countries now suffer of the disease. At present, treatment at best achieves symptom control rather than cure, and there is a strong need to identify new methods of disease prevention. While earlier approaches focused on allergen avoidance strategies, there has been a clear shift towards attempts to induce tolerance and enhancement of skin barrier function, as skin barrier breakdown plays an important role in AD development. This article reviews the latest developments in the prevention of AD.
Collapse
Affiliation(s)
- C. Flohr
- Departments of Paediatric Dermatology & Children's Allergies; St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust and King's College; London UK
| | - J. Mann
- Department of Dermatology; Medway NHS Foundation Trust; Medway Maritime Hospital; Gillingham Kent UK
| |
Collapse
|
24
|
Timing of introduction of solid food and risk of allergic disease development: understanding the evidence. Allergol Immunopathol (Madr) 2013; 41:337-45. [PMID: 23287585 DOI: 10.1016/j.aller.2012.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/28/2012] [Indexed: 01/09/2023]
Abstract
Strategies to prevent or reduce the risk of allergic diseases are needed. The time of exclusive breastfeeding and introduction of solid foods is a key factor that may influence the development of allergy. For this reason, the aim of this review was to examine the association between exposure to solid foods in the infant's diet and the development of allergic diseases in children. Classical prophylactic feeding guidelines recommended a delayed introduction of solids for the prevention of atopic diseases. Is it really true that a delayed introduction of solids (after the 4th or 6th month) is protective against the development of eczema, asthma, allergic rhinitis and food or inhalant sensitisation? In recent years, many authors have found that there is no statistically significant association between delayed introduction of solids and protection for the development of allergic diseases. Furthermore, late introduction of solid foods could be associated with increased risk of allergic sensitisation to foods, inhalant allergens and celiac disease in children. Tolerance may be driven by the contact of the mucosal immune system with the allergen at the right time of life; the protective effects seem to be enhanced by the practice of the breastfeeding at the same time when weaning is started. Therefore, recent guidelines propose a "window" approach for weaning practice starting at the 17th week and introducing almost all foods within the 27th week of life to reduce the risk of chronic diseases such as allergic ones and the celiac disease. Guidelines emphasize the role of breastfeeding during the weaning practice.
Collapse
|
25
|
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.
Collapse
Affiliation(s)
- Susanne Lau
- Department of Pediatric Pneumology and Immunology, Charité Campus Virchow, Charité Medical University, Berlin, Germany.
| |
Collapse
|
26
|
Yong SB, Wu CC, Wang L, Yang KD. Influence and mechanisms of maternal and infant diets on the development of childhood asthma. Pediatr Neonatol 2013; 54:5-11. [PMID: 23445737 DOI: 10.1016/j.pedneo.2012.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/15/2012] [Accepted: 07/13/2012] [Indexed: 10/27/2022] Open
Abstract
Perinatal nutrition has been implicated in the programming of diseases in children and adults. The prevalence of asthma has dramatically increased in the past few decades, particularly in children. This suggests that the perinatal environment, including maternal and infant diets, may be involved in the increase in the prevalence of asthma. Recent studies have demonstrated that certain maternal and infant diets have a protective or augmentative effect on the development of asthma. Maternal diets with higher vitamin D, vitamin E, or/and probiotics are related to asthma prevention. Infants with breast feeding for at least 4 months and/or complementary diets between 4 and 6 months may have regulatory effects on the prevention of asthma. In summary, diets may have epigenetic or immune regulatory effects on the promotion or prevention of asthma. This article analyzes recent reports on the potential mechanism and mechanism-driven early prevention of childhood asthma by modification of maternal and infant diets.
Collapse
Affiliation(s)
- Su-Boon Yong
- Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
| | | | | | | |
Collapse
|
27
|
Abstract
This review highlights the progress made in food allergy (FA) and anaphylaxis research in pediatrics published in the journal Pediatric Allergy and Immunology since 2010. Putative risk factors for FA are as follows: a family history of allergic disease, particularly in the mother, low birth order, season of birth, and severe atopic eczema. Obstetric practices, antibiotic use, and home environment are factors deserving further research. Diagnostic decision levels and component-specific IgE are useful in the diagnosis of FA; however, oral food challenges remain the gold standard and may also be a means to reduce parental anxiety and to improve education. Oral immunotherapy studies show promise in increasing the threshold of reactivity of allergic patients and therefore improving their quality of life. In single-nut-allergic patients, introduction of other nuts allows broadening the diet and thus reducing the psychological impact of allergen avoidance. Nutritional deficiencies are not uncommon in food-allergic children and should be specifically assessed. The prescription of injectable adrenaline is still insufficient and not consistent among practitioners, requiring improved training and implementation of guidelines. Current research into the epidemiology and immunological mechanisms of FA and tolerance will enable us to devise strategies to both prevent and treat food allergies.
Collapse
Affiliation(s)
- Alexandra F Santos
- Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
| | | |
Collapse
|
28
|
Coit J, Grossman X, Buczek M, Feldman-Winter L, Merewood A. Introducing solid foods: validity of report among mothers who do not adhere to recommended US guidelines. J Hum Lact 2012; 28:490-4. [PMID: 22777763 DOI: 10.1177/0890334412448928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Introducing solids foods to infants before 6 months has been associated with adverse long-term health outcomes. Studies and surveys frequently use maternal report to identify the age when infants start solid foods. OBJECTIVE To address the accuracy of maternal report at 1 year postpartum regarding introduction of solid foods. METHODS Between 2008 and 2009, the authors enrolled mothers of healthy term singletons at an urban Boston hospital within 72 hours of giving birth. We called mothers monthly for 6 months and asked if they had given their baby solid foods in the previous month. At 1 year, we contacted mothers again and asked when they first gave solid foods; answers at 1 year were compared with the data collected monthly. RESULTS The authors analyzed data on 157 women, all of whom had, according to monthly responses, started solid foods before 6 months. At 1 year, only 14% (22/157) of reports matched data recorded monthly. Although 100% of women introduced solids before 6 months, at 1 year, 41.4% reported starting solids at 6 months. CONCLUSIONS Among women who started feeding solids before 6 months, most did not give an accurate response at 1 year. Most said they started giving solids later than they did. Maternal report may not be the best way to collect such data, and health outcomes based on such data may be biased toward the null.
Collapse
Affiliation(s)
- Julia Coit
- Research Assistant, the Breastfeeding Center, Boston Medical Center, Boston, MA, USA
| | | | | | | | | |
Collapse
|
29
|
Infant Feeding Practices and Nut Allergy over Time in Australian School Entrant Children. Int J Pediatr 2012; 2012:675724. [PMID: 22811733 PMCID: PMC3397206 DOI: 10.1155/2012/675724] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/09/2012] [Accepted: 05/17/2012] [Indexed: 11/27/2022] Open
Abstract
Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT) primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2%) and 307 (3.9%), children, respectively. There was a positive association between parent reported nut allergy and breast feeding (OR = 1.53; 1.11–2.11) and having a regular general practitioner (GP) (OR = 1.42; 1.05–1.92). A protective effect was found in children who were fed foods other than breast milk in the first six months (OR = 0.71; 0.60–0.84). Conclusion. Children were at an increased risk of developing a parent-reported nut allergy if they were breast fed in the first six months of life.
Collapse
|
30
|
Development of atopic dermatitis according to age of onset and association with early-life exposures. J Allergy Clin Immunol 2012; 130:130-6.e5. [DOI: 10.1016/j.jaci.2012.02.043] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 01/17/2023]
|
31
|
Skypala I. Adverse Food Reactions—An Emerging Issue for Adults. ACTA ACUST UNITED AC 2011; 111:1877-91. [DOI: 10.1016/j.jada.2011.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/20/2011] [Indexed: 01/03/2023]
|
32
|
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.
Collapse
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.
| | | | | | | | | | | | | |
Collapse
|
33
|
West CE, D'Vaz N, Prescott SL. Dietary immunomodulatory factors in the development of immune tolerance. Curr Allergy Asthma Rep 2011; 11:325-33. [PMID: 21538229 DOI: 10.1007/s11882-011-0200-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Emerging evidence suggests that exposures during pregnancy and the early postnatal period can modify gene expression and disease propensity. Diet is a major environmental exposure, and dietary factors, including polyunsaturated fatty acids, probiotics, oligosaccharides, antioxidants, folate, and other vitamins, have effects on immune function. Some also have been implicated in reduced risk of allergy in observational studies. Intervention trials with polyunsaturated fatty acids, probiotics, and oligosaccharides suggest preliminary but as-of-yet-unconfirmed benefits. Food allergen avoidance during pregnancy, lactation, or infancy has provided no consistent evidence in allergy prevention and is no longer recommended. Rather, there is now a focus on food allergens in tolerance induction. Specific nutrients can induce changes in gene expression during early development and have been implicated in potentially heritable "epigenetic" changes in disease predisposition. Collectively, these observations emphasize that early exposures may modify tolerance development and that further research on these exposures should remain a priority.
Collapse
Affiliation(s)
- Christina E West
- Department of Clinical Sciences, Pediatrics, Umeå University, SE-901 87, Umeå, Sweden.
| | | | | |
Collapse
|
34
|
Abstract
Over the past several decades, the incidence of atopic diseases such as asthma, atopic dermatitis and food allergies has increased dramatically. Although atopic diseases have a clear genetic basis, environmental factors, including early infant nutrition, may have an important influence on their development. Therefore, attempts have been made to reduce the risk of the development of allergy using dietary modifications, mainly focused on longer breast-feeding and delayed introduction or elimination of foods identified as potentially most allergenic. Recently, there is also an increasing interest in the active prevention of atopy using specific dietary components. Many studies have shown that breast-feeding may have the protective effect against future atopic dermatitis and early childhood wheezing. Concerning complementary feeding, there is evidence that the introduction of complementary foods before 4 months of age may increase the risk for atopic dermatitis. However, there is no current convincing evidence that delaying introduction of solids after 6 months of age has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow's milk protein formula or human subject's milk, and this includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs and foods containing peanut protein. In conclusion, as early nutrition may have profound implications for long-term health and atopy later in life, it presents an opportunity to prevent or delay the onset of atopic diseases.
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Diet is arguably one of the most significant environmental exposures during early development. Here, we explore the effects of key perinatal dietary exposures on immune development and susceptibility to allergic disease. RECENT FINDINGS Dietary changes are at the centre of the emerging epigenetic paradigms that underpin the rise in many modern diseases. There is growing evidence that exposures in pregnancy and the early postnatal period can modify gene expression and disease susceptibility. Specific nutrients, including antioxidants, oligosaccharides, polyunsaturated fatty acids, folate and other vitamins, have documented effects on immune function. Some have also been implicated in modified risk of allergic disease in observational studies. Intervention studies are largely limited to trials with polyunsaturated fatty acids and oligosaccharides, showing preliminary but yet unconfirmed benefits in allergy prevention. Avoidance of food allergens in pregnancy, lactation or infancy has provided no clear evidence in allergy prevention and is no longer recommended. Rather there is focus on their role in tolerance induction. SUMMARY Modern dietary changes are clearly implicated in the rising propensity for inflammatory immune responses. These dietary changes, which appear to be providing less tolerogenic conditions during early immune programming, may provide important avenues for preventing disease.
Collapse
|
36
|
Abstract
The relationship between food and atopic dermatitis (AD) is complex. A common misunderstanding is that food allergies have a significant impact on the course of AD, resulting in uncontrolled attempts at elimination diets and undertreatment of the skin itself. Studies have shown that only a small portion of cutaneous reactions to food in the form of late, eczematous eruptions will directly exacerbate AD in young infants who have moderate-to-severe AD. Given the low frequency of food allergies actually inducing flares of AD, the focus should return to appropriate skin therapy, and identification of true food allergies should be reserved for recalcitrant AD in children in whom the suspicion for food allergy is high. A different relationship between food and AD involves delaying or preventing AD in high-risk infants by exclusive breastfeeding during the first 4 months of life. Finally, the skin barrier defect in AD may allow for easier and earlier sensitization of food and airborne allergens; therefore, exposure of food proteins on AD skin may act as a risk factor for development of food allergies.
Collapse
Affiliation(s)
- Ki-Young Suh
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
| |
Collapse
|