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Ding Y, Zhu C, Li S, Liu N, Liu Q, Li W, Zhao C, Yuan B. Breastfeeding and risk of food allergy and allergic rhinitis in offspring: a systematic review and meta-analysis of cohort studies. Eur J Pediatr 2024; 183:3433-3443. [PMID: 38771371 PMCID: PMC11263247 DOI: 10.1007/s00431-024-05580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024]
Abstract
The association between breastfeeding and the occurrence of allergic rhinitis (AR) and food allergy (FA) in offspring remains inconclusive. This review aims to comprehensively explore the potential relationships between various patterns and durations of breastfeeding and allergic diseases in offspring. We systematically searched PubMed, EMBASE, Cochrane, WOS databases, and Google Scholar for observational studies published up to March 30, 2023, that investigated the link between breastfeeding and allergies in offspring. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI). Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated employing an appropriate model based on the degree of heterogeneity. A total of 68 studies, encompassing 772,142 children, were ultimately included. The findings indicated that breastfeeding for more than 6 months was associated with a reduced risk of AR (OR = 0.88, 95% CI: 0.79 to 0.98) but posed a risk for FA (OR = 1.69, 95% CI: 1.27 to 2.25). Exclusive breastfeeding exhibited a protective effect against AR (OR = 0.94, 95% CI: 0.90 to 0.97), whereas non-breastfeeding was identified as a risk factor for AR (OR = 1.48; 95% CI: 1.03 to 2.12). No significant association was observed between breastfeeding patterns and FA. CONCLUSION Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, large prospective high-quality studies are needed to investigate the potential risk of FA in children with prolonged breastfeeding. WHAT IS KNOWN • The impact of breastfeeding on allergic rhinitis and food allergy in offspring is controversial. • Previous meta-analyses fail to prove the effect of breastfeeding on food allergy in offspring of all ages. WHAT IS NEW • Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, it potentially elevates the risk of FA in children. Non-breastfeeding is linked to an increased risk of AR in children, but there is no evidence of an association between breastfeeding patterns and FA in children. • The impact of breastfeeding on allergic rhinitis and food allergy in offspring may vary with the time and pattern of breastfeeding.
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Affiliation(s)
- Yali Ding
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
- Nanjing Gaochun Traditional Chinese Medicine Hospital, Nanjing Jiangsu, 211300, China
| | - Chengbi Zhu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
| | - Shuo Li
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
| | - Naixu Liu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
| | - Qian Liu
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
| | - Weifeng Li
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China
- Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210023, China
| | - Changjiang Zhao
- Department of Pediatrics, Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangyin Jiangsu, 214400, China.
| | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210004, China.
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Cronin C, Salzberg N, Woon Y, Wurttele JT. Primary, secondary and tertiary prevention of food allergy: current practices and future directions. Allergol Immunopathol (Madr) 2024; 52:32-44. [PMID: 38459888 DOI: 10.15586/aei.v52i2.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/27/2023] [Indexed: 03/11/2024]
Abstract
The incidence of food allergies has risen around the globe, and experts have been exploring methods of preventing such allergies in young children to ease the burden of disease and reduce the morbidity and mortality caused by anaphylaxis to food allergens. Such preventative measures can be categorised as primary, secondary and tertiary prevention, which are discussed in detail in this review. Primary prevention is defined as the prevention of becoming sensitised towards specific allergens. The evidence suggests that avoiding common allergenic foods during pregnancy and breastfeeding is not protective against food allergies, and guidelines recommend weaning from 4 to 6 months of age, with recent studies supporting the early introduction of peanuts at 4 months to prevent peanut allergy. Secondary prevention targets patients who are already sensitised and aims to halt the progression of sensitisation, with evidence for high rates of success and safety in trials of early introduction to milk and peanuts using oral immunotherapy in sensitised infants. Tertiary allergy prevention focuses on reducing the risk of a patient having anaphylaxis, with oral immunotherapy being the most common method of promoting tolerance in allergic children. Several studies have demonstrated successful reintroduction for milk, egg and peanut; however, no such guidelines are recommended for other foods. Finally, dietary advancement therapy in the form of milk and egg ladders has been employed as a method of primary, secondary and tertiary prevention of allergies, particularly in Ireland, the UK and Canada.
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Affiliation(s)
- Caoimhe Cronin
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
- Cork University Hospital, Irish Centre for Maternal and Child Health Research (INFANT), HRB Clinical Research Facility Cork (CRF-C), Cork, Ireland
| | - Noah Salzberg
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Yuxin Woon
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Juan Trujillo Wurttele
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
- Cork University Hospital, Irish Centre for Maternal and Child Health Research (INFANT), HRB Clinical Research Facility Cork (CRF-C), Cork, Ireland;
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Peddi NC, Muppalla SK, Sreenivasulu H, Vuppalapati S, Komuravelli M, Navab R. Navigating Food Allergies: Advances in Diagnosis and Treatment Strategies. Cureus 2024; 16:e56823. [PMID: 38654770 PMCID: PMC11037442 DOI: 10.7759/cureus.56823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Food allergy is a major health concern worldwide, encompassing both immunologic and non-immunologic reactions. This review thoroughly examines the pathophysiology, clinical manifestations, and treatment options for various types of food allergies. Immunologic food allergies, including IgE-mediated reactions such as oral allergy syndrome and systemic anaphylaxis, pose various diagnostic and management challenges. Non-IgE-mediated reactions such as food protein-induced enterocolitis syndrome, dermatitis herpetiformis, and proctocolitis necessitate individualized patient care. In addition, mixed reactions such as eosinophilic esophagitis and atopic dermatitis complicate the clinical picture. Skin prick tests, serum-specific IgE tests, and oral food challenges are all necessary for accurate food allergy diagnosis. The primary therapeutic options are allergen avoidance, epinephrine-based emergency management, and emerging treatments like immunotherapy. Our review emphasizes the importance of multidisciplinary collaboration and ongoing research in improving our understanding and managing food allergies, promising a brighter future for those affected.
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Affiliation(s)
| | | | | | - Sravya Vuppalapati
- General Physician, PES Institute of Medical Sciences and Research, Kuppam, IND
| | - Myna Komuravelli
- Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Hanamkonda, IND
| | - Rahul Navab
- Internal Medicine, PES Institute of Medical Sciences and Research, Kuppam, IND
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Kou R, Wang J, Li A, Wang Y, Fan D, Zhang B, Fu W, Liu J, Fu H, Wang S. 2'-Fucosyllactose alleviates OVA-induced food allergy in mice by ameliorating intestinal microecology and regulating the imbalance of Th2/Th1 proportion. Food Funct 2023; 14:10924-10940. [PMID: 38009336 DOI: 10.1039/d3fo03272h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Food allergy (FA) has become a prominent problem in public health. 2'-Fucosyllactose (2'-FL) was reported to alleviate FA symptoms; however, the regulatory mechanism is still unclear. This study evaluated the 2'-FL antiallergic potential in an ovalbumin (OVA)-sensitized mouse model and explored the systemic effects of 2'-FL on gut microecology and the intestinal immune barrier. The results showed that 2'-FL alleviated allergy symptoms, decreased serum allergic indicator levels, enhanced the intestinal barrier, and attenuated low-grade inflammation. The up-regulation of G protein-coupled receptors (GPRs) was associated with higher levels of short-chain fatty acids (SCFAs) in 2'-FL intervention mice. 2'-FL also improved the intestinal microbiota diversity and increased the abundance of Akkermansia, Lachnospiraceae UCG-006, and Ruminococcaceae while suppressing Muribaculaceae, Desulfovibrionaceae, and Erysipelotrichaceae. Additionally, 2'-FL ameliorated the imbalance of Th2/Th1, mainly by decreasing Th2-type immune response and enhanced CD4 + Foxp3 + Treg immunoreaction. These results suggest that 2'-FL restores intestinal barrier defects, gut microbiota disorder, and immune impairment while alleviating ovalbumin-induced allergic symptoms in FA mice.
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Affiliation(s)
- Ruixin Kou
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Jin Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Ang Li
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Yuanyifei Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Dancai Fan
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Bowei Zhang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Wenhui Fu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Jingmin Liu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Hanyue Fu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
| | - Shuo Wang
- Tianjin Key Laboratory of Food Science and Health, School of Medicine, Nankai University, Tianjin 300071, China.
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5
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Su KW, Yan DC, Ou LS, Lin LL, Wu CY, Huang SJ, Yao TC, Yeh KW, Huang JL. Rising prevalence of food allergies in Taiwan: An epidemiological study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:863-870. [PMID: 37169610 DOI: 10.1016/j.jmii.2023.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 03/12/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Food allergies are becoming more prevalent globally. The purpose of this study was to investigate the epidemiology of food allergies in Taiwan. METHODS In 2017, a food allergy questionnaire was administered to 6-7-year-old children, 13-14-year-old adolescents, and their parents in Taipei. The results were compared to those from a previous survey conducted in 2004. RESULTS A total of 16,200 questionnaires were completed, revealing a rise in the prevalence of food allergies from 7.7% to 10.4% in the pediatric group and from 6.4% to 12.5% in the adult group. Peanut allergies also increased to 1.1%. Shrimp and crabs were the most common allergens, with urticaria being the most common symptom. Shortness of breath or wheezing occurred in 10% of individuals, while 2.1% experienced syncope or shock, and 0.1% were admitted to an intensive care unit. Personal history of allergic rhinitis and atopic dermatitis, as well as family histories of food allergies, were risk factors for food allergy in 6-7-year-old children. In the 13-14-year-old group, personal history of asthma, allergic rhinitis, or atopic dermatitis, recent use of acetaminophen, and living with dogs were risk factors. Females, personal histories of asthma, allergic rhinitis, atopic dermatitis, and moist and damp at home were risk factors in adults. Breastfeeding was a protective factor in 6-7-year-old children. CONCLUSION The increasing prevalence of food allergies, including peanut allergies, in Taiwan warrants attention from physicians to provide appropriate care and education to patients with food allergies. The protective effect of breastfeeding against food allergies shall be emphasized.
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Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Dah-Chin Yan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Liang-Shiou Ou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Lun Lin
- Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chao-Yi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Jung Huang
- Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
| | - Tsung-Chieh Yao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Jing-Long Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan.
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Switkowski KM, Oken E, Rifas-Shiman SL, Camargo CA, Gold DR, Sordillo JE, Lightdale JR. Timing of Cow's Milk Protein Introduction and Childhood Adverse Reactions to Cow's Milk. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2713-2721.e2. [PMID: 35779778 PMCID: PMC10846592 DOI: 10.1016/j.jaip.2022.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current guidelines emphasize early introduction to potentially allergenic foods, but the optimal timing, amount, and exposure routes for foods other than peanut are not well-established. Cow's milk is often the first allergenic food introduced through infant formulas. OBJECTIVE To examine timing of cow's milk protein introduction (CMPI), including interaction with formula supplementation after delivery, in relation to reported cow's milk adverse reactions throughout childhood. METHODS Among children in the Boston, Mass-area Project Viva cohort, we assessed timing of CMPI (<2 weeks, 2 weeks-<6 months, ≥6 months) with questionnaires administered in infancy. Outcomes were (1) parent-reported cow's milk adverse reactions via annual questionnaires from age 2 to 13 years (n = 1298) and (2) milk sensitization (n = 505) and IgE-mediated milk allergy (n = 491) at age approximately 8 years. We used multivariable logistic regression models adjusted for parental atopy history, delivery mode, gestational age at delivery, child race, and census tract median household income, and investigated effect modification by ever/never breast-fed status and formula supplementation in the delivery hospital. RESULTS A total of 32% were introduced to cow's milk protein at age less than 2 weeks, 38% at age 2 weeks to less than 6 months, and 30% at age 6 months or more. Compared with children with CMPI at age less than 2 weeks, children with CMPI at age 6 months or more had a higher risk of cow's milk adverse reaction at age 2 to 5 years (odds ratio, 2.4 [1.2-4.7]). Children given formula after delivery + CMPI at age less than 2 weeks had the lowest risk overall. Among children not given formula after delivery, CMPI at age 2 weeks to 6 months appeared most protective. Results were similar among ever-breast-fed children. Timing of CMPI was not associated with milk sensitization or IgE-mediated milk allergy in mid-childhood. CONCLUSIONS Early, consistent cow's milk exposure appears protective against adverse reactions to cow's milk.
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Affiliation(s)
- Karen M Switkowski
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Carlos A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Jenifer R Lightdale
- Division of Gastroenterology/Nutrition, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass; Pediatric Gastroenterology, UMass Memorial Medical Center, Worcester, Mass
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Tang CM, Lin G, Chiang MH, Yeh KW, Huang JL, Su KW, Tsai MH, Hua MC, Liao SL, Lai SH, Chiu CY. Longitudinal Metabolomic Analysis Reveals Gut Microbial-Derived Metabolites Related to Formula Feeding and Milk Sensitization Development in Infancy. Metabolites 2022; 12:metabo12020127. [PMID: 35208202 PMCID: PMC8877196 DOI: 10.3390/metabo12020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Early exposure to formula milk increases the likelihood of cow’s milk sensitization and food allergies in the later childhood. However, the underlying mechanisms are multifactorial and unclear. Fifty-five children from a follow-up birth cohort study were grouped into exclusive breastfeeding (EBF, n = 33) and formula feeding (EFF, n = 22) in the first six months of life. Urinary metabolites were longitudinally assessed and analyzed at 6 months, 1, and 2 years of age using 1H-nuclear magnetic resonance (NMR) spectroscopy. Integrated analysis of metabolic profiling associated with formula feeding and milk sensitization related to IgE reactions was also investigated. Twenty-two metabolites were significantly obtained in the EFF set at age 0.5, whereas nine metabolites were predominantly obtained in the milk sensitization set at age 1. A subsequent analysis of metabolic change from 6 months to age 1 identified eight metabolites, including 3-methyl-2-oxovaleric acid, glutarate, lysine, N-phenylacetylglycine, N,N-dimethylglycine, 3-indoxysulfate, 2-oxoglutaric acid, and pantothenate associated with formula feeding and milk sensitization with same trend variation. Among them, 3-indoxysulfate, N-phenylacetylglycine, and N,N-dimethylglycine were gut microbial-derived without IgE association. By contrast, 3-methyl-2-oxovaleric acid, glutarate, and lysine were IgE related associated with formula feeding contributing to milk sensitization (p < 0.05). Longitudinal urinary metabolomic analysis provides molecular insight into the mechanism of formula feeding associated with milk sensitization. Gut microbial-derived metabolites associated with formula feeding and IgE associated metabolites related to branched-chain amino acid metabolism play roles in developing sensitization and allergic symptoms in response to formula feeding.
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Affiliation(s)
- Ching-Min Tang
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan; (C.-M.T.); (K.-W.Y.); (S.-H.L.)
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan;
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
| | - Meng-Han Chiang
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan; (C.-M.T.); (K.-W.Y.); (S.-H.L.)
| | - Jing-Long Huang
- Department of Pediatrics, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuan-Wen Su
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.S.); (M.-H.T.); (M.-C.H.); (S.-L.L.)
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.S.); (M.-H.T.); (M.-C.H.); (S.-L.L.)
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.S.); (M.-H.T.); (M.-C.H.); (S.-L.L.)
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan; (K.-W.S.); (M.-H.T.); (M.-C.H.); (S.-L.L.)
| | - Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan; (C.-M.T.); (K.-W.Y.); (S.-H.L.)
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan; (C.-M.T.); (K.-W.Y.); (S.-H.L.)
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- Correspondence:
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8
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Su KW, Chiu CY, Tsai MH, Liao SL, Chen LC, Hua MC, Yao TC, Huang JL, Yeh KW. Cord blood soluble Fas ligand linked to allergic rhinitis and lung function in seven-year-old children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:300-306. [PMID: 33879403 DOI: 10.1016/j.jmii.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Serum or cord blood soluble Fas ligand (FasL) has been related to asthma, allergic rhinitis, and atopic dermatitis in cross-sectional and short-term follow-up studies. However, the association of cord blood soluble FasL with long-term allergic outcomes has seldom been investigated. METHODS The Prediction of Allergies in Taiwanese Children birth cohort study recruited healthy newborns upon delivery. At birth, blood was collected from the umbilical cords of these children, and the cord blood soluble Fas ligand levels were measured. At the age of seven years, the allergic outcome of each child was diagnosed by pediatric allergists and pulmonologists. Tests were conducted to measure the specific immunoglobulin E, fractional exhaled nitric oxide (FeNO), and pulmonary function levels of each child. RESULTS Cord blood soluble FasL levels were higher in seven-year-old children with allergic rhinitis (Odds ratio [OR] = 2.41, p = 0.012) and expiratory airway obstruction (the highest forced expiratory volume in 1 second/forced vital capacity < 90%, OR = 2.11, p = 0.022). The FeNO and Dermatophagoides pteronyssinus-specific immunoglobulin E levels of seven-year-old children were positively correlated with cord blood soluble FasL levels (p = 0.006 and 0.02, respectively). CONCLUSION In this birth cohort, the cord blood soluble FasL levels were associated with allergic rhinitis, obstructive-type lung function, FeNO, and house dust mite sensitization in 7-year-old children. The cord blood soluble FasL level might be used as a predictor for allergic diseases in children who are 7 years old.
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Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Pediatric Pulmonology, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sui-Lin Liao
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Chen Chen
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Maternal awareness to the timing of allergenic food introduction in Saudi infants: A cross-sectional study. Int J Pediatr Adolesc Med 2021; 8:239-245. [PMID: 34401449 PMCID: PMC8356115 DOI: 10.1016/j.ijpam.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
Background Current guidelines recommend the introduction of allergenic foods as early as 4–6 months of age to decrease the risk of food allergy. However, caregivers’ knowledge about such practices and adherence to them is ambiguous. Objectives The purpose of this study was to evaluate the timing of introduction of potentially allergenic foods into children’s diet and the level of maternal awareness about and degree of compliance with current recommendations. Materials and methods We conducted a cross-sectional study from May 2019 to January 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 405 mothers were enrolled in the study. The eligibility criteria included mothers of children between the ages of 12 and 36 months. Results Most mothers in this study had initiated allergenic foods, and the average time of introduction was 9.84 ± 3.16 months for eggs, 14.6 ± 5.78 months for peanuts, and 13.6 ± 5.37 months for fish. Around one-quarter (n = 102, 25.2%) of the children were identified as being in the high-risk group. Most mothers did not know or disagreed that the timing of introducing allergenic foods might help in preventing food allergy, but there was no difference between the risk groups (33.8% and 26.2%, respectively). Moreover, only 18.6% and 13.2% of the high- and low-risk groups, respectively, received correct information from their health care providers (P = .004). Mothers with only one child were less likely to start eggs at an early age (odds ratio [OR] = 0.5 and P = .005). Furthermore, children at a high risk of food allergy were two times more likely to start eggs at an earlier age (OR = 2.12 and P = .003). Conclusion In this study, the allergenic food feeding practices being followed for infants and young children were found to be suboptimal. Parental education level and the number of siblings were identified as potential barriers to the implementation of and adherence to recent guidelines. There is a need for corrective measures to ensure safe and appropriate feeding practices in the Saudi community.
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El-Hodhod MA, El-Shabrawi MHF, AlBadi A, Hussein A, Almehaidib A, Nasrallah B, AlBassam EM, El Feghali H, Isa HM, Al Saraf K, Sokhn M, Adeli M, Al-Sawi NMM, Hage P, Al-Hammadi S. Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: a modified Delphi-based study. World J Pediatr 2021; 17:576-589. [PMID: 34817828 PMCID: PMC8639571 DOI: 10.1007/s12519-021-00476-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to develop an expert consensus regarding the epidemiology, diagnosis, and management of cow's milk protein allergy (CMPA) in the Middle East. METHODS A three-step modified Delphi method was utilized to develop the consensus. Fifteen specialized pediatricians participated in the development of this consensus. Each statement was considered a consensus if it achieved an agreement level of ≥ 80%. RESULTS The experts agreed that the double-blind placebo-controlled oral challenge test (OCT) should be performed for 2-4 weeks using an amino acid formula (AAF) in formula-fed infants or children with suspected CMPA. Formula-fed infants with confirmed CMPA should be offered a therapeutic formula. The panel stated that an extensively hydrolyzed formula (eHF) is indicated in the absence of red flag signs. At the same time, the AAF is offered for infants with red flag signs, such as severe anaphylactic reactions. The panel agreed that infants on an eHF with resolved symptoms within 2-4 weeks should continue the eHF with particular attention to the growth and nutritional status. On the other hand, an AAF should be considered for infants with persistent symptoms; the AAF should be continued if the symptoms resolve within 2-4 weeks, with particular attention to the growth and nutritional status. In cases with no symptomatic improvements after the introduction of an AAF, other measures should be followed. The panel developed a management algorithm, which achieved an agreement level of 90.9%. CONCLUSION This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.
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Affiliation(s)
- Moustafa A. El-Hodhod
- grid.7269.a0000 0004 0621 1570Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.412319.c0000 0004 1765 2101Faculty of Medicine, October 6 University, Giza, Egypt
| | - Mortada H. F. El-Shabrawi
- grid.7776.10000 0004 0639 9286Faculty of Medicine, Cairo University, Cairo, Egypt ,International Pediatric Association (IPA), Marengo, USA ,International Society of Tropical Pediatrics (ISTP), Manila, Philippines
| | | | | | - Ali Almehaidib
- grid.415310.20000 0001 2191 4301Pediatric Gastroenterology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center Riyadh, Riyadh, Saudi Arabia
| | | | - Ebtsam Mohammed AlBassam
- Nutrition Service Department, King Faisal Specialist and Research Center Riyadh, Riyadh, Saudi Arabia
| | | | - Hasan M. Isa
- grid.416646.70000 0004 0621 3322Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain ,grid.411424.60000 0001 0440 9653Pediatric department, Arabian Gulf University, Manama, Bahrain
| | - Khaled Al Saraf
- Pediatrics Department, Dar Al Shifa Hospital, Kuwait, Kuwait
| | - Maroun Sokhn
- grid.33070.370000 0001 2288 0342Pediatric Gastroenterology, Hepatology, and Nutrition Department, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Mehdi Adeli
- grid.467063.00000 0004 0397 4222Sidra Medicine, Doha, Qatar
| | | | - Pierre Hage
- grid.33070.370000 0001 2288 0342Pediatric Pulmonology and Allergology, University of Balamand, Beirut, Lebanon
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, 505055, Dubai, United Arab Emirates.
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11
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Royal C, Gray C. Allergy Prevention: An Overview of Current Evidence. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:689-698. [PMID: 33380931 PMCID: PMC7757062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: There has been a rapid rise in allergic disorders across the globe. This has increased research into the determinants of allergy development, to identify factors that may be manipulated to mitigate risk. An opportune window in immunological development appears to exist in early life whereby certain exposures may promote or prevent the development of an allergic disposition. Furthermore, factors that affect the composition and diversity of the microbiome in early life have been explored. In this review, we discuss current literature and recommendations relating to exposures that may prevent allergy development or promote tolerance. Risk factors and recommendations: Delivery by caesarean section, omission of breastfeeding, vitamin D insufficiency, and environmental exposures, such as cigarette smoke exposure, all increase the risk of an allergic predisposition. Dietary diversity during pregnancy, lactation, and in infancy is protective. Breastfeeding for at least 4 months reduces the risk of eczema. Recommendations for food-allergen exposure has shifted from delayed introduction to early introduction as a tolerance-inducing strategy. Supplements such as probiotics and vitamins during pregnancy and infancy have yet to produce conclusive results for allergy prevention. Emollient use in infancy has not been shown to be protective against eczema or food allergy.
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Affiliation(s)
- Candice Royal
- To whom all correspondence should be addressed:
Candice Royal, Paediatric Allergology, Kidsallergy Paediatric and Allergy
Centre, Cape Town, South Africa;
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12
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Suther C, Moore MD, Beigelman A, Zhou Y. The Gut Microbiome and the Big Eight. Nutrients 2020; 12:nu12123728. [PMID: 33287179 PMCID: PMC7761723 DOI: 10.3390/nu12123728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Food allergies are increasing at an alarming rate, with 6.5% of the general population affected. It has been hypothesized that the increase in allergies stems from the “hygiene hypothesis”. The gut microbiome, a collection of microbiota and their genetic contents from the gastrointestinal tract, has been shown to play a part in the development of food allergies. The Food and Drug Administration requires all regulated food companies to clearly state an inclusion of the major, or “big eight” food allergens on packaging. This review is to provide information on the significant advancements related to the gut microbiome and each of the eight major food allergies individually. Establishment of causal connection between the microbiome and food allergies has uncovered novel mechanisms. New strategies are discussed to prevent future sensitization and reaction through novel treatments involving functional additives and dietary changes that target the microbiome.
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Affiliation(s)
- Cassandra Suther
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; (C.S.); (M.D.M.)
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Matthew D. Moore
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA; (C.S.); (M.D.M.)
| | - Avraham Beigelman
- Kipper Institute of Allergy and Immunology, Schneider Children’s Medical Center, Tel Aviv University, Tel Aviv 5891000, Israel;
| | - Yanjiao Zhou
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
- Correspondence: ; Tel.: +1-860-679-6379
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13
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14
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Huang H, Luo W, Wei N, Liang X, Zheng P, Hu H, Sun B. Distribution characteristics of cow's milk-sIgE components in children with respiratory allergic diseases in southern China. BMC Pediatr 2020; 20:88. [PMID: 32093634 PMCID: PMC7038540 DOI: 10.1186/s12887-020-1971-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/11/2020] [Indexed: 12/27/2022] Open
Abstract
Background Cow’s milk (CM) is the main food allergen for toddlers and infants. Presently, studies on CM specific immunoglobulin E (sIgE) sensitization and positive distribution of CM components ALA-, CAS-, and BLG-sIgE are lacking in infants with respiratory allergic diseases, especially in southern China. This study therefore aimed to investigate the distribution of CM sensitization and the relation between its components α-lactalbumin (ALA), β-lactoglobulin (BLG) and casein (CAS) sIgE in children with respiratory allergic diseases in southern China. Methods A total of 1839 children (≤12 years) with respiratory diseases and detected CM-sIgE levels were included. Serum samples were collected from the Respiratory Diseases Bioresources Center of the National Center for Respiratory Diseases in southern China from August 2012 to July 2017. ALA-, BLG-, and CAS-sIgE were detected and questionnaires were completed in 103 children. Results A total of 36.7% children were positive for CM-sIgE. CM-sIgE levels were higher in asthmatic bronchitis (AB) group than in other allergic respiratory disease groups (all P < 0.05). Among the 103 CM-sIgE-sensitized children, 64.08% had a history of family allergies. There were 84.47% of the children who tested positive for two or more sIgE components. The average ALA-, BLG-, and CAS-sIgE levels were 1.91 kU/L, 1.81 kU/L, and 0.62 kU/L, respectively. The CM-sIgE level showed a correlation with BLG-sIgE (rs = 0.833), ALA-sIgE (rs = 0.816), and CAS-sIgE (rs = 0.573) levels (all p < 0.001). Conclusions In southern China, CM-sIgE levels were higher in children with AB than in those with other respiratory allergic diseases. ALA and BLG were the main allergenic components detected in CM-sIgE-sensitized children with respiratory allergic diseases.
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Affiliation(s)
- Huimin Huang
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Wenting Luo
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Nili Wei
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Xueqing Liang
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Peiyan Zheng
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China
| | - Haisheng Hu
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China.
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, National Clinical Research Center of Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong, China.
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15
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Lai SH, Chiang MC, Chu SM, Hsu JF, Yao TC, Tsai MH, Hua MC, Chiu CY, Yeh KW, Huang JL, Liao SL. Evolution and Determinants of Lung Function until Late Infancy among Infants Born Preterm. Sci Rep 2020; 10:490. [PMID: 31949250 PMCID: PMC6965604 DOI: 10.1038/s41598-019-57359-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/06/2019] [Indexed: 01/08/2023] Open
Abstract
To investigate the evolution of lung function in preterm infants with and without bronchopulmonary dysplasia (BPD) and to determine the perinatal characteristics associated with indexes of lung function in later infancy. Longitudinal lung function assessments were performed at approximately 6, 12, 18, and 24 months of corrected age in preterm infants. Perinatal characteristics were further analyzed to ascertain the determinants of lung function indexes. Although all preterm infants (n = 121; 61 without BPD and 60 with BPD) exhibited decreased lung function in early infancy (6 months of age), after body length was adjusted for, only infants with BPD exhibited poor performance. Furthermore, the lung function of infants with mild to moderate BPD caught up gradually, but the generally poor lung function performance of infants with severe BPD, especially in forced expiratory flow, persisted until later age (24 months). Regarding perinatal characteristics, the z-score of body length at the time of examination and total number of days on positive-pressure ventilation are the major determinants of lung function in later infancy.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Chou Chiang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan.
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan.
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Carucci L, Nocerino R, Paparo L, Di Scala C, Berni Canani R. Dietary Prevention of Atopic March in Pediatric Subjects With Cow's Milk Allergy. Front Pediatr 2020; 8:440. [PMID: 32850553 PMCID: PMC7431922 DOI: 10.3389/fped.2020.00440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
Cow's milk allergy (CMA) is one of the most prevalent food allergies and the most expensive allergic diseases in the pediatric age. There is no cure for CMA, and actual disease management is based on strict avoidance of cow milk protein-containing foods, access to rescue medication, and use of substitutive formulas. Early-life CMA could be one of the first steps of the "allergic march" (AM), leading to the occurrence of other atopic manifestations later in the life, including asthma and oculorhinitis, with subsequent further increase of costs for health care systems and families of affected children. In the last years, diet is emerged as a relevant strategy to prevent allergic diseases through, at least in part, epigenetic modulation of immune system. We provide an overview of studies that investigate the potential role of different dietary strategies in preventing the AM in pediatric patients with CMA.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Carmen Di Scala
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy.,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy.,Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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Davisse-Paturet C, Raherison C, Adel-Patient K, Divaret-Chauveau A, Bois C, Dufourg MN, Lioret S, Charles MA, de Lauzon-Guillain B. Use of partially hydrolysed formula in infancy and incidence of eczema, respiratory symptoms or food allergies in toddlers from the ELFE cohort. Pediatr Allergy Immunol 2019; 30:614-623. [PMID: 31206800 DOI: 10.1111/pai.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/07/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Partially hydrolyzed formulas (pHF) are recommended in non-breastfed infants with familial history of allergy to prevent allergy development. However, recent meta-analysis does not provide strong support for their protective effect. The present work assesses the links between 2-month infant formula use and the incidence of eczema, respiratory symptoms, or food allergies (FA) up to 2 years of age. METHODS The nationwide ELFE birth cohort is a population-based study from mainland France. Infant feeding (breast milk only, partially hydrolyzed formula with [pHF-HA] or without a hypoallergenic label [pHF-non-HA], and non-hydrolyzed formula [Nhf]) was reported at 2 months. Eczema, FA, and respiratory symptoms such as wheezing and asthma were reported at 2 months, 1 year, and 2 years. Infants with prior FA at 2 months were excluded from analyses. RESULTS Among 11 720 infants, those who received only breast milk at 2 months were at lower risk of eczema at 1 year than those who received nHF (OR[95% CI] = 0.78[0.65-0.94] in non-at-risk infants; 0.86[0.75-0.98] in at-risk infants). The use of pHF-HA, compared with nHF, at 2 months was related to higher risk of wheezing at 1 year in at-risk infants (1.68[1.24-2.28]) and higher risk of FA at 2 years both in non-at-risk infants (3.78[1.52-9.41]) and in at-risk infants (2.31[1.36-3.94]). CONCLUSIONS In this nationwide study, pHF-HA use was not associated with a lower risk of any of the studied outcomes. Quite the reverse, it was associated with a higher risk of wheezing and FA. This should be confirmed in further studies.
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Affiliation(s)
- Camille Davisse-Paturet
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France
| | - Chantal Raherison
- Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux University, Bordeaux, France
| | - Karine Adel-Patient
- UMR Service de Pharmacologie et Immunoanalyse, CEA, INRA, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Amandine Divaret-Chauveau
- Unité d'allergologie Pédiatrique, Hôpital d'enfants, CHRU de Nancy, Vandoeuvre les Nancy, France.,EA3450, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Corinne Bois
- Unité Mixte Inserm-Ined-EFS Elfe, INED, Paris, France.,Service Départemental de PMI, Conseil Départemental des Hauts-de-Seine, Nanterre, France
| | | | - Sandrine Lioret
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France
| | - Marie-Aline Charles
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France.,Unité Mixte Inserm-Ined-EFS Elfe, INED, Paris, France
| | - Blandine de Lauzon-Guillain
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France.,INRA, U1125 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France
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Kim H, Sitarik AR, Woodcroft K, Johnson CC, Zoratti E. Birth Mode, Breastfeeding, Pet Exposure, and Antibiotic Use: Associations With the Gut Microbiome and Sensitization in Children. Curr Allergy Asthma Rep 2019; 19:22. [PMID: 30859338 PMCID: PMC7376540 DOI: 10.1007/s11882-019-0851-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The infant gut microbiota has become a focus of multiple epidemiologic and cohort studies. This microbiome is derived from the mother (via the vaginal canal, maternal skin contact, breastfeeding, and possibly in utero microbial transfer) and is likely influenced by multiple external factors. It is now believed by some experts that colonization and formation of the newborn and alterations of gut microbiota in children are dependent on earlier alterations of the microbiota of mothers during or perhaps even before pregnancy. This review will focus on specific factors (pet keeping, breastfeeding, antibiotic use, and mode of delivery) that influence the infant gut microbiome and atopy. RECENT FINDINGS This is a review of recent literature describing how pet keeping, breastfeeding, antibiotic use, and mode of delivery influences and changes the infant gut microbiome and atopy. General trends in gut microbiota differences have emerged in different birth cohorts when each external factor is analyzed, but consistency between studies is difficult to replicate. The aforementioned factors do not seem to confer an overwhelming risk for development of atopy alone. This review provides a comprehensive review of early life environmental factors and their influence on the infant gut microbiome and atopy.
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Affiliation(s)
- Haejin Kim
- Division of Allergy and Clinical Immunology, Henry Ford Health System, WSU School of Medicine, One Ford Place 4B, Detroit, MI, 48202, USA.
| | - Alexandra R Sitarik
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Kimberley Woodcroft
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Edward Zoratti
- Division of Allergy and Clinical Immunology, Henry Ford Health System, WSU School of Medicine, One Ford Place 4B, Detroit, MI, 48202, USA
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Peters RL, Koplin JJ, Dharmage SC, Tang ML, McWilliam VL, Gurrin LC, Neeland MR, Lowe AJ, Ponsonby AL, Allen KJ. Early Exposure to Cow's Milk Protein Is Associated with a Reduced Risk of Cow's Milk Allergic Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:462-470.e1. [DOI: 10.1016/j.jaip.2018.08.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 02/01/2023]
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20
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Liao SL, Tsai MH, Yao TC, Hua MC, Yeh KW, Chiu CY, Su KW, Huang SY, Kao CC, Lai SH, Huang JL. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Sci Rep 2017; 7:9053. [PMID: 28831038 PMCID: PMC5567317 DOI: 10.1038/s41598-017-07894-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022] Open
Abstract
The relationship between cesarean section (CS) and allergic disorders such as asthma and wheezing has been inconsistent, and the mechanisms for their connection remained largely unknown. We aimed to investigate whether CS is associated with infantile wheeze and to explore the connection between CS and several risk factors known to correlate with allergy development. Mononuclear cells were isolated from cord blood and assessed for cytokine responses by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture methods. Infant lung function tests were performed at 6 and 12 months of age. IgE levels and clinical outcomes were assessed at 12 months. The result showed that children delivered by CS were associated with increased risk of wheezing (aHR 1.63; 95% CI: 1.01–2.62) and decreased compliance of the respiratory system at 12 months (p = 0.045). In addition, CS was associated with reduced TLR1–2- triggered TNF-α and IL-6 responses at birth. By12 months of age, children delivered by CS had significantly less airway bacterial clearance. Our findings suggested that CS was associated with decreased pro-inflammatory cytokine response to TLR1–2 stimulation, followed by higher abundance of bacterial colonization in the airway during late infancy, thus increasing the risk of infantile wheezing.
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Affiliation(s)
- Sui-Ling Liao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ming-Han Tsai
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Man-Chin Hua
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chih-Yung Chiu
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kuan-Wen Su
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shih-Yin Huang
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chuan-Chi Kao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shen-Hao Lai
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. .,Division of Pulmonology, Department of Pediatric, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Jing-Long Huang
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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21
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Human Milk and Allergic Diseases: An Unsolved Puzzle. Nutrients 2017; 9:nu9080894. [PMID: 28817095 PMCID: PMC5579687 DOI: 10.3390/nu9080894] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
There is conflicting evidence on the protective role of breastfeeding in relation to the development of allergic sensitisation and allergic disease. Studies vary in methodology and definition of outcomes, which lead to considerable heterogeneity. Human milk composition varies both within and between individuals, which may partially explain conflicting data. It is known that human milk composition is very complex and contains variable levels of immune active molecules, oligosaccharides, metabolites, vitamins and other nutrients and microbial content. Existing evidence suggests that modulation of human breast milk composition has potential for preventing allergic diseases in early life. In this review, we discuss associations between breastfeeding/human milk composition and allergy development.
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22
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Gil F, Amezqueta A, Martinez D, Aznal E, Etayo V, Durá T, Sánchez-Valverde F. Association between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy. Int Arch Allergy Immunol 2017; 173:147-152. [PMID: 28787733 DOI: 10.1159/000477725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cow milk allergy (CMA) is the most common food allergy in breastfed infants. The aim of this study is to verify whether certain perinatal factors may influence the development of CMA immunoglobulin E (IgE)+. METHODS A retrospective, observational study of case and control groups was carried out. Information was collected of patients with CMA IgE+ from our department during the years 1990-2013. Patients of the same age and sex were recruited for the control group. Information on the following variables was collected: sex, age, pregnancy tolerance, duration of pregnancy, type of delivery, isolated doses of formula feeding in hospital (FFH), duration of breastfeeding, and family history of allergy (defined as ≥1 first-degree family member with allergic disease). Statistical analysis was performed using multivariate logistic regression techniques. RESULTS A total of 211 cases were included in this study. Multivariate analysis showed an influence of duration of breastfeeding, FFH to be a risk factor (OR 4.94; 95% CI 2.68-9.08), especially in caesarean delivery (OR 11.82; 95% CI 2.64-47.50), and prematurity (OR 0.29; 95% CI 0.09-0.92) to be a protective factor. CONCLUSIONS Perinatal factors play a key role in the development of CMA IgE+, with an influence of breastfeeding duration, FFH and caesarean delivery as risk factors and prematurity as a protective factor. While family history had no important role, environmental factors were more decisive.
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Affiliation(s)
- Francisco Gil
- Department of Pediatrics, Estella Hospital, Estella, Spain
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23
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Kellams A, Harrel C, Omage S, Gregory C, Rosen-Carole C. ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeed Med 2017; 12:188-198. [PMID: 28294631 DOI: 10.1089/bfm.2017.29038.ajk] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Ann Kellams
- 1 Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| | - Cadey Harrel
- 2 Department of Family & Community Medicine, University of Arizona College of Medicine and Family Medicine Residency , Tucson, Arizona
| | - Stephanie Omage
- 3 Discipline of General Practice, The University of Queensland , Brisbane, Australia
| | - Carrie Gregory
- 4 Department of Pediatrics, University of Rochester , Rochester, New York.,5 Department of OBGYN, University of Rochester , Rochester, New York
| | - Casey Rosen-Carole
- 4 Department of Pediatrics, University of Rochester , Rochester, New York.,5 Department of OBGYN, University of Rochester , Rochester, New York
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24
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Lai SH, Liao SL, Tsai MH, Hua MC, Chiu CY, Yeh KW, Yao TC, Huang JL. Low cord-serum 25-hydroxyvitamin D levels are associated with poor lung function performance and increased respiratory infection in infancy. PLoS One 2017; 12:e0173268. [PMID: 28267792 PMCID: PMC5340372 DOI: 10.1371/journal.pone.0173268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background Perinatal vitamin D deficiency is associated with a higher risk of wheezing in childhood. However, the relationship between vitamin D levels and lung function in infancy has not been investigated. The aim of this study was to investigate the impact of perinatal vitamin D levels on respiratory function and disease outcome in infancy. Materials and methods Full-term infants without any chronic diseases or major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children cohort study. Maternal and cord blood were collected for determining the 25(OH)D level. Questionnaires were recorded at birth and 6 months of age. Infant lung function, including tidal breathing analysis, respiratory mechanics, and forced tidal expiration, was tested at 6 months of age. Results A total of 122 mother—infant pairs were enrolled in this study, and 71 infants underwent lung function testing at 6 months of age. 25(OH)D levels in maternal and cord serum were highly correlated (r2 = 0.457, p < 0.0001). Infants with lower cord serum 25(OH)D levels (< 13.7 ng/ml) had higher resistance of respiratory system (p < 0.01) and a higher risk of a respiratory tract infection before the age of 6 months (p < 0.01). Conclusion Although a high correlation was found between maternal and cord vitamin D levels, the effect on respiratory outcome was different. Our study is the first to show that low cord 25(OH)D levels significantly relationship with poorer lung function performance and higher likelihood of a respiratory tract infection before 6 months of age.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
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25
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Breastfeeding and IL-10 levels in children affected by cow’s milk protein allergy: A restrospective study. Immunobiology 2017; 222:358-362. [PMID: 27622938 DOI: 10.1016/j.imbio.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 12/30/2022]
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26
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Sakihara T, Sugiura S, Ito K. The ingestion of cow's milk formula in the first 3 months of life prevents the development of cow's milk allergy. Asia Pac Allergy 2016; 6:207-212. [PMID: 27803880 PMCID: PMC5088256 DOI: 10.5415/apallergy.2016.6.4.207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022] Open
Abstract
Background IgE-mediated cow's milk allergy (CMA) is one of the most common food allergies in infants. It is still controversial whether the early introduction of cow's milk formula (CMF) prevents the development of CMA. Objective We aimed to evaluate the duration and frequency of CMF ingestion as compere with exclusive breast-fed for preventing CMA in high-risk infants. Methods We enrolled the patients diagnosed with hen's egg allergy by an oral food challenge. A questionnaire was completed by the caregivers of the patients regarding the timing of introduction and discontinuation of CMF, and the frequency of CMF ingestion. Based on the information, we analyzed the relationship between the duration and frequency of CMF ingestion and the development of CMA at 3–24 months of age. Results Three hundred seventy-four patients were analyzed; 171 were diagnosed with CMA (45.7%). The analyzed patients (n = 374) were categorized into the following subgroups: exclusively breast-fed (breast-fed group, n = 75); discontinued ingestion of CMF before 3 months of age (temporary group, n = 177); continuous ingestion of CMF, but not daily, up to 3 months of age (nondaily group, n = 47); continuous ingestion of CMF at least once daily (daily group, n = 75). The incidence of developing CMA between the breast-fed group and temporary group did not show any statistical difference. Nondaily group and daily group had significantly lower incidence of developing CMA in comparison to the breast-fed group (nondaily group odds ratio 0.43; p = 0.02, daily group odds ratio 0.11; p < 0.001). Conclusion Ingestion of CMF during the first 3 months of life might prevent the development of CMA in high-risk infants.
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Affiliation(s)
- Tetsuhiro Sakihara
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan.; Department of Pediatrics, Heartlife Hospital, Okinawa 901-2492, Japan
| | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
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27
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[Guidelines for complementary feeding in healthy infants]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:338-356. [PMID: 29384128 DOI: 10.1016/j.bmhimx.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/07/2016] [Indexed: 12/20/2022] Open
Abstract
A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.
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28
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Chiu CY, Liao SL, Su KW, Tsai MH, Hua MC, Lai SH, Chen LC, Yao TC, Yeh KW, Huang JL. Exclusive or Partial Breastfeeding for 6 Months Is Associated With Reduced Milk Sensitization and Risk of Eczema in Early Childhood: The PATCH Birth Cohort Study. Medicine (Baltimore) 2016; 95:e3391. [PMID: 27082611 PMCID: PMC4839855 DOI: 10.1097/md.0000000000003391] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
There is insufficient evidence to confirm the association between breastfeeding and allergic outcomes later in life. This study aimed to determine the relationships between different breastfeeding patterns and allergen sensitizations and risk of developing atopic diseases in early childhood. A total of 186 children from a birth cohort in the Prediction of Allergies in Taiwanese Children study for a 4-year follow-up period were enrolled. Total serum immunoglobulin E (IgE) levels and specific IgE antibodies against food and inhalant allergens were measured sequentially at 6 months as well as at 1, 1.5, 2, 3, and 4 years of age. A significantly lower prevalence of milk sensitization was found in children at ages 1 and 1.5 years who were exclusively or partially breastfed for ≥6 months. Breastfeeding ≥6 months was significantly associated with a reduced risk of developing eczema but not allergic rhinitis and asthma at ages 1 and 2 years. Compared with exclusive breastfeeding ≥6 months, partial breastfeeding <6 months was significantly associated with an increased risk of developing eczema at ages 1 and 2 years. As with exclusive breastfeeding, partial breastfeeding for at least 6 months appears to be associated with a reduced prevalence of milk sensitization as well as a reduced risk of developing eczema in early childhood.
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Affiliation(s)
- Chih-Yung Chiu
- From the Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine (C-YC, S-LL, K-WS, M-HT, M-CH); and Division of Pediatric Pulmonology (C-YC, S-HL) and Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics (L-CC, T-CY, K-WY, J-LH), Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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29
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Sánchez-García S, Cipriani F, Ricci G. Food Allergy in childhood: phenotypes, prevention and treatment. Pediatr Allergy Immunol 2015; 26:711-20. [PMID: 26595763 DOI: 10.1111/pai.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
The prevalence of food allergy in childhood increased in the last decades, especially in Westernized countries where this phenomenon has been indicated as a second wave of the allergic epidemic. In parallel, scientific interest also increased with the effort to explain the reasons of this sudden rise and to identify potential protective and risk factors. A great attention has been focused on early exposures to allergenic foods, as well as on other nutritional factors or supplements that may influence the immune system in a positive direction. Both interventions on maternal diet before birth or during breastfeeding and then directly on infant nutrition have been investigated. Furthermore, the natural history of food allergy also seems to be changing over time; IgE-mediated cow's milk allergy and egg allergy seem to be more frequently a persistent rather than a transient disease in childhood, as described in the last years. Food avoidance and the emergency drugs in case of an adverse event, such as epinephrine self-injector, are currently the first-line treatment in patients with food allergies, with a resulting impairment in the quality of life and social behaviour. During the last decade, oral immunotherapy emerged as an optional treatment with remarkable results, offering a novel perspective in the treatment for and management of food allergy.
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Affiliation(s)
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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30
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Yeh KW, Huang JL. Respiratory Function in Healthy Taiwanese Infants: Tidal Breathing Analysis, Passive Mechanics, and Tidal Forced Expiration. PLoS One 2015; 10:e0142797. [PMID: 26559673 PMCID: PMC4641614 DOI: 10.1371/journal.pone.0142797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023] Open
Abstract
Background Although infant lung function (ILF) testing is widely practiced in developed Western countries it is not typically performed in Eastern countries, and lung measurements are scarce for Asian infants. Therefore, this study aimed to establish normal reference values for Taiwanese infants. Materials and Methods Full-term infants without any chronic diseases and major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children (PATCH) cohort study. Detailed medical data, such as body weight and length, birth history, and histories of previous illness and hospitalization were recorded. Lung function measurements such as analysis of tidal breathing, passive respiratory mechanics, and forced tidal expiratory flow-volume curves were obtained through Jaeger Masterscreen BabyBody Paediatrics System. Multiple linear analyses were performed to determine various parameters of the lung function tests. Results ILF test parameters were collected from 126 infants, and 189 tests were performed. The results revealed that the ratio of time to peak expiratory flow to total expiratory time, the ratio of volume to peak expiratory flow to total expiratory volume, and the ratio of inspiratory time to total respiratory time remained relatively constant despite differences in age. However, body length is the strongest independent variable influencing tidal volume, respiratory rate, resistance, compliance, and maximal expiratory flow at functional residual capacity. Conclusion According to our review of relevant literature, this is the first study to establish a reference data of ILF tests in the Asian population. This study provided reference values and regression equations for several variables of lung function measurements in healthy infants aged less than 2 years. With these race-specific reference data, ILF can more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
- * E-mail:
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31
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Graham F, Bégin P, Paradis L, Des Roches A. Prenatal and/or Breastfeeding Food Exposures and Risk of Food Allergies in the Offspring. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Chiu CY, Huang SY, Peng YC, Tsai MH, Hua MC, Yao TC, Yeh KW, Huang JL. Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood. Pediatr Allergy Immunol 2015; 26:337-43. [PMID: 25847488 DOI: 10.1111/pai.12384] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are few studies addressing the impact of maternal vitamin D status on the vitamin D levels in offspring, their sensitization to common allergens and atopic disease development. METHODS Children aged 0 through 4 yr from a birth cohort in the Prediction of Allergies in Taiwanese Children (PATCH) study were enrolled. Time series of serum 25-hydroxyvitamin D (25(OH)D) levels were measured in maternal blood before delivery, cord blood, and at age 1.5, 3, and 4 using an electrochemiluminescence-based assay. Specific IgE antibodies against food and inhalant allergens were measured at 6 months, and 1, 1.5, 2, 3, and 4 yr of age. RESULTS A total of 164 mother-child pairs from a birth cohort were recruited in this study. The mean levels of maternal 25(OH)D were 23.2 ± 7.7 ng/ml with a high (up to 80%) prevalence of insufficient vitamin D status (< 30 ng/ml). A significant correlation was seen between maternal and cord blood 25(OH)D levels (p < 0.001), and a persistent lower 25(OH)D level was found in children born to mothers with deficient 25(OH)D levels. Deficient maternal 25(OH)D levels (<20 ng/ml) appeared to be associated with a higher prevalence of allergen sensitization before age 2. Higher maternal 25(OH)D levels were significantly associated with lower risk of eczema (OR 0.12; 95% CI 0.02-0.63; p = 0.012) and asthma (OR 0.22; 95% CI 0.06-0.92; p = 0.038) at age 4. CONCLUSIONS Low maternal 25(OH)D levels appear not only to be associated with an increase in the prevalence of allergic sensitization but also the risk of eczema and asthma in early childhood.
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Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yin Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chieh Peng
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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33
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Chiu CY, Yao TC, Chen SH, Tsai MH, Tu YL, Hua MC, Yeh KW, Huang JL. Low cord blood vitamin D levels are associated with increased milk sensitization in early childhood. Pediatr Allergy Immunol 2014; 25:767-72. [PMID: 25389018 DOI: 10.1111/pai.12304] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The association between vitamin D status at birth and allergen sensitizations is uncertain. The aim of this study was to investigate the relationship between cord blood vitamin D status with allergen sensitizations and the development of atopic diseases in early childhood. METHODS Children aged 0 through 4 yr from a birth cohort in the Prediction of Allergies in Taiwanese Children (PATCH) study were enrolled. Serum levels of 25-hydroxyvitamin D (25(OH)D) in cord blood were measured by a new automated electrochemiluminescence-based assay. Specific IgE antibodies against food and inhalant allergens were measured at 6 months, and 1, 1.5, 2, 3, and 4 yr of age. RESULTS A total of 186 children were regular followed up at clinics for a 4-yr follow-up period. The mean level of cord blood 25(OH)D was 23.8 ± 9.5 ng/ml with a high prevalence of low vitamin D status (<20 ng/ml) at birth (42%). There was a tendency of low cord blood 25(OH)D levels being associated with higher risk of food sensitization throughout childhood. Cord blood 25(OH)D levels were inversely associated with the risk of milk sensitization at age 2, at which age a higher prevalence of milk sensitization was significantly associated with the risk of allergic rhinitis, and asthma development at age 4. CONCLUSIONS Low cord blood vitamin D levels appear to be associated with increased milk sensitization but not with asthma, eczema, or allergic rhinitis in early childhood.
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Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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34
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Cipriani F, Dondi A, Ricci G. Recent advances in epidemiology and prevention of atopic eczema. Pediatr Allergy Immunol 2014; 25:630-8. [PMID: 25406640 DOI: 10.1111/pai.12309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 12/22/2022]
Abstract
Atopic dermatitis (AD), named also atopic eczema, is a chronic relapsing inflammatory skin disease with a considerable social and economic burden. The primum movens of AD is in most cases a genetic and/or immune-supported defect of the skin barrier, facilitating penetration and sensitization to food or airborne allergens, as well as infections by Staphylococcus aureus, herpes simplex virus, or other microbes. New pathogenetic concepts have generated new approaches to prevention and therapy of AD. In particular, the daily use of emollients in newborns at high risk of AD has shown interesting results, with a reduction in the cumulative incidence of AD ranging from 32% to 50% of the treated infants. On the other hand, the AD preventive efficacy of food and/or inhalant allergen avoidance has been questioned, and supplementation strategies (vitamin D, probiotics, or other compounds) need to be further investigated.
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Affiliation(s)
- Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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