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Gravina A, Olivero F, Brindisi G, Comerci AF, Ranucci C, Fiorentini C, Sculco E, Figliozzi E, Tudini L, Matys V, De Canditiis D, Piccioni MG, Zicari AM, Anania C. Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art? Int J Mol Sci 2024; 25:2769. [PMID: 38474015 DOI: 10.3390/ijms25052769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Food allergy (FA) affects approximately 6-8% of children worldwide causing a significant impact on the quality of life of children and their families. In past years, the possible role of weaning in the development of FA has been studied. According to recent studies, this is still controversial and influenced by several factors, such as the type of food, the age at food introduction and family history. In this narrative review, we aimed to collect the most recent evidence about weaning and its role in FA development, organizing the gathered data based on both the type of study and the food. As shown in most of the studies included in this review, early food introduction did not show a potential protective role against FA development, and we conclude that further evidence is needed from future clinical trials.
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Affiliation(s)
- Alessandro Gravina
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Giulia Brindisi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonia Fortunata Comerci
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Chiara Ranucci
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Cinzia Fiorentini
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Eleonora Sculco
- Department of Translation and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Ethel Figliozzi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Tudini
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Matys
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Maria Grazia Piccioni
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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Vandenplas Y, Meyer RM, Huysentruyt K. Food allergy: Prevention and treatment of Cow's milk allergy. Clin Nutr ESPEN 2024; 59:9-20. [PMID: 38220412 DOI: 10.1016/j.clnesp.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Yvan Vandenplas
- Paediatric Gastroenterology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Rosan M Meyer
- Imperial College, London, United Kingdom; Winchester University, Winchester, United Kingdom
| | - Koen Huysentruyt
- Paediatric Gastroenterology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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3
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Wang S, Yin P, Yu L, Tian F, Chen W, Zhai Q. Effects of Early Diet on the Prevalence of Allergic Disease in Children: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100128. [PMID: 37827490 PMCID: PMC10831899 DOI: 10.1016/j.advnut.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
Recent evidence suggests that the timing of introduction, types, and amounts of complementary foods/allergenic foods may influence the risk of allergic disease. However, the evidence has not been updated and comprehensively synthesized. The Cochrane Library, EMBASE, Web of Science, and PubMed databases were searched from the inception of each database up to 31 May 2023 (articles prior to 2000 were excluded manually). Statistical analyses were performed using RevMan 5. The GRADE approach was followed to rate the certainty of evidence. Compared with >6 mo, early introduction of eggs (≤6 mo of age) might reduce the risk of food allergies in preschoolers aged <6 y (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53, 0.81), but had no effect on asthma or atopic dermatitis (AD). Consumption of fish at 6-12 mo might reduce the risk of asthma in children (aged 5-17 y) compared with late introduction after 12 mo (OR, 0.61; 95% CI: 0.52, 0.72). Introduction of allergenic foods for ≤6 mo of age, compared with >6 mos, was a protective factor for the future risk (children aged ≤10 y) of AD (OR, 0.93; 95% CI: 0.89, 0.97). Probiotic intervention for infants at high risk of allergic disease significantly reduced the risk of food allergy at ages 0-3 y (OR, 0.72; 95% CI: 0.56, 0.94), asthma at 6-12 y (OR, 0.61; 95% CI: 0.41, 0.90), and AD at aged <6 y (3-6 y: OR, 0.70; 95% CI: 0.52, 0.94; 0-3 y: OR, 0.73; 95% CI: 0.59, 0.91). Early introduction of complementary foods or the high-dose vitamin D supplementation in infancy was not associated with the risk of developing food allergies, asthma, or AD during childhood. Early introduction to potential allergen foods for normal infants or probiotics for infants at high risk of allergies may protect against development of allergic disease. This study was registered at PROSPERO as CRD42022379264.
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Affiliation(s)
- Shumin Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Pingping Yin
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Leilei Yu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Fengwei Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu, China
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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D'Hollander CJ, Keown-Stoneman CDG, Birken CS, O'Connor DL, Maguire JL. Timing of introduction to solid food, eczema and wheezing in later childhood: a longitudinal cohort study. BMC Pediatr 2023; 23:514. [PMID: 37845652 PMCID: PMC10577938 DOI: 10.1186/s12887-023-04262-0] [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: 08/21/2022] [Accepted: 08/21/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The timing of introduction to solid food has been associated with eczema and wheezing in childhood. Our aim was to determine whether differences persist within the recommended 4 to 6 month age range. METHODS A longitudinal cohort study with repeated measures was conducted among children from birth to 10 years of age who were participating in the TARGet Kids! practice based research network in Toronto, Canada. The primary exposure was the timing of introduction to infant cereal as the first solid food. The primary outcome was eczema and the secondary outcome was wheezing collected by parent report using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multinomial generalized estimating equations were used and effect modification by family history of asthma and breastfeeding duration were explored. RESULTS Of the 7843 children included, the mean (standard deviation) age of introduction to infant cereal was 5.7 (1.9) months. There was evidence for family history of asthma and breastfeeding duration to be effect modifiers in the eczema (P = 0.04) and wheezing (P = 0.05) models. Introduction to infant cereal at 4 vs. 6 months of age was associated with higher odds of eczema (OR 1.62; 95% CI: 1.12, 2.35; P = 0.01) among children without a family history of asthma who were not breastfeeding when solid foods were introduced. Introduction to infant cereal at 4 vs. 6 months of age was associated with a higher odds of wheezing (OR 1.31; 95% CI: 1.13, 1.52; P < .001) among children without a family history of asthma who were breastfeeding when solid foods were introduced. There was little evidence of an association among the remaining strata for either outcome. CONCLUSION The findings of this study support recommendations to introduce solid food around 6 months of age.
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Affiliation(s)
- Curtis J D'Hollander
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St Michael's Hospital, Toronto, ON, Canada
- Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, St Michael's Hospital, Toronto, ON, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Current Insights into Atopic March. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111067. [PMID: 34828780 PMCID: PMC8620020 DOI: 10.3390/children8111067] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
The incidence of allergic diseases is increasing, and research on their epidemiology, pathophysiology, and the prevention of onset is urgently needed. The onset of allergic disease begins in infancy with atopic dermatitis and food allergy and develops into allergic asthma and allergic rhinitis in childhood; the process is defined as “atopic march”. Atopic march is caused by multiple immunological pathways, including allergen exposure, environmental pollutants, skin barrier dysfunction, type 2 inflammation, and oxidative stress, which promote the progression of atopic march. Using recent evidence, herein, we explain the involvement of allergic inflammatory conditions and oxidative stress in the process of atopic march, its epidemiology, and methods for prevention of onset.
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Stampfli M, Frei R, Divaret-Chauveau A, Schmausser-Hechfellner E, Karvonen AM, Pekkanen J, Riedler J, Schaub B, von Mutius E, Lauener R, Roduit C. Inverse associations between food diversity in the second year of life and allergic diseases. Ann Allergy Asthma Immunol 2021; 128:39-45. [PMID: 34648974 DOI: 10.1016/j.anai.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The influence of diet in early childhood on later allergic diseases is currently a highly debated research topic. We and others have suggested that an increased diet diversity in the first year of life has a protective effect on the development of allergic diseases. OBJECTIVE This follow-up study aimed to investigate associations between diet in the second year of life and later allergic diseases. METHODS A total of 1014 children from rural areas in 5 European countries (the Protection against Allergy: Study in Rural Environments or PASTURE birth cohort) were included. Information on feeding practices in their second year of life and allergic diseases were collected up to age 6 years. Multivariate logistic regressions were performed with different models considering reverse causality, such as excluding children with a positive sensitization to egg and those with a positive sensitization to cow's milk at the age of 1 year. RESULTS An increased food diversity score during the second year of life was negatively associated with the development of asthma. Consumption of dairy products and eggs in the second year of life found an inverse association with reported allergic outcomes. Consumption of butter was strongly associated with protection against asthma and food sensitization. Egg was inversely associated with atopic dermatitis (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.04-0.77). Yogurt and cow's milk were inversely associated with food allergy (OR for yogurt, 0.05; 95% CI, 0.01-0.55; OR for cow's milk, 0.31; 95% CI, 0.11-0.89). CONCLUSION Increased food diversity in the second year of life is inversely associated with the development of asthma, and consumption of dairy products might have a protective effect on allergic diseases.
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Affiliation(s)
- Martha Stampfli
- Department of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Remo Frei
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Division of Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, University Hospital of Nancy, Nancy, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Nancy, France; Unité de Mixte de Recherche (UMR) 6249 Chrono-environment, Centre National De La Recherche Scientifique (CNRS) and University of Franche-Comté, Besançon, France
| | - Elisabeth Schmausser-Hechfellner
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Josef Riedler
- Children's Hospital Schwarzach, Kardinal Schwarzenbergplatz 1, Schwarzach, Austria; Teaching Hospital of Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Bianca Schaub
- Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Erika von Mutius
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany; Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Caroline Roduit
- Department of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
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Zepeda-Ortega B, Goh A, Xepapadaki P, Sprikkelman A, Nicolaou N, Hernandez REH, Latiff AHA, Yat MT, Diab M, Hussaini BA, Setiabudiawan B, Kudla U, van Neerven RJJ, Muhardi L, Warner JO. Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy. Front Immunol 2021; 12:608372. [PMID: 34177882 PMCID: PMC8222906 DOI: 10.3389/fimmu.2021.608372] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
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Affiliation(s)
- Benjamin Zepeda-Ortega
- Pediatric Allergist Private Practice, Angeles Lomas Hospital Huixquilucan Mexican State, Mexico City, Mexico
| | - Anne Goh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Aline Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | | | - Miu Ting Yat
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China
| | - Mohamed Diab
- Pediatric Department Faculty of Medicine, Children Hospital Cairo University, Cairo, Egypt
| | - Bakr Al Hussaini
- Department of Pediatrics, Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Univesitas Padjadjaran, Bandung, Indonesia.,Department of Pediatrics, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - R J Joost van Neerven
- R&D, FrieslandCampina, Amersfoort, Netherlands.,Wageningen University & Research, Wageningen, Netherlands
| | - Leilani Muhardi
- Medical Affairs, Friesland Campina AMEA, Singapore, Singapore
| | - John O Warner
- Inflammation Repair and Development, National Heart and Lung Institute Imperial College, London, United Kingdom.,Paediatrics, University of Cape Town, Cape Town, South Africa
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Song MW, Kim KT, Paik HD. Probiotics as a Functional Health Supplement in Infant Formulas for the Improvement of Intestinal Microflora and Immunity. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1928178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Myung Wook Song
- Department of Food Science and Biotechnology of Animal Resources, Konkuk University, Seoul, Republic of Korea
| | - Kee-Tae Kim
- Department of Food Science and Biotechnology of Animal Resources, Konkuk University, Seoul, Republic of Korea
| | - Hyun-Dong Paik
- Department of Food Science and Biotechnology of Animal Resources, Konkuk University, Seoul, Republic of Korea
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10
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Hand S, Dunstan F, Jones K, Doull I. The effect of diet in infancy on asthma in young adults: the Merthyr Allergy Prevention Study. Thorax 2021; 76:1072-1077. [PMID: 33963089 DOI: 10.1136/thoraxjnl-2020-215040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Early infant diet might influence the risk of subsequent allergic disease. METHODS The Merthyr Allergy Prevention Study (MAPS) was a randomised controlled trial in infants at high risk of allergic disease. The trial determined whether a cow's milk exclusion diet for the first 4 months of life decreased the risk of allergic disease including asthma compared with a normal diet. A soya milk preparation was offered to those in the intervention group. A standardised questionnaire for allergic disease was completed at ages 1, 7, 15 and 23 years, with clinical assessment at 1, 7 and 23 years. The effect of the intervention on the risk of atopy, asthma and wheeze at age 23 years was determined. FINDINGS 487 subjects entered the study; at age 23 years 299 completed the questionnaire, of which 119 attended clinical assessment. Subjects randomised to the intervention group had a significantly increased risk of atopy (adjusted OR 2.97, 95% CI 1.30 to 6.80; p=0.01) and asthma (OR 2.07, 95%CI 1.09 to 3.91; p=0.03) at age 23 years, but not wheeze (OR 1.43, 95%CI 0.87 to 2.37; p=0.16). Earlier exposure to cow's milk was associated with a decreased risk of wheeze and asthma at age 23 years, while earlier exposure to soya milk was associated with an increased risk of atopy and asthma. INTERPRETATION In infants at high risk of allergic disease, either cow's milk exclusion or early soya milk introduction for the first 4 months of life increases the risk of atopy, wheeze and asthma in adulthood.
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Affiliation(s)
- Sadiyah Hand
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | | | - Ken Jones
- School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Iolo Doull
- Respiratory/Cystic Fibrosis Unit, Children's Hospital for Wales, Cardiff, UK .,Medical Directorate, Welsh Health Specialised Services Committee, Pontypridd, UK
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Vandenplas Y, Meyer R, Chouraqui JP, Dupont C, Fiocchi A, Salvatore S, Shamir R, Szajewska H, Thapar N, Venter C, Verhasselt V. The role of milk feeds and other dietary supplementary interventions in preventing allergic disease in infants: Fact or fiction? Clin Nutr 2021; 40:358-371. [DOI: 10.1016/j.clnu.2020.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
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Parekh K, Mehta TA, Dhas N, Kumar P, Popat A. Emerging Nanomedicines for the Treatment of Atopic Dermatitis. AAPS PharmSciTech 2021; 22:55. [PMID: 33486609 PMCID: PMC7828097 DOI: 10.1208/s12249-021-01920-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, the prevalence of Atopic dermatitis (AD) is significantly increasing and affecting around 20% of population including children. Complex interactions amongst abnormality in epidermal barrier function, environment, infectious agents and immunological defects are considered as key factors in the pathogenesis of AD. Although the role of oxidative stress has been studied in some skin diseases, investigation of the same in AD is intermittent. Calcineurin inhibitors and/or topical corticosteroids are currently available; however, it causes atrophy of the skin, burning sensation, and systemic side effects which leads to poor patient compliance. These limitations provoke the strong need to develop an innovative approach in managing AD. Nanomaterials for effective drug delivery to skin conditions such as AD have attracted a lot of attention owing to its ability to encapsulate, protect, and release the cargo at the diseased skin site. However, there are lots of unmet challenges especially in terms of development of non-toxic formulations and clinical translation of established nanomedicines in the form of accessible products. Numerous formulations have emerged as carrier for poorly soluble and permeable drugs, viz., lipidic, polymeric, metal, silica, liposomes, hydrocarbon gels and this field is evolving. This review is intended to provide an insight incidences associated with pathophysiology of AD and challenges with existing treatments of AD. Focus is kept on reviewing current development and emerging nanomedicines for effective treatment of AD. The review also inculcates merits of several nanomedicines in overcoming challenges of existing products and its future implications.
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Yuan M, Tan M, Moore D, Shen S, Qiu X, Thomas GN, Cheng K. Timing of Cow's Milk or Cow's Milk Formula Introduction to the Infant Diet and Atopic Risk in Children: a Systematic Review and Meta-analysis. Clin Rev Allergy Immunol 2021; 59:46-60. [PMID: 31768874 DOI: 10.1007/s12016-019-08770-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infant feeding is an important early-life exposure that may influence the development of atopic disease. The optimal timing of introduction of food allergens, including cow's milk (CM), is not known. This study aims to systematically review the evidence describing the effects of timing of CM or cow's milk formula (CMF) introduction to the infant diet on the development of atopic diseases during childhood. Pubmed, Embase, CINAHL, Cochrane CENTRAL, and CNKI were searched through May 30, 2019. Study screening and data extraction by two reviewers followed the PRISMA statement. Data were extracted independently in duplicate, and meta-analyses were performed by pooling unadjusted and adjusted odds ratio (OR) separately. Heterogeneity was explored using I2 and publication bias by funnel plots and Begg's tests. In total, 45 studies from 20 countries were included. Meta-analyses using adjusted data showed that no associations were observed between early introduction of CM or CMF and the risk of asthma (< 4 vs. ≥ 4 months: OR 1.16, 95% confidence interval (CI) 0.89, 1.51), wheeze (< 6 vs. ≥ 6 months: OR 1.15, 95% CI 0.85, 1.56), and eczema or atopic dermatitis (< 6 vs. ≥ 6 months: OR 0.96, 95% CI 0.65, 1.41). Overall, quite little high-quality evidence was identified to allow for definitive conclusions on the association between early CM or CMF introduction and risk of allergic diseases. Our meta-analysis on this topic highlights the specific gaps in information for public recommendations regarding CM or CMF feeding practice in an early stage of life, particularly before 3 months of age.
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Affiliation(s)
- Mingyang Yuan
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miaoyu Tan
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kar Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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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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15
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Kok CR, Brabec B, Chichlowski M, Harris CL, Moore N, Wampler JL, Vanderhoof J, Rose D, Hutkins R. Stool microbiome, pH and short/branched chain fatty acids in infants receiving extensively hydrolyzed formula, amino acid formula, or human milk through two months of age. BMC Microbiol 2020; 20:337. [PMID: 33167908 PMCID: PMC7650147 DOI: 10.1186/s12866-020-01991-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early infant feeding with intact or extensively hydrolyzed (EH) proteins or free amino acids (AA) may differentially affect intestinal microbiota composition and immune reactivity. This multicenter, double-blind, controlled, parallel-group, pilot study compared stool microbiota from Baseline (1-7 days of age) up to 60 days of age in healthy term infants who received mother's own milk (assigned to human milk [HM] reference group) (n = 25) or were randomized to receive one of two infant formulas: AA-based (AAF; n = 25) or EH cow's milk protein (EHF; n = 28). Stool samples were collected (Baseline, Day 30, Day 60) and 16S rRNA genes were sequenced. Alpha (Shannon, Simpson, Chao1) and beta diversity (Bray Curtis) were analyzed. Relative taxonomic enrichment and fold changes were analyzed (Wilcoxon, DESEq2). Short/branched chain fatty acids (S/BCFA) were quantified by gas chromatography. Mean S/BCFA and pH were analyzed (repeated measures ANOVA). RESULTS At baseline, alpha diversity measures were similar among all groups; however, both study formula groups were significantly higher versus the HM group by Day 60. Significant group differences in beta diversity at Day 60 were also detected, and study formula groups were compositionally more similar compared to HM. The relative abundance of Bifidobacterium increased over time and was significantly enriched at Day 60 in the HM group. In contrast, a significant increase in members of Firmicutes for study formula groups were detected at Day 60 along with butyrate-producing species in the EHF group. Stool pH was significantly higher in the AAF group at Days 30 and 60. Butyrate increased significantly from Baseline to Day 60 in the EHF group and was significantly higher in study formula groups vs HM at Day 60. Propionate was also significantly higher for EHF and AAF at Day 30 and AAF at Day 60 vs HM. Total and individual BCFA were higher for AAF and EHF groups vs HM through Day 60. CONCLUSIONS Distinct patterns of early neonatal microbiome, pH, and microbial metabolites were demonstrated for infants receiving mother's own milk compared to AA-based or extensively hydrolyzed protein formula. Providing different sources of dietary protein early in life may influence gut microbiota and metabolites. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02500563 . Registered July 28, 2015.
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Affiliation(s)
- Car Reen Kok
- Department of Food Science and Technology, University of Nebraska-Lincoln, Lincoln, NE 68588 USA
| | - Bradford Brabec
- Midwest Children’s Health Research Institute, LLC, 3262 Salt Creek Circle, Lincoln, NE 68504 USA
| | - Maciej Chichlowski
- Global Nutrition Science, Mead Johnson Nutrition, Evansville, IN 47721 USA
| | - Cheryl L. Harris
- Clinical Research, Department of Medical Affairs, Mead Johnson Nutrition, Evansville, IN 47721 USA
| | - Nancy Moore
- Clinical Research, Department of Medical Affairs, Mead Johnson Nutrition, Evansville, IN 47721 USA
| | - Jennifer L. Wampler
- Clinical Research, Department of Medical Affairs, Mead Johnson Nutrition, Evansville, IN 47721 USA
| | - Jon Vanderhoof
- Boston Children’s Hospital, Gastroenterology, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Devin Rose
- Department of Food Science and Technology, University of Nebraska, 268 Food Innovation Center, Lincoln, NE 68588-6205 USA
| | - Robert Hutkins
- Department of Food Science and Technology, University of Nebraska, 258 Food Innovation Center, Lincoln, NE 68588-6205 USA
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16
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Hicke-Roberts A, Wennergren G, Hesselmar B. Late introduction of solids into infants' diets may increase the risk of food allergy development. BMC Pediatr 2020; 20:273. [PMID: 32493408 PMCID: PMC7268275 DOI: 10.1186/s12887-020-02158-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background This study investigated risk factors associated with food allergy or food intolerance among school children in two Swedish towns. Methods Questionnaires were used to collect data on self-reported food allergy or intolerance (SRFA) in children aged 7–8 years from Mölndal in southwestern Sweden and Kiruna in northern Sweden. It included questions about specific food allergy or intolerance to cows’ milk, hens’ eggs, fish, peanuts, tree nuts, and cereals and also age of onset, type of symptoms and age of cessation. Information was also gathered on family allergy history, dietary habits, and certain lifestyle aspects. Results Of 1838 questionnaires distributed, 1029 were returned: 717/1354 (53%) from Mölndal and 312/484 (64%) from Kiruna. The cumulative incidence of SRFA was 19.6% with a significantly higher cumulative incidence in Kiruna (28.5%) than in Mölndal (15.7%), P < .001. Solids were introduced at a later age in Kiruna. Introduction of solids into a child’s diet from the age of 7 months or later, and maternal history of allergic disease, were both risk factors associated with a higher risk of food allergy or intolerance. Conclusion Late introduction of solids into an infant’s diet may be one risk factor for developing food allergy or intolerance. Later introduction of solids in Kiruna may be one explanation for the higher cumulative incidence of SRFA in that region.
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Affiliation(s)
- Anna Hicke-Roberts
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Göran Wennergren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bill Hesselmar
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Mastrorilli C, Santoro A, Caffarelli C. Primary Prevention of Allergic Diseases: The Role of Early Exposure to Cow's Milk Formula. Front Pediatr 2020; 8:420. [PMID: 32850536 PMCID: PMC7399633 DOI: 10.3389/fped.2020.00420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
The burden of atopic disorders is continuously worsening worldwide, especially in childhood. Therefore, risk factors and preventive measures have been called into question. The age when infants introduce complementary foods, varies greatly according to traditional habits, clinical practice recommendations, and breastfeeding duration. It is still debated the impact of early exposure to cow's milk on the increase of allergic diseases, mainly food allergy, and atopic dermatitis. Many factors may play a role in this potential link, such as genetic variation, parental atopy, infant feeding regimens. Recent evidences suggest that the early introduction of complementary foods (up to 6 months of age), including cow's milk, could prevent the development of food allergies. So, several countries included this new approach into feeding guidelines. Our review will focus on the influence of early exposure to cow's milk formula on the development of allergic diseases. Some trials found that cow's milk supplementation in the first days of life could even increase the development of IgE sensitization and food allergies. Other trials did not show any efficacy on prevention of allergic disorders. Further studies are needed to understand the prospective for allergy prevention related to optimal timing of cow's milk formula introduction.
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Affiliation(s)
- Carla Mastrorilli
- UO Pediatria e Pronto Soccorso, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
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18
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Tham EH, Rajakulendran M, Lee BW, Van Bever HPS. Epicutaneous sensitization to food allergens in atopic dermatitis: What do we know? Pediatr Allergy Immunol 2020; 31:7-18. [PMID: 31541586 DOI: 10.1111/pai.13127] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/05/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease mainly affecting children, which has no definitive curative therapy apart from natural outgrowing. AD is persistent in 30%-40% of children. Epithelial barrier dysfunction in AD is a significant risk factor for the development of epicutaneous food sensitization, food allergy, and other allergic disorders. There is evidence that prophylactic emollient applications from birth may be useful for primary prevention of AD, but biomarkers are needed to guide cost-effective targeted therapy for high-risk individuals. In established early-onset AD, secondary preventive strategies are needed to attenuate progression to other allergic disorders such as food allergy, asthma, and allergic rhinitis (the atopic march). This review aims to describe the mechanisms underpinning the development of epicutaneous sensitization to food allergens and progression to clinical food allergy; summarize current evidence for interventions to halt the progression from AD to food sensitization and clinical food allergy; and highlight unmet needs and directions for future research.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Mohana Rajakulendran
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hugo P S Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
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19
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Corica D, Aversa T, Caminiti L, Lombardo F, Wasniewska M, Pajno GB. Nutrition and Avoidance Diets in Children With Food Allergy. Front Pediatr 2020; 8:518. [PMID: 33014926 PMCID: PMC7498536 DOI: 10.3389/fped.2020.00518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022] Open
Abstract
Food allergy (FA) is a significant health issue which considerably influences the quality of life of both children and their family. The increasing prevalence of FA, documented in the last 3 decades, has led to the reassessment of FA prevention strategies and particularly to giving up the approach based on delaying the introduction of potential food allergens. Several observational and interventional studies demonstrated a potential effectiveness of the early food introduction strategy in FA prevention, although strong evidence from randomized controlled trials are lacking and, sometimes, contrasting. The current approach to FA is mainly based on avoidance diet and the use of rescue medications in case of allergic reaction, although active allergen immunotherapy has recently become an increasingly important therapeutic strategy to approach IgE-mediated FA, potentially able to induce improvement through desensitization to a specific food. This review provides an overview on the historical evolution of recommendations about FA and on evidence published in the last 15 years on nutritional intervention strategy, i.e., early introduction of allergen or avoidance diet, in the prevention and management of IgE-mediated and non-IgE-mediated FA in children.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Lucia Caminiti
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
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20
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Ohya Y. Current research gaps and unmet clinical needs in food allergy. Allergol Int 2020; 69:1-2. [PMID: 31888860 DOI: 10.1016/j.alit.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 10/25/2022] Open
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21
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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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22
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Burgess JA, Dharmage SC, Allen K, Koplin J, Garcia-Larsen V, Boyle R, Waidyatillake N, Lodge CJ. Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:754-769. [PMID: 30861244 DOI: 10.1111/cea.13383] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/11/2018] [Accepted: 02/11/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. METHODS Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-analysis. RESULTS Cohort studies-Introducing complementary solids at age ≥ 4 months vs <4 months was not associated with food allergy (OR 1.22; 95% CI, 0.76-1.96) but was associated with food sensitization (OR 1.93; 95% CI 1.57-2.38). First exposure from age 4 to 6 months vs <4 months was not associated with food allergy (OR 1.01; 95% CI, 0.64-1.60) but was associated with food sensitization (OR 2.46; 95% CI 1.55-3.86). Randomized controlled trials-Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95% CI, 0.44-0.90) and sensitization (OR 0.76, 95% CI, 0.51-0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95% CI 0.14-0.57). CONCLUSIONS We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4 to 6 months and peanut from 4 to 11 months reduced the risk of egg allergy, peanut allergy and egg sensitization. PROSPERO systematic review registry (CRD42016033473).
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Affiliation(s)
- John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina Allen
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert Boyle
- Department of Paediatric Allergy, Imperial College London, London, UK
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Irahara M, Shinahara W, Sugimoto M, Ogawa Y, Shitsukawa K, Kubota K, Yang L, Ohya Y, Saito H, Kagami S, Arisawa K, Kido H. Trajectories of class-switching-related egg and cow's milk allergen-specific immunoglobulin isotype formation and its modification by eczema with low- and high-affinity immunoglobulin E during early infancy. IMMUNITY INFLAMMATION AND DISEASE 2019; 7:74-85. [PMID: 30859748 PMCID: PMC6485699 DOI: 10.1002/iid3.245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Allergen-specific immunoglobulin isotype formation associated with immunoglobulin class-switching during the lactation period is the immunological background for food allergy in infants. We analyzed the serial changes in the production of feeding type-related egg- and milk-specific immunoglobulin isotypes from birth to 6 months of age with or without eczema in 84 infants. METHODS Allergen-specific immunoglobulin G1 (IgG1), IgG2, IgG3, IgG4, IgA, and IgE levels of hen's egg and bovine milk were measured in cord blood and blood samples from infants at 2, 4, and 6 months of age by the densely carboxylated protein microarray. RESULTS Formula and mixed feeding were associated with a rapid increase in cow's milk allergen-specific immunoglobulins and feeding type-related significant differences in casein-specific immunoglobulin levels were detected. Breast and mixed feeding were associated with slow but significant increase in ovalbumin-specific IgG1 and IgE levels, but not other immunoglobulins. We found two different immunoglobulin isotype formation at 6 months of age with low- or high-affinity IgE against ovalbumin. One isotype formation pattern had relatively high ovalbumin-specific IgG1 levels, detectable IgG2, and low-affinity IgE, while the other had low ovalbumin-specific IgG1 levels, undetectable IgG2, and high levels of high-affinity IgE. The incidence of eczema was significantly higher in the latter pattern (84.6%), compared with the remaining infants (42.2%). CONCLUSIONS Feeding practice-related allergen sensitization and immunoglobulin isotype formation were identified during the lactation period. The development of eczema during the lactation period could potentially modify the immunoglobulin isotype formation with high levels of high-affinity IgE.
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Affiliation(s)
- Makoto Irahara
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan.,Department of Pediatrics, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Wakako Shinahara
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
| | - Mayumi Sugimoto
- Department of Pediatrics, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yukiko Ogawa
- Department of Pediatrics, Tokushima Prefecture Naruto Hospital, Naruto, Tokushima, Japan
| | - Keiji Shitsukawa
- Department of Obstetrics and Gynecology, Tokushima Prefecture Naruto Hospital, Naruto, Tokushima, Japan
| | - Kenji Kubota
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
| | - Limin Yang
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Yukihiro Ohya
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Hirohisa Saito
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Shoji Kagami
- Department of Pediatrics, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Kido
- Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima, Japan
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24
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Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the life span: a systematic review. Am J Clin Nutr 2019; 109:772S-799S. [PMID: 30982870 PMCID: PMC6500928 DOI: 10.1093/ajcn/nqy283] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the USDA and Department of Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding prior to infant formula introduction, 4) feeding a lower versus higher intensity of human milk to mixed-fed infants, and 5) feeding a higher intensity of human milk by bottle versus breast with food allergies, allergic rhinitis, atopic dermatitis, and asthma. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published between January 1980 and March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS The systematic reviews numbered 1-5 above included 44, 35, 1, 0, and 0 articles, respectively. Moderate, mostly observational, evidence suggests that 1) never versus ever being fed human milk is associated with higher risk of childhood asthma, and 2) among children and adolescents who were fed human milk as infants, shorter versus longer durations of any human milk feeding are associated with higher risk of asthma. Limited evidence does not suggest associations between 1) never versus ever being fed human milk and atopic dermatitis in childhood or 2) the duration of any human milk feeding and allergic rhinitis and atopic dermatitis in childhood. CONCLUSIONS Moderate evidence suggests that feeding human milk for short durations or not at all is associated with higher childhood asthma risk. Evidence on food allergies, allergic rhinitis, and atopic dermatitis is limited.
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Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA,Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Ekhard E Ziegler
- Panum Group, Bethesda, MD,Department of Pediatrics, The University of Iowa, Iowa City, IA
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25
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Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr 2019; 109:890S-934S. [PMID: 30982864 DOI: 10.1093/ajcn/nqy220] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.
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Affiliation(s)
| | | | | | - Nancy F Butte
- USDA-Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
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26
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Selby A, Munro A, Grimshaw KE, Cornelius V, Keil T, Grabenhenrich L, Clausen M, Dubakiene R, Fiocchi A, Kowalski ML, Papadopoulos NG, Reche M, Sigurdardottir ST, Sprikkelman AB, Xepapadaki P, Mills ENC, Beyer K, Roberts G. Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort. Thorax 2018; 73:1049-1061. [PMID: 29748253 DOI: 10.1136/thoraxjnl-2016-209429] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preschool wheeze is an important problem worldwide. No comparative population-based studies covering different countries have previously been undertaken. OBJECTIVE To assess the prevalence of early childhood wheeze across Europe and evaluate risk factors focusing on food allergy, breast feeding and smoke exposure. METHODS Infants from nine countries were recruited into the EuroPrevall birth cohort. At 12 and 24 months, data on wheeze, allergic signs/symptoms, feeding, smoke exposure, infections and day care attendance were collected using questionnaires. Poisson regression was used to assess risk factors for wheeze. RESULTS 12 049 infants were recruited. Data from the second year of life were available in 8805 (73.1%). The prevalence of wheeze in the second year of life ranged from <2% in Lodz (Poland) and Vilnius (Lithuania) to 13.1% (95% CI 10.7% to 15.5%) in Southampton (UK) and 17.2% (95% CI 15.0% 19.5%) in Reykjavik (Iceland). In multivariable analysis, frequent lower respiratory tract infections in the first and second years of life (incidence rate ratio (IRR) 1.9 (95% CI 1.3 to 2.6) and 2.5 (95% CI 1.9 to3.4), respectively), postnatal maternal smoking (IRR 1.6, 95% CI 1.1 to 2.4), day care attendance (IRR 1.6, 95% CI 1.1 to 2.5) and male gender (IRR 1.3, 95% CI 1.0 to 1.7) were associated with wheeze. The strength of their association with wheeze differed between countries. Food allergy and breast feeding were not independently associated with wheeze. CONCLUSION The prevalence of early childhood wheeze varied considerably across Europe. Lower respiratory tract infections, day care attendance, postnatal smoke exposure and male gender are important risk factors. Further research is needed to identify additional modifiable risk factors that may differ between countries.
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Affiliation(s)
- Anna Selby
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alasdair Munro
- Department of Paediatrics, Royal Hampshire County Hospital, Winchester, UK
| | - Kate E Grimshaw
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany
| | - Linus Grabenhenrich
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Department for Dermatology, Venerology and Allergology, Charité University Medical Centre, Berlin, Germany
| | - Michael Clausen
- Children's Hospital, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ruta Dubakiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Nikolaos G Papadopoulos
- Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece.,Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - Marta Reche
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Aline B Sprikkelman
- Department of Pediatric Pulmonology and Allergology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - E N Clare Mills
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Kirsten Beyer
- Department of Paediatric Pulmonology and Immunology, Charité University Medical Centre, Berlin, Germany
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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27
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Waidyatillake NT, Dharmage SC, Allen KJ, Bowatte G, Boyle RJ, Burgess JA, Koplin JJ, Garcia-Larsen V, Lowe AJ, Lodge CJ. Association between the age of solid food introduction and eczema: A systematic review and a meta-analysis. Clin Exp Allergy 2018; 48:1000-1015. [PMID: 29570230 DOI: 10.1111/cea.13140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/25/2018] [Accepted: 03/03/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed. METHODS PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure. RESULTS A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, 2 case-controls, 1 cross-sectional study and 2 randomized controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema. CONCLUSIONS The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema.
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Affiliation(s)
- N T Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - K J Allen
- Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - G Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - R J Boyle
- Section of Paediatrics, Imperial College London, London, UK
| | - J A Burgess
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J J Koplin
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Food and Allergy Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - V Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
| | - C J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch, Childrens Research Institute, Parkville, VIC, Australia
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28
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Fortson EA, Li B, Bhayana M. Introduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1027:1-10. [PMID: 29063426 DOI: 10.1007/978-3-319-64804-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing condition that is characterized by itching and redness of the skin. Our modern usage of atopic dermatitis dates back to 1933, when Wise and Sulzberger first coined the term to signify the disease's close association with other respiratory atopy, such as bronchial asthma and allergic rhinitis. A recent systematic review of 69 cross-sectional and cohort studies has confirmed that AD is now a worldwide phenomenon with lifetime AD prevalences of well over 20% in many affluent country settings. Although there is no obvious consistent overall global trend in the prevalence of AD, studies have shown that climate, urbanization, lifestyle, and socioeconomic class influence the prevalence of atopic dermatitis. Despite the pervasiveness of the disease, an understanding of atopic dermatitis has been hampered by a number of factors. Data suggests that extrinsic environmental factors work in concert with intrinsic immune mechanism and genetic factors to drive disease progression. With such a complex etiology, management of atopic dermatitis currently at best achieves symptomatic control rather than cure. This approach poses a significant burden on healthcare resources, as well as patients' quality of life. Current management methods of AD often involves a combination of non-pharmacologic modalities and prescription medications. Though they can be effective when employed, there are significant barriers to treatment for patients including time, costs, and medication side effects. Our aim, throughout this text, is to explore the complexities of AD, providing the healthcare provider with tips and tricks to improve patient care and satisfaction and the most current trends and treatment approaches on the horizon.
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Affiliation(s)
- Erica A Fortson
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
| | - Becky Li
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Mahima Bhayana
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
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29
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Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: the PIAMA birth cohort study. Eur J Nutr 2018; 57:1985-1993. [PMID: 29470690 PMCID: PMC6060808 DOI: 10.1007/s00394-018-1639-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/17/2018] [Indexed: 12/03/2022]
Abstract
Purpose To investigate whether early introduction of complementary foods (CF) is associated with an increased risk of overweight during childhood, and whether this association differs between formula-fed and breastfed infants. Methods We included 2611 participants that were born at term from a Dutch population-based birth cohort (n = 3963) designed to investigate the development of asthma and allergies. Parents kept records of their infant’s age when CF were first introduced. Weight and height were parent reported yearly from age 1 to 8 years, and at ages 11, 14 and 17 years. We used multivariate generalized estimating equations analysis to investigate the association between timing of CF introduction (before 4 months vs at or after 4 months of age) and overweight at ages 1–17 years. Results Children with CF introduction before 4 months had higher odds of being overweight during childhood than children with CF introduction at or after 4 months (OR 1.32, 95% CI 1.19, 1.47). This association was observed in formula-fed infants (OR 1.51, 95% CI 1.17, 1.94) and breastfed infants (OR 1.32, 95% CI 1.19, 1.47). The duration of breastfeeding modified the association between CF introduction and overweight: children breastfed for shorter than 4 months, but not children breastfed for 4 months or longer with CF introduction before 4 months had higher odds of being overweight (OR 1.37, 95% CI 1.19, 1.57 and 1.07, 95% CI 0.87, 1.32, respectively), compared to those with CF introduction at or after 4 months. Conclusions In children born at term, formula-fed infants and infants who were breastfed for shorter than 4 months, but not infants who were breastfed for 4 months or longer, had a higher risk of being overweight during childhood when being introduced to CF before 4 months of age. Electronic supplementary material The online version of this article (10.1007/s00394-018-1639-8) contains supplementary material, which is available to authorized users.
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30
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Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction. J Allergy Clin Immunol 2017; 141:620-625.e1. [PMID: 28916221 DOI: 10.1016/j.jaci.2017.06.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent trials have shown that avoiding peanuts during infancy increases the risk of peanut allergy; however, these studies did not address maternal peanut consumption. OBJECTIVE We sought to investigate the relationship between maternal peanut consumption while breast-feeding, timing of direct peanut introduction, and peanut sensitization at age 7 years. METHODS Secondary analysis of a nested cohort within the 1995 Canadian Asthma Primary Prevention Study intervention study was performed. Breast-feeding and maternal and infant peanut consumption were captured by repeated questionnaires during infancy. Skin prick testing for peanut sensitization was performed at age 7 years. RESULTS Overall, 58.2% of mothers consumed peanuts while breast-feeding and 22.5% directly introduced peanuts to their infant by 12 months. At 7 years, 9.4% of children were sensitized to peanuts. The lowest incidence (1.7%) was observed among children whose mothers consumed peanuts while breast-feeding and directly introduced peanuts before 12 months. Incidence was significantly higher (P < .05) if mothers consumed peanuts while breast-feeding but delayed introducing peanuts to their infant beyond 12 months (15.1%), or if mothers avoided peanuts themselves but directly introduced peanuts by 12 months (17.6%). Interaction analyses controlling for study group and maternal atopy confirmed that maternal peanut consumption while breast-feeding and infant peanut consumption by 12 months were protective in combination, whereas either exposure in isolation was associated with an increased risk of sensitization (P interaction = .003). CONCLUSIONS In this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.
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Larson K, McLaughlin J, Stonehouse M, Young B, Haglund K. Introducing Allergenic Food into Infants' Diets: Systematic Review. MCN Am J Matern Child Nurs 2017; 42:72-80. [PMID: 27879501 DOI: 10.1097/nmc.0000000000000313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to explore the association between timing of introduction of potentially allergenic foods to infants and development of food allergies. METHODS CINAHL, Medline, PubMed, Science Direct, and Web of Science were searched using the terms solid food, complementary food, or infant feeding combined with allergy or hypersensitivity for articles published in English in 2000 or later. Inclusion criteria were 1) primary research articles with 2) a focus on association between introduction of complementary foods including potentially allergenic foods into diets of infants less than 12 months of age and development of food allergies. Articles were excluded if they were 1) not primary research, 2) about complementary foods only (without specificity of allergenic foods), or 3) on allergic conditions other than food allergy (such as asthma or eczema). RESULTS The initial literature search yielded 533 articles; 14 articles met inclusion criteria. Level of evidence of each study was determined with the SORT criteria. Results found that delayed introduction of solid foods in general and allergenic foods in particular was not associated with decreased risk for allergic diseases among high and low-risk infants. Later introduction was associated with increased risk for allergy development. CLINICAL IMPLICATIONS For infants at low risk for development of food allergies, providers should advise caregivers to introduce potentially allergenic foods with other solid foods between 4 and 6 months of age when children show an interest in eating solids. Infants at high risk for peanut allergy, should be evaluated by an allergy specialist prior to introduction of peanuts and work with providers to create an individualized plan for introduction of peanuts and other allergenic foods as needed.
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Affiliation(s)
- Katelin Larson
- Katelin Larson is a Pediatric Nurse Practitioner, Olympia Pediatrics, Olympia, WA. Jessica McLaughlin is a Pediatric Nurse Practitioner, School Health Clinics of Santa Clara County, San Jose, CA. Mallory Stonehouse is a Graduate Student, Marquette University College of Nursing, Milwaukee, WI. Brittany Young is a Graduate Student, Marquette University College of Nursing, Milwaukee, WI. Kristin Haglund is an Associate Professor, Pediatric Nurse Practitioner, Marquette University College of Nursing, Milwaukee, WI. She can be reached at
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32
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Role of Microbial Modulation in Management of Atopic Dermatitis in Children. Nutrients 2017; 9:nu9080854. [PMID: 28792444 PMCID: PMC5579647 DOI: 10.3390/nu9080854] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
Abstract
The pathophysiology of atopic dermatitis (AD) is multifactorial and is a complex interrelationship between skin barrier, genetic predisposition, immunologic development, skin microbiome, environmental, nutritional, pharmacological, and psychological factors. Several microbial modulations of the intestinal microbiome with pre- and/or probiotics have been used in AD management, with different clinical out-come (both positive, as well as null findings). This review provides an overview of the clinical evidence from trials in children from 2008 to 2017, aiming to evaluate the effect of dietary interventions with pre- and/or pro-biotics for the treatment of AD. By searching the PUBMED/MEDLINE, EMBADE, and COCHRANE databases 14 clinical studies were selected and included within this review. Data extraction was independently conducted by two authors. The primary outcome was an improvement in the clinical score of AD severity. Changes of serum immunological markers and/or gastrointestinal symptoms were explored if available. In these studies some dietary interventions with pre- and/or pro-biotics were beneficial compared to control diets in the management of AD in children, next to treatment with emollients, and/or local corticosteroids. However, heterogeneity between studies was high, making it clear that focused clinical randomized controlled trials are needed to understand the potential role and underlying mechanism of dietary interventions in children with AD.
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Tran MM, Lefebvre DL, Dai D, Dharma C, Subbarao P, Lou W, Azad MB, Becker AB, Mandhane PJ, Turvey SE, Sears MR. Timing of food introduction and development of food sensitization in a prospective birth cohort. Pediatr Allergy Immunol 2017; 28:471-477. [PMID: 28557044 DOI: 10.1111/pai.12739] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effect of infant feeding practices on the development of food allergy remains controversial. We examined the relationship between timing and patterns of food introduction and sensitization to foods at age 1 year in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study. METHODS Nutrition questionnaire data prospectively collected at age 3, 6, 12, 18, and 24 months were used to determine timing of introduction of cow's milk products, egg, and peanut. At age 1 year, infants underwent skin prick testing to cow's milk, egg white, and peanut. Logistic regression models were fitted to assess the impact of timing of food exposures on sensitization outcomes, and latent class analysis was used to study patterns of food introduction within the cohort. RESULTS Among 2124 children with sufficient data, delaying introduction of cow's milk products, egg, and peanut beyond the first year of life significantly increased the odds of sensitization to that food (cow's milk adjOR 3.69, 95% CI 1.37-9.08; egg adjOR 1.89, 95% CI 1.25-2.80; peanut adjOR 1.76, 95% CI 1.07-3.01). Latent class analysis produced a three-class model: early, usual, and delayed introduction. A pattern of delayed introduction, characterized by avoidance of egg and peanut during the first year of life, increased the odds of sensitization to any of the three tested foods (adjOR 1.78, 95% CI 1.26-2.49). CONCLUSIONS Avoidance of potentially allergenic foods during the first year of life significantly increased the odds of sensitization to the corresponding foods.
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Affiliation(s)
- Maxwell M Tran
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David Dai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Meghan B Azad
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Allan B Becker
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Verduci E, Martelli A, Miniello VL, Landi M, Mariani B, Brambilla M, Diaferio L, Peroni DG. Nutrition in the first 1000 days and respiratory health: A descriptive review of the last five years' literature. Allergol Immunopathol (Madr) 2017; 45:405-413. [PMID: 28411961 DOI: 10.1016/j.aller.2017.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/19/2022]
Abstract
The aim of this paper is to discuss the current evidence regarding short and long-term health respiratory effects of nutrients and dietary patterns during the first 1000 days from conception. Population of interest included children from birth to two years and their mothers (during pregnancy and lactation). Studies were searched on MEDLINE® and Cochrane database, inserting individually and using the Boolean ANDs and ORs, 'nutrients', 'micronutrients', 'LC-PUFA', 'Mediterranean Diet', 'human milk', 'complementary food', 'pregnancy', 'respiratory disease', 'pulmonary disease', 'asthma', 'epigenetics', 'first 1000 days', 'maternal diet' and 'respiratory health'. All sources were retrieved between 01-09-2015 and 07-12-2016. While unhealthy maternal dietary patterns (high fat intake) during pregnancy can result in alteration of foetal lung development, with increased risk of respiratory disorders, Mediterranean diet has been associated with a lower risk of allergic sensitisation and allergic rhinitis. Breastfeeding has beneficial effects on respiratory infections while evidences about its protective effect on allergic disorders are unclear. During complementary feeding there is no evidence to avoid or encourage exposition to 'highly allergenic' foods to have modification of tolerance development. In children from birth to two years of age, Mediterranean diet has been associated with a lower risk of atopy, wheezing and asthma. Micronutrients, antioxidant and LCPUFA supplementation is not recommended and a whole food approach should be preferred, except for Vitamin D.
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Affiliation(s)
- E Verduci
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy.
| | - A Martelli
- Paediatric Unit, Garbagnate Hospital, Garbagnate, Italy
| | - V L Miniello
- Department of Paediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari, Italy
| | - M Landi
- Primary Care Paediatrics, Turin, Italy; Unit Research of Paediatric Pulmonology and Allergy, Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - B Mariani
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - M Brambilla
- Department of Paediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Italy
| | - L Diaferio
- Department of Paediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari, Italy
| | - D G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Italy
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35
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Du Toit G, Foong RX, Lack G. The role of dietary interventions in the prevention of IgE-mediated food allergy in children. Pediatr Allergy Immunol 2017; 28:222-229. [PMID: 28258631 DOI: 10.1111/pai.12711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
Over the last 30 years, the prevalence of food allergy has been on the rise and remains a disease that can have a significant impact on the quality of life of children and their families. There are several hypotheses that have been suggested to account for the increasing prevalence, but this review will focus on the impact that dietary factors have on food allergy development. In the past food allergy, prevalence has largely focused on allergen avoidance; however, there is increasing evidence from interventional studies that have shown that early introduction to potential food allergens may have a beneficial role in allergy prevention. This review aims to look at the evidence in support of early introduction of allergens into infant diets to prevent against the development of food allergy.
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Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ru-Xin Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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36
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Palmer DJ, Prescott SL, Perkin MR. Early introduction of food reduces food allergy - Pro and Con. Pediatr Allergy Immunol 2017; 28:214-221. [PMID: 28039897 DOI: 10.1111/pai.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Perth, WA, Australia
| | - Susan L Prescott
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), Perth, WA, Australia
| | - Michael R Perkin
- Population Health Research Institute, St George's, University of London, London, UK
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Grimshaw K, Logan K, O'Donovan S, Kiely M, Patient K, van Bilsen J, Beyer K, Campbell DE, Garcia-Larsen V, Grabenhenrich L, Lack G, Mills C, Wal JM, Roberts G. Modifying the infant's diet to prevent food allergy. Arch Dis Child 2017; 102:179-186. [PMID: 27530541 DOI: 10.1136/archdischild-2015-309770] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 07/02/2016] [Accepted: 07/24/2016] [Indexed: 01/03/2023]
Abstract
Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals. The review was undertaken as part of the European Union funded Integrated Approaches to Food Allergy and Allergen Management (iFAAM) study. This is a wide ranging project bringing together expertise across the breadth of food allergy research. Specifically, the review discusses dietary manipulation in food allergy prevention, and covers the possible preventive strategies of allergen avoidance, early allergen introduction, general nutrition and supplements, as well as other strategies, such as prebiotics and probiotics. The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4-6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic.
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Affiliation(s)
- Kate Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kirsty Logan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sinead O'Donovan
- Vitamin D Research Group, School of Food and Nutritional Science, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Vitamin D Research Group, School of Food and Nutritional Science, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | | | | | - Kirsten Beyer
- Charite-Universitatsmedizin Berlin, Department of Paediatric Pneumology & Immunology, Berlin, Germany
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney University, Sydney, New South Wales, Australia
| | - Vanessa Garcia-Larsen
- Respiratory Epidemiology, Occupational Medicine and Public Health Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Linus Grabenhenrich
- Charite-Universitatsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Gideon Lack
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, UK
| | - Clare Mills
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Drug nanocarrier, the future of atopic diseases: Advanced drug delivery systems and smart management of disease. Colloids Surf B Biointerfaces 2016; 147:475-491. [DOI: 10.1016/j.colsurfb.2016.08.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022]
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39
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Du Toit G, Foong RXM, Lack G. Prevention of food allergy - Early dietary interventions. Allergol Int 2016; 65:370-377. [PMID: 27617655 DOI: 10.1016/j.alit.2016.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022] Open
Abstract
The prevalence of food allergy has increased over the last 30 years and remains a disease, which significantly impacts on the quality of life of children and their families. Several hypotheses have been formulated to explain the increasing prevalence; this review will focus on the hypothesis that dietary factors may influence the development of food allergy. Historically, the prevention of food allergy has focused on allergen avoidance. However, recent findings from interventional studies have prompted a shift in the mind set from avoidance to early introduction of potentially allergenic foods. This review aims to facilitate a better understanding of contemporary research studies that make use of early introduction of common allergenic foods into infant diets as a preventative strategy against the development of food allergy.
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40
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Palmer DJ. Timing of Introduction of Solids and Early-Onset Allergic Disease. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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di Mauro G, Bernardini R, Barberi S, Capuano A, Correra A, de’ Angelis GL, Iacono ID, de Martino M, Ghiglioni D, Di Mauro D, Giovannini M, Landi M, Marseglia GL, Martelli A, Miniello VL, Peroni D, Sullo LRMG, Terracciano L, Vascone C, Verduci E, Verga MC, Chiappini E. Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics. World Allergy Organ J 2016; 9:28. [PMID: 27583103 PMCID: PMC4989298 DOI: 10.1186/s40413-016-0111-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/07/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Allergic sensitization in children and allergic diseases arising therefrom are increasing for decades. Several interventions, functional foods, pro- and prebiotics, vitamins are proposed for the prevention of allergies and they can't be uncritically adopted. OBJECTIVE This Consensus document was developed by the Italian Society of Preventive and Social Paediatrics and the Italian Society of Paediatric Allergy and Immunology. The aim is to provide updated recommendations regarding allergy prevention in children. METHODS The document has been issued by a multidisciplinary expert panel and it is intended to be mainly directed to primary care paediatricians. It includes 19 questions which have been preliminarily considered relevant by the panel. Relatively to each question, a literature search has been performed, according to the Italian National Guideline Program. Methodology, and a brief summary of the available literature data, has been provided. Many topics have been analyzed including the role of mother's diet restriction, use of breast/formula/hydrolyzed milk; timing of introduction of complementary foods, role (if any) of probiotics, prebiotics, vitamins, exposure to dust mites, animals and to tobacco smoke. RESULTS Some preventive interventions have a strong level of recommendation. (e.g., the dehumidifier to reduce exposure to mite allergens). With regard to other types of intervention, such as the use of partially and extensively hydrolyzed formulas, the document underlines the lack of evidence of effectiveness. No preventive effect of dietary supplementation with polyunsaturated fatty acids, vitamins or minerals has been demonstrated. There is no preventive effect of probiotics on asthma, rhinitis and allergic diseases. It has demonstrated a modest effect, but steady, in the prevention of atopic dermatitis. CONCLUSIONS The recommendations of the Consensus are based on a careful analysis of the evidence available. The lack of evidence of efficacy does not necessarily imply that some interventions may not be effective, but currently they can't be recommended.
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Affiliation(s)
- Giuseppe di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Roberto Bernardini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Salvatore Barberi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Annalisa Capuano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Antonio Correra
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi de’ Angelis
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Iride Dello Iacono
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maurizio de Martino
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Daniele Ghiglioni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Dora Di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Marcello Giovannini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Massimo Landi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi Marseglia
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Alberto Martelli
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Vito Leonardo Miniello
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Diego Peroni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Lucilla Ricottini Maria Giuseppa Sullo
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Luigi Terracciano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Cristina Vascone
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elvira Verduci
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maria Carmen Verga
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elena Chiappini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
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Turati F, Bertuccio P, Galeone C, Pelucchi C, Naldi L, Bach JF, La Vecchia C, Chatenoud L. Early weaning is beneficial to prevent atopic dermatitis occurrence in young children. Allergy 2016; 71:878-88. [PMID: 26893011 DOI: 10.1111/all.12864] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epidemiological data on infant feeding practices and allergic diseases are controversial. The purpose of this study was to explore the association of early weaning with the occurrence of atopic dermatitis (AD). METHODS We conducted a matched case-control study on incident physician-diagnosed AD in early childhood including 451 cases and 451 controls. Data on several factors, including feeding practices, were collected through an interviewer-administered questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated through logistic regression models, conditioned on study center, age, sex, and period of interview, and adjusted for potential confounders. RESULTS Early weaning, defined as the introduction of solid foods at 4 or 5 months of age, was inversely related to the risk of AD, with children weaned at 4 months having lower AD risk (OR = 0.41, 95% CI, 0.20-0.87) compared to those exclusively breastfed. Similar results were observed for weaning started at 5 months of age (OR = 0.39, 95% CI, 0.18-0.83). This association persisted when children with and without family history of allergy were considered separately. Prolonged partial breastfeeding (breastmilk plus milk formulas) was not associated with AD. Consistently, the introduction of a high number of different solid foods reduced the risk of AD (P trend = 0.02 at 4 months of age and P trend = 0.04 at 5 months). CONCLUSION Our data provide evidence against the preventing role of prolonged exclusive (but not partial) breastfeeding in AD occurrence and confirm recent results indicating a beneficial role of early weaning in AD.
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Affiliation(s)
- F. Turati
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - P. Bertuccio
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - C. Galeone
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - C. Pelucchi
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - L. Naldi
- Department of Dermatology; Azienda Ospedaliera Papa Giovanni XXIII; Centro Studi GISED; Bergamo Italy
| | - J.-F. Bach
- Université Paris Descartes; 75015 Paris France
- INSERM, Unité 1151; Paris France
| | - C. La Vecchia
- Department of Clinical Sciences and Community Health; Università degli Studi di Milano; Milan Italy
| | - L. Chatenoud
- Department of Epidemiology - IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
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Hartman H, Dodd C, Rao M, DeBlasio D, Labowsky C, D'Souza S, Lenkauskas S, Roeser E, Heffernan A, Assa'ad A. Parental timing of allergenic food introduction in urban and suburban populations. Ann Allergy Asthma Immunol 2016; 117:56-60.e2. [PMID: 27184198 DOI: 10.1016/j.anai.2016.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Recommendations on timing for introduction of allergenic foods in an infant diet have changed twice during the past decade. How families with different demographic characteristics implement the change has not been studied in the United States. OBJECTIVE To compare the age of introduction of allergenic foods between an urban Medicaid-based population and a suburban private insurance-based population in Cincinnati, Ohio. METHODS Two hundred parent surveys were distributed at well-child checkups between 4 and 36 months of age. Data were analyzed using distribution mapping to determine the difference in the age of introduction of infant formula, infant solids, whole cow's milk, eggs, peanut, and fish. Random forest analysis was used to determine the most important factors affecting the age of introduction for both populations. RESULTS There was no statistically significant difference in the age of infant solid introduction, but urban populations introduced allergenic foods earlier than suburban populations, with a statistically significant difference in the age of introduction of infant formula, whole cow's milk, eggs, peanut, and fish. The most important factor for the timing of all food introductions was the recommended age of introduction from health care professionals. CONCLUSION There is a difference between urban and suburban populations in the timing of introduction of allergenic foods but not in other infant solid foods. The reliance on physician recommendation for both populations supports the need for education and guidance to health care professionals on up-to-date guidance and recommendations.
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Affiliation(s)
- Heather Hartman
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitlin Dodd
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marepalli Rao
- Center for Clinical and Translational Science and Training, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, Ohio
| | - Dominick DeBlasio
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. amal.assa'
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Vega F, Panizo C, Dordal M, González M, Velázquez E, Valero A, Sánchez M, Rondón C, Montoro J, Matheu V, Lluch-Bernal M, González R, Fernández-Parra B, Del Cuvillo A, Dávila I, Colás C, Campo P, Antón E, Navarro A. Relationship between respiratory and food allergy and evaluation of preventive measures. Allergol Immunopathol (Madr) 2016; 44:263-75. [PMID: 26316421 DOI: 10.1016/j.aller.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 01/24/2023]
Abstract
Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions.
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Abstract
PURPOSE OF REVIEW The paradigm for the primary prevention of peanut allergy was, until recently, strict avoidance of peanut during pregnancy, infancy, and early childhood. However, in countries that had these dietary guidelines, the prevalence of peanut allergy greatly increased in contrast to low prevalence rates of peanut allergy in countries where infant diets included peanut at an early age, suggesting the hypothesis that early introduction of peanut is superior to delayed introduction of peanut as a strategy for the primary prevention of food allergy. This review examines recent high-quality studies that support this hypothesis. RECENT FINDINGS Publication of the Learning Early about Allergy to Peanut interventional trial showed that 17% of children avoiding peanut until 5 years of age developed peanut allergy compared with 3% of children who started eating peanut at ages of 4-11 months. Two birth cohort studies demonstrated that high maternal consumption of peanut during the pregnancy period reduced the risk of peanut allergy in offspring by 50-75%. SUMMARY Recent studies indicate that early introduction of peanut enhances the development of tolerance to peanut, reducing the risk of childhood peanut allergy.
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Affiliation(s)
- Elissa M Abrams
- Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man.
| | - Allan B Becker
- Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man
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48
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Heratizadeh A, Werfel T. Prävention der atopischen Dermatitis. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koplin JJ, Suaini NHA, Vuillermin P, Ellis JA, Panjari M, Ponsonby AL, Peters RL, Matheson MC, Martino D, Dang T, Osborne NJ, Martin P, Lowe A, Gurrin LC, Tang MLK, Wake M, Dwyer T, Hopper J, Dharmage SC, Allen KJ. Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25[OH]D3) and food allergy. J Allergy Clin Immunol 2015; 137:500-506.e4. [PMID: 26260969 DOI: 10.1016/j.jaci.2015.05.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/17/2015] [Accepted: 05/14/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is evolving evidence that vitamin D insufficiency may contribute to food allergy, but findings vary between populations. Lower vitamin D-binding protein (DBP) levels increase the biological availability of serum vitamin D. Genetic polymorphisms explain almost 80% of the variation in binding protein levels. OBJECTIVE We sought to investigate whether polymorphisms that lower the DBP could compensate for adverse effects of low serum vitamin D on food allergy risk. METHODS From a population-based cohort study (n = 5276) we investigated the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and food allergy at age 1 year (338 challenge-proven food-allergic and 269 control participants) and age 2 years (55 participants with persistent and 50 participants with resolved food allergy). 25(OH)D3 levels were measured using liquid chromatography-tandem mass spectrometry and adjusted for season of blood draw. Analyses were stratified by genotype at rs7041 as a proxy marker of DBP levels (low, the GT/TT genotype; high, the GG genotype). RESULTS Low serum 25(OH)D3 level (≤50 nM/L) at age 1 years was associated with food allergy, particularly among infants with the GG genotype (odds ratio [OR], 6.0; 95% CI, 0.9-38.9) but not in those with GT/TT genotypes (OR, 0.7; 95% CI, 0.2-2.0; P interaction = .014). Maternal antenatal vitamin D supplementation was associated with less food allergy, particularly in infants with the GT/TT genotype (OR, 0.10; 95% CI, 0.03-0.41). Persistent vitamin D insufficiency increased the likelihood of persistent food allergy (OR, 12.6; 95% CI, 1.5-106.6), particularly in those with the GG genotype. CONCLUSIONS Polymorphisms associated with lower DBP level attenuated the association between low serum 25(OH)D3 level and food allergy, consistent with greater vitamin D bioavailability in those with a lower DBP level. This increases the biological plausibility of a role for vitamin D in the development of food allergy.
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Affiliation(s)
- Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Noor H A Suaini
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Peter Vuillermin
- Murdoch Childrens Research Institute, Parkville, Australia; Child Health Research Unit, Barwon Health and Deakin University, Geelong, Australia
| | - Justine A Ellis
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Mary Panjari
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel L Peters
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Melanie C Matheson
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - David Martino
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Thanh Dang
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
| | - Pamela Martin
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Adrian Lowe
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Lyle C Gurrin
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia
| | - Terry Dwyer
- Murdoch Childrens Research Institute, Parkville, Australia
| | - John Hopper
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Shyamali C Dharmage
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; School of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
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Abstract
PURPOSE OF REVIEW Allergic rhinitis is a highly prevalent inflammatory disease affecting 20-40% of the children worldwide. Allergen-specific immunotherapy (SIT) is an effective treatment for allergic rhinitis. This article reviews the recent advances in SIT for children. RECENT FINDINGS In current clinical practice, immunotherapy is delivered as either subcutaneous immunotherapy or sublingual immunotherapy (SLIT). Most meta-analyses and reviews concluded a trend that subcutaneous immunotherapy was better than SLIT in reducing symptoms of allergic rhinitis and rescue medication use, however, SLIT has a better safety profile than subcutaneous immunotherapy. Additionally, the absence of pain on administration of therapy is a character of SLIT, which is well suited for children. T regulatory cells, especially Tr1 cells that secrete interleukin-10 and induce production of immunoglobulin G4, play a role during SIT. SUMMARY Although there is substantial evidence for effectiveness of both subcutaneous immunotherapy and SLIT, safer and more effective SIT approaches are needed. New approaches to improve SIT include omalizumab pretreatment, use of recombinant allergens, and alternate routes of administration.
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