Atopy in children with and without a family history of atopy. I. Clinical manifestations, with special reference to diet in infancy

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

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.

Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review

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.

Understanding the evidence for and against the role of breastfeeding in allergy prevention

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.

[Atopic dermatitis and prolonged exclusive breast-feeding]

BACKGROUND

We sought to compare the prevalence of exclusive breastfeeding throughout at least the first 6 months of life in patients presenting atopic dermatitis (AD) with a control group, and to check for a correlation between the duration of exclusive breastfeeding and the severity of AD.

PATIENTS AND METHODS

We conducted a case-control study with prospective inclusion over a period of 3 years. The study group consisted of 114 patients aged less than 15 years, from an urban area, presenting AD but with no personal or family history of atopy. Each patient was compared with two controls from the same town, matched for age and gender, with no personal or family history of atopy, and free of AD. Data analysis was performed using the SPSS software package, version 15.0. A P-value of less than 0.05 was considered as statistically significant.

RESULTS

The prevalence of exclusive breastfeeding for at least the first 6 months of life in the patient group was significantly lower than in the control group (P=0.0413). On the other hand, AD was significantly less severe in patients exclusively breastfed for longer than 9 months (P=0.0079).

CONCLUSION

The correlations recorded in our study do not allow us to draw any definite conclusions about a protective effect of exclusive breastfeeding with regard to AD. However, other benefits of extended exclusive breastfeeding justify supporting breastfeeding in a community with an existing sociocultural predisposition for this feeding method.

Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort

BACKGROUND

  Early onset of allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. This study analyses the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort.

METHODS

  Data on AR-like symptoms (runny nose, blocked nose, sneezing apart from a cold) were collected using a standardized questionnaire administered during the health examination at age 18 months included in the follow-up of the PARIS birth cohort. Parental history of allergy and children's atopy blood markers (blood eosinophilia ≥470 eosinophils/mm(3) , total immunoglobulin E ≥45 U/ml and presence of allergen-specific IgE) were assessed. Associations were studied using multivariate logistic regression models adjusted for potential confounders.

RESULTS

  Prevalence of AR-like symptoms in the past year was 9.1% of the 1850 toddlers of the study cohort. AR-like symptoms and dry cough apart from a cold were frequent comorbid conditions. Parental history of AR in both parents increased the risk of suffering from AR-like symptoms with an OR 2.09 (P=0.036). Significant associations were found with the presence of concurrent biological markers of atopy, especially blood eosinophilia and sensitization to house dust mite (OR 1.54, P=0.046 and OR 2.91, P=0.042) whereas there was no relation with sensitization to food.

CONCLUSIONS

  These results support the hypothesis that AR could begin as early as 18 months of life. Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens.

What are the risks associated with formula feeding? A re-analysis and review

BACKGROUND

Most infant feeding studies present infant formula use as "standard" practice, supporting perceptions of formula feeding as normative and hindering translation of current research into counseling messages supportive of exclusive breastfeeding. To promote optimal counseling, and to challenge researchers to use exclusive breastfeeding as the standard, we have reviewed the scientific literature on exclusive breastfeeding and converted reported odds ratios to allow discussion of the "risks" of any formula use.

METHODS

Studies indexed in PubMed that investigated the association between exclusive breastfeeding and otitis media, asthma, types 1 and 2 diabetes, atopic dermatitis, and infant hospitalization secondary to lower respiratory tract diseases were reviewed. Findings were reconstructed with exclusive breastfeeding as the standard, and levels of significance calculated.

RESULTS

When exclusive breastfeeding is set as the normative standard, the re-calculated odds ratios communicate the risks of any formula use. For example, any formula use in the first 6 months is significantly associated with increased incidence of otitis media (OR: 1.78, 95% CI: 1.19, 2.70 and OR: 4.55, 95% CI: 1.64, 12.50 in the available studies; pooled OR for any formula in the first 3 mo: 2.00, 95% CI: 1.40, 2.78). Only shorter durations of exclusive breastfeeding are available to use as standards for calculating the effect of "any formula use" for type 1 diabetes, asthma, atopic dermatitis, and hospitalization secondary to lower respiratory tract infections.

CONCLUSIONS

Exclusive breastfeeding is an optimal practice, compared with which other infant feeding practices carry risks. Further studies on the influence of presenting exclusive breastfeeding as the standard in research studies and counseling messages are recommended.

Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Breastfeeding is undisputedly preferable to formula feeding for infant nutrition because of its nutritional, immunological and psychological benefits. However, studies on the association between breastfeeding and development of atopic dermatitis (AD) have shown inconsistent results.

OBJECTIVES

To examine the association between exclusive breastfeeding for at least 3 months after birth and the development of AD in childhood.

METHODS

An electronic literature search of MEDLINE (January 1966-May 2008) and EMBASE (1980-May 2008) was conducted. Prospective cohort studies that met the predetermined criteria were independently assessed by three reviewers. The pooled effect estimate was calculated by random effects model. Heterogeneity across the studies was investigated by meta-regression analysis.

RESULTS

Twenty-one studies with 27 study populations were included for meta-analysis. The summary odds ratio (OR) for the effect of exclusive breastfeeding on the risk of AD was 0.89 (95% confidence interval, CI 0.76-1.04). Heterogeneity was found across the studies (chi(2) = 83.6, d.f. = 26; P < 0.001). Breastfeeding was associated with a decreased risk of AD (OR 0.70; 95% CI 0.50-0.99) when analysis was restricted to the studies comparing breastfeeding with conventional formula feeding. The pooled OR for study populations with atopic heredity was 0.78 (95% CI 0.58-1.05).

CONCLUSIONS

There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.

Inverse association between periodontitis and respiratory allergies

BACKGROUND

Periodontitis is an infection with systemic effects and a high prevalence among adults. In the aetiology of allergic diseases the hygiene hypothesis claims that infections in early infancy may protect against allergic diseases.

OBJECTIVE

The aim of the present analyses was to investigate the independent relation between periodontitis and respiratory allergies such as hayfever, house dust mite (HDM) allergy and asthma.

METHODS

From the Study of Health in Pomerania (SHIP) a total number of 2837 subjects aged 20 to 59 years were included in the analysis. In our study population 326, 111 and 114 subjects were classified as suffering from hayfever, HDM allergy or asthma, respectively. The attachment loss (AL) were measured. Periodontitis was defined according to the percentage of surfaces which exceeded 3 mm AL [healthy: 0-7.7%, mild: 7.8-28.6%, moderate: 28.7-63.9%, severe: >63.9%]. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression.

RESULTS

After adjustment for confounding factors these analyses revealed inverse associations between periodontitis and hayfever as well as periodontitis and HDM allergy. For increasing AL, a trend of decreasing risk could be observed for hayfever (healthy: reference; mild AL: OR 0.87 [95%-CI 0.6-1.2]; moderate AL: OR 0.80 [95% CI 0.6-1.2]; server AL: OR 0.53 [95% CI 0.3-0.9]; P(trend)=0.01) and for HDM allergy (healthy: reference; mild AL: OR 0.80 [95% CI 0.5-1.3]; moderate AL: OR 0.64 [95% CI 0.3-1.2]; server AL: OR 0.39 [95% CI 0.2-0.9]; P(trend)=0.02). Furthermore, for asthma were observed a slightly inverse association in the full-adjusted model (healthy: reference; mild AL: OR 1.10 [95% CI 0.6-2.0]; moderate AL: OR 0.96 [95% CI 0.5-1.8]; server AL: OR 0.48 [95% CI 0.2-1.0]; P(trend)=0.11).

CONCLUSION

There is an inverse association between periodontitis and respiratory allergies. Our results might support the hygiene hypothesis.

Exclusive breastfeeding and risk of atopic dermatitis in some 8300 infants

Earlier studies on breastfeeding and atopy in infants have yielded contradictory results. We examined the relationship between exclusive breastfeeding and atopic dermatitis (AD) in a cohort of infants born between 1 October 1997 and 1 October 1999 in south-east Sweden. We evaluated the risk of AD 'at least once' or 'at least three times' during the first year of life in relation to duration of exclusive breastfeeding: <4 months (short exclusive breastfeeding; SEBF) vs. > or = 4 months. All data were obtained through questionnaires. Of 8346 infants with breastfeeding data, 1943 (23.3%) had suffered from AD during the first year of life. Duration of exclusive breastfeeding was not associated with lower risk of AD (p = 0.868). SEBF did not influence the risk of any AD (OR = 1.03; 95% CI OR = 0.91-1.17; p = 0.614) or AD at least three times (OR = 0.97; 95% CI OR = 0.81-1.16; p = 0.755) during the first year of life. Adjustment for confounders did not change these point estimates. Neither was there any link between SEBF and risk of AD among infants with a family history of atopy [adjusted odds ratio (AOR) = 1.16; 95% CI AOR = 0.90-1.48; p = 0.254]. Furred pets at home were linked to a lower risk of AD both among infants with a family history of atopy (AOR = 0.76; 95% CI AOR = 0.60-0.96; p = 0.021) and among infants with no such history (AOR = 0.79; 95% CI AOR = 0.69-0.90; p < 0.001). Infants with no family history of atopy were less prone to develop AD if parents smoked (AOR = 0.76; 95% CI AOR = 0.61-0.95; p = 0.016). This study indicates that exclusive breastfeeding does not influence the risk of AD during the first year of life, while presence of furred pets at home seems to be negatively associated with AD.

Rhinitis (allergic and nonallergic) in an atopic pediatric referral population in the grasslands of inland South Africa

BACKGROUND

Allergic rhinitis is a common condition, which causes considerable morbidity. South African data are scarce.

OBJECTIVE

We sought to describe allergic rhinitis in atopic children in inland South Africa.

METHODS

An observational, descriptive study of rhinitis occurring in 771 new patients seen consecutively by a single observer at a referral pediatric allergy clinic (Universitas Hospital, Bloemfontein) over an 8 1/2-year period (August 1984 to March 1993) was carried out. A detailed questionnaire was used to record clinical data. Chest and sinus x-rays, skin prick testing, and radioallergosorbent test were performed, and serum immunoglobulin E levels were determined. Response to drug treatment regimens was recorded at subsequent followup visits.

RESULTS

Significant rhinitis was reported in 78.1% of patients, and mild intermittent rhinitis was reported in 21.4%. Male to female ratio was 1.6:1. Median age at onset of rhinitis symptoms was 6 months (range 0 months to 12 years), with 30.1% experiencing symptoms from birth. Rhinitis was chronic in 61.3%, although 53.5% reported seasonal variation. More children with rhinitis were born in midsummer than during other seasons, although this did not reach statistical significance (P = 0.46). Breast-feeding had no protective effect, and parental smoking and household pets were not found to be risk factors. Family history was positive for allergic rhinitis in 88% of patients. Exposure to dust, weather changes, strong odors, pets, pollens, and tobacco smoke were the most common trigger factors. Sinus x-ray findings associated poorly with clinical findings. The most common allergens identified were grass pollen, tree pollen, and cat. Oral antihistamines provided good symptomatic relief in 62.9% of patients who used them. Intranasal corticosteroids provided good relief in 78.0% of those who used them, and ketotifen provided relief in 54.4% of those who used it.

CONCLUSIONS

Rhinitis is a common manifestation of allergy in the population studied. Onset occurs early in childhood. A family history of allergy is a risk factor for the development of the condition, and grass pollen is the most common allergen involved. Special investigations are of limited value. Appropriate treatment is very effective.

Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies

BACKGROUND

Despite the numerous studies on the possible protective effect of breast-feeding against the onset of atopic dermatitis during childhood, this issue remains controversial.

OBJECTIVE

We conducted a systematic review with meta-analysis of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and atopic dermatitis.

METHODS

A comprehensive search of the 1966-2000 MEDLINE database and review of the reference lists of relevant articles identified 18 prospective studies that met the predefined inclusion criteria. By means of a standardized approach, 2 of the investigators independently assessed the methodologic quality of the studies, duration and exclusivity of breast-feeding, outcome measures, and control for potential confounding factors. The same approach was applied during data abstraction and evaluation of the estimates of association. Summary measures of association were then calculated.

RESULTS

The summary odds ratio (OR) for the protective effect of breast-feeding in the studies analyzed was 0.68 (95% confidence interval [CI], 0.52-0.88). This effect estimate was higher in the group of studies wherein children with a family history of atopy were investigated separately (OR = 0.58; CI, 0.41-0.92) than in those of combined populations (OR = 0.84; CI, 0.59-1.19). A small subset of studies of children without a history of atopy in first-degree relatives showed no association between breast-feeding and the onset of atopic dermatitis (OR = 1.43; CI, 0.72-2.86).

CONCLUSION

Exclusive breast-feeding during the first 3 months of life is associated with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy. This effect is lessened in the general population and negligible in children without first-order atopic relatives. Breast-feeding should be strongly recommended to mothers of infants with a family history of atopy, as a possible means of preventing atopic eczema.

Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years' follow-up

A prospective case-control study is presented to assess an allergy prevention programme in children up to 36 months of age. Infants born at three maternity hospitals were followed from birth: 279 infants with high atopic risk (intervention group) were compared with 80 infants with similar atopic risk but no intervention (non-intervention group). The intervention programme included dietary measures (exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet) and environmental measures (avoidance of parental smoking in the presence of the babies, day care > 2 years of life). Mothers in this group who had insufficient breast milk were randomly assigned to one of two coded formulas: either a hydrolysed milk formula (Nidina HA, Nestlé) or a conventional adapted formula (Nan, Nestlé). Other environmental measures remained the same as for the breastfeeding mothers. The non-intervention group were either breastfed or received the usual Italian milk feeding and weaning diet, without environmental advice. The main outcome measures were anthropometric measurements and allergic disease manifestations. Normal anthropometric data were observed both in the intervention group and in the non-intervention group. The incidence of allergic manifestations was much lower in the intervention group than in the non-intervention group at 1 year (11.5 versus 54.4%, respectively) and at 2 years (14.9 versus 65.6%) and 3 years (20.6 versus 74.1%). Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non-intervention group from birth up to the second year of life, while urticaria and gastrointestinal disorders were only present in the non-intervention group in the first year of life. Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non-intervention group. Relapse of the same allergic symptom was less in the intervention group (13.0%) than in the non-intervention group (36.9%). In comparison to the non-intervention group, there were fewer intervention group cases with two or more different allergic symptoms (8.7 versus 32.6%), and they were more likely to avoid steroid treatment (0 versus 10.8%) and hospital admission (0 versus 6.5%). Babies in the non-intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group. In the intervention group the breastfed infants had the lowest incidence of allergic symptoms, followed by the infants fed the hydrolysed formula (ns). Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants, although less than their counterparts in the non-intervention group. Of the affected subjects in the intervention group, 80.4% were RAST and/or Prick positive to food or inhalant allergens. Total serum IgE values detected at birth in the intervention group were not predictive, but at 1 and 2 years of age, IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy. In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups. Of the various factors tested in the non-intervention group, the following were the most important in the pathogenesis of allergic symptoms: (i) formula implementation begun in the first week of life; (ii) early weaning (< 4 months); (iii) feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6 months); and (v) parental smoking in the presence of the babies and early day care admission (< 2 years of life). All the preventive measures used in this study (exclusive breastfeeding and/or hydrolysed milk feeding, delayed and selective introduction of solid foods, and environmental advice) were effective at the third year of follow-up, greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions

Bronchial asthma after early childhood wheezing: a follow-up until 4.5-6 years of age

Over a period of 12 months from 1981 to 1982, 83 patients aged less than 2 years were treated in hospital for acute bronchiolitis. The children were followed-up prospectively; 68 (83%) completed the study until 4.5-6.0 years of age. At this age, 17 (25%) of the 68 children with bronchiolitis still suffered from wheezing attacks. These 17 asthmatics suffered from both atopic dermatitis (29 versus 6%) and allergic rhinitis (29 versus 8%) more frequently than non-asthmatic children. In contrast, positive results in the skin prick tests were almost equally common (29 and 20%) in asthmatic and non-asthmatic children. In these tests, allergies to birch pollen, timothy grass pollen and house dust mite were most common; asthma was particularly associated with house dust mite allergy. The presence of atopic dermatitis, elevated immunoglobulin E values and repeated wheezing episodes between 1 and 2 years of age were significant risk factors for later asthma. In conclusion, the risk for later asthma is increased after early childhood bronchiolitis; the frequency of asthma was 25% in the present study. Our results confirm that atopics are at a greater risk of developing asthma later in childhood than non-atopics; the risk was significant from 1 year of age onwards.

Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. A prospective study of 159 "high-risk" infants

A total of 105 "high-risk" infants born in 1988 were studied prospectively from birth to 18 months of age. The infants were recommended breastfeeding and/or hypoallergenic formula (Nutramigen or Profylac) combined with avoidance of solid foods during the first 6 months of life. All mothers had unrestricted diet. Avoidance of daily exposure to tobacco smoke, furred pets and dust-collecting materials in the bedroom were advised. This prevention group was compared with a control group consisting of 54 identically defined "high-risk" infants born in 1985 in the same area. All infants had either severe single atopic predisposition combined with cord blood IgE > or = 0.5 KU/l or biparental atopic predisposition. The control group had unrestricted diet and was not advised about environmental factors. Apart from the prevention programme and year of birth the prevention group and the control group were comparable. The parents were highly motivated and compliance was good. The rate of participation was 97%, and 85% followed the dietary measures strictly. The cumulative prevalence of atopic symptoms was significantly lower at 18 months in the prevention group (32%), as compared with the control group (74%) (p < 0.01), due to reduced prevalence of recurrent wheezing (13% versus 37%; p < 0.01), atopic dermatitis (14% versus 31%; p < 0.01), vomiting/diarrhoea (5% versus 20%; p < 0.01) and infantile colic (9% versus 24%; p < 0.01). The cumulative prevalence of food allergy was significantly lower in the prevention group (6% versus 17%; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Diet in infancy and bronchial hyperreactivity later in childhood

Sixty-seven atopy-prone children (atopic family group, AFG) and 52 children with no family history of atopy (NAFG) were followed for 10 years. During infancy, the mothers of the newborn AFG children were advised to adjust their infants' diet, with a view toward minimizing the risk of atopy, and not to keep pets. Pulmonary function tests, methacholine inhalation challenge (MIC), and skin prick tests (SPT) were done in order to evaluate the bronchial reactivity and skin reactivity in the two groups. A pathological result in MIC was found in 20 (30%) of the AFG children and in 10 (19%) of the NAFG children. Such results of MIC were more common in the children with positive SPT results than in those without (67% vs. 24%). In regard to the diet consumed in infancy, MIC was pathological in 23% of children with and in 36% without prophylactic diet in infancy. For MIC, using the new, Spira electro 2 dosimeter equipment, the sensitivity was 75% and specificity 97%, but the predictive value for diagnosing bronchial asthma was only 25%. The important advantage of our method is that the degree of bronchial reactivity can be estimated by responses to increasing provocative doses. Our observations confirm that the new method is suitable for detecting bronchial asthma in clinical practice but it seems not to be optimal for epidemiological studies. We concluded that later bronchial hyperreactivity can not be diminished by avoiding home pets or providing a hypoallergenic diet during infancy.

Allergic symptoms up to 4-6 years of age in children given cow milk neonatally. A prospective study

In a previously published prospective study, we followed the development of allergic symptoms in term infants with a slightly reduced birthweight (-1 SD to -2 SD). These children received, according to local routine, early feeding with cow milk formula in order to diminish such neonatal problems as hypoglycemia and hyperbilirubinemia. Of 216 infants 207 were observed for allergic symptoms up to 18 months of age. One group (F) received cow milk formula during the first days of life before the mother's breastmilk production started and was then breastfed; the other (B) was not given any formula before normal breastfeeding started. Unexpectedly, we found fewer allergic symptoms, in particular allergic skin problems, in the group fed cow milk, the difference being concentrated to children with a family history of allergic symptoms. At 5 years of age 183 of the 207 children have been reinvestigated. Mild symptoms of allergy (suspected and obvious) were found in 22% (F) and 27% (B) respectively (NS). Moderate and severe symptoms of allergy (obvious) were found in 4.2% (F) and 4.5% (B). In the subgroup with a double family history of allergic symptoms, 28% (7/25, F) and 59% (10/17, B) had symptoms of allergy (p less than 0.05). This difference was even more pronounced when laboratory tests in favour of atopic diagnosis were included, 14% (F) and 53% (B) respectively (p less than 0.05). Thus at 5 years we still find a significantly lower frequency of allergic symptoms in the subgroup fed cow milk formula early with a family history of allergic symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)