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Harvey NT, Palmer DJ, Tucker P, Chakera A, Foster R, Lim W, Trevithick RW, Wood BA. Histological predictors of outcome for cutaneous squamous cell carcinoma in renal transplant patients: A case-control study. JAAD Int 2024; 15:51-58. [PMID: 38371661 PMCID: PMC10869928 DOI: 10.1016/j.jdin.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 02/20/2024] Open
Abstract
Background Cutaneous squamous cell carcinoma is a significant cause of morbidity for immunosuppressed patients such as organ transplant recipients; however, histological parameters which predict the likelihood of tumor progression are typically based on general population studies in which immunosuppressed patients represent only a small fraction of cases. Objectives To determine the histological parameters which have independent prognostic value for cutaneous squamous cell carcinoma arising in renal transplant recipients. Methods Case-control study incorporating a retrospective blinded histological review of 70 archived specimens of cutaneous squamous cell carcinoma diagnosed in renal transplant recipients, comprising 10 cases where the tumor had progressed and 60 controls. Results Progression was significantly associated with head and neck location, size, depth, poor histological grade, perineural invasion (including small caliber perineural invasion), lymphovascular invasion, and a desmoplastic growth pattern. Limitations The retrospective nature and the low number of cases compared to controls. Conclusion In immunosuppressed patients both small caliber perineural invasion and a desmoplastic growth pattern may also have prognostic significance in addition to other histological parameters already recognized in formal staging schemes.
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Affiliation(s)
- Nathan T. Harvey
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Debra J. Palmer
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Paige Tucker
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Aron Chakera
- Renal Medicine and Transplantation, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Rachael Foster
- Dermatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Wai Lim
- Renal Medicine and Transplantation, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Benjamin A. Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
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Jones JM, Reinke SN, Mousavi-Derazmahalleh M, Garssen J, Jenmalm MC, Srinivasjois R, Silva D, Keelan J, Prescott SL, Palmer DJ, Christophersen CT. Maternal prebiotic supplementation during pregnancy and lactation modifies the microbiome and short chain fatty acid profile of both mother and infant. Clin Nutr 2024; 43:969-980. [PMID: 38452522 DOI: 10.1016/j.clnu.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND & AIMS Improving maternal gut health in pregnancy and lactation is a potential strategy to improve immune and metabolic health in offspring and curtail the rising rates of inflammatory diseases linked to alterations in gut microbiota. Here, we investigate the effects of a maternal prebiotic supplement (galacto-oligosaccharides and fructo-oligosaccharides), ingested daily from <21 weeks' gestation to six months' post-partum, in a double-blinded, randomised placebo-controlled trial. METHODS Stool samples were collected at multiple timepoints from 74 mother-infant pairs as part of a larger, double-blinded, randomised controlled allergy intervention trial. The participants were randomised to one of two groups; with one group receiving 14.2 g per day of prebiotic powder (galacto-oligosaccharides GOS and fructo-oligosaccharides FOS in ratio 9:1), and the other receiving a placebo powder consisting of 8.7 g per day of maltodextrin. The faecal microbiota of both mother and infants were assessed based on the analysis of bacterial 16S rRNA gene (V4 region) sequences, and short chain fatty acid (SCFA) concentrations in stool. RESULTS Significant differences in the maternal microbiota profiles between baseline and either 28-weeks' or 36-weeks' gestation were found in the prebiotic supplemented women. Infant microbial beta-diversity also significantly differed between prebiotic and placebo groups at 12-months of age. Supplementation was associated with increased abundance of commensal Bifidobacteria in the maternal microbiota, and a reduction in the abundance of Negativicutes in both maternal and infant microbiota. There were also changes in SCFA concentrations with maternal prebiotics supplementation, including significant differences in acetic acid concentration between intervention and control groups from 20 to 28-weeks' gestation. CONCLUSION Maternal prebiotic supplementation of 14.2 g per day GOS/FOS was found to favourably modify both the maternal and the developing infant gut microbiome. These results build on our understanding of the importance of maternal diet during pregnancy, and indicate that it is possible to intervene and modify the development of the infant microbiome by dietary modulation of the maternal gut microbiome.
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Affiliation(s)
- Jacquelyn M Jones
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA 6102, Australia; The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA 6027, Australia.
| | - Stacey N Reinke
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Mahsa Mousavi-Derazmahalleh
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, 3584 CS Utrecht, the Netherlands; Nutricia Research, 3584 CT Utrecht, the Netherlands
| | - Maria C Jenmalm
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Ravisha Srinivasjois
- Joondalup Health Campus, Joondalup, WA 6027, Australia; School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia
| | - Desiree Silva
- Joondalup Health Campus, Joondalup, WA 6027, Australia; School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia; School of Medical & Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Jeffrey Keelan
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia; School of Biomedical Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Susan L Prescott
- School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia; Department of Immunology and Dermatology, Perth Children's Hospital, Nedlands, WA 6009, Australia; Nova Institute for Health, Baltimore, MD 21231, USA
| | - Debra J Palmer
- School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia
| | - Claus T Christophersen
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA 6102, Australia; The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA 6027, Australia; Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA 6027, Australia.
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Stevens R, Gorman S, Arabiat D, Christophersen CT, Palmer DJ. Associations between sun exposure, skin pH, and epidermal permeability in pregnancy: A longitudinal observational study. Photochem Photobiol 2024. [PMID: 38339836 DOI: 10.1111/php.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Little is known about how sun exposure may affect the maternal skin barrier during pregnancy when many hormonal and physiological changes occur. In this longitudinal observational study, 50 pregnant women were recruited at 18-24 weeks' gestation, 25 in summer-autumn, and 25 in winter-spring. At three time points in pregnancy at 18-24, 28-30, and 36-38 weeks' gestation, participants completed a validated sun exposure questionnaire and had skin permeability and surface pH measured on the volar forearm. We identified an association between increased sun exposure and increased skin permeability at 18-24 weeks' gestation (β = 0.85, p = 0.01). Lower transepidermal water loss (decreased skin permeability), mean = 12.1 (SD = 5.1) at 28-30 weeks' gestation was observed, compared to mean = 12.6 (SD = 4.0) at 18-24 weeks' and mean = 13.7 (SD = 8.5) at 36-38 weeks' gestation (n = 27, β = -1.83, p = 0.007). Higher skin pH readings, mean = 5.80 (SD = 0.58) were found at 28-30 weeks' gestation, compared to mean = 5.25 (SD = 0.62) at 18-24 weeks' and mean = 5.47 (SD = 0.57) at 36-38 weeks' gestation (n = 27, β = 0.40, p = 0.004). These gestational fluctuations remained after adjusting for Fitzpatrick skin type, season, and sun exposure. We observed gestational fluctuations in both skin permeability and skin pH, with 28-30 weeks' gestation being a significant point of difference compared to mid- and late-pregnancy periods.
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Affiliation(s)
- Rachel Stevens
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Diana Arabiat
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Maternal and Child Nursing Department, The University of Jordan, Amman, Jordan
| | - Claus T Christophersen
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Molecular and Life Sciences, WA Human Microbiome Collaboration Centre, Curtin University, Bentley, Western Australia, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
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Parkin K, Palmer DJ, Verhasselt V, Amenyogbe N, Cooper MN, Christophersen CT, Prescott SL, Silva D, Martino D. Metagenomic Characterisation of the Gut Microbiome and Effect of Complementary Feeding on Bifidobacterium spp. in Australian Infants. Microorganisms 2024; 12:228. [PMID: 38276213 PMCID: PMC10819277 DOI: 10.3390/microorganisms12010228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Complementary feeding induces dramatic ecological shifts in the infant gut microbiota toward more diverse compositions and functional metabolic capacities, with potential implications for immune and metabolic health. The aim of this study was to examine whether the age at which solid foods are introduced differentially affects the microbiota in predominantly breastfed infants compared with predominantly formula-fed infants. We performed whole-genome shotgun metagenomic sequencing of infant stool samples from a cohort of six-month-old Australian infants enrolled in a nested study within the ORIGINS Project longitudinal birth cohort. Infants born preterm or those who had been administered antibiotics since birth were excluded. The taxonomic composition was highly variable among individuals at this age. Predominantly formula-fed infants exhibited a higher microbiome diversity than predominantly breastfed infants. Among the predominantly breastfed infants, the introduction of solid foods prior to five months of age was associated with higher alpha diversity than solid food introduction after six months of age, primarily due to the loss of Bifidobacterium infantis. In contrast, the age at which solid food was introduced was not associated with the overall change in diversity among predominantly formula-fed infants but was associated with compositional changes in Escherichia abundance. Examining the functional capacity of the microbiota in relation to these changes, we found that the introduction of solid foods after six months of age was associated with elevated one-carbon compound metabolic pathways in both breastfed and formula-fed infants, although the specific metabolic sub-pathways differed, likely reflecting different taxonomic compositions. Our findings suggest that the age of commencement of solid foods influences the gut microbiota composition differently in predominantly breastfed infants than in predominantly formula-fed infants.
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Affiliation(s)
- Kimberley Parkin
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
- Medical School, University of Western Australia, Nedlands, Perth, WA 6009, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
- Medical School, University of Western Australia, Nedlands, Perth, WA 6009, Australia
| | - Valerie Verhasselt
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
- Larsson-Rosenquist Foundation Centre for Immunology and Breastfeeding, Medical School, University of Western Australia, Nedlands, Perth, WA 6009, Australia
| | - Nelly Amenyogbe
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
| | - Matthew N. Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
| | - Claus T. Christophersen
- School of Molecular Life Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
- School of Medical and Health Sciences, Edith Cowen University, Joondalup, Perth, WA 6027, Australia
| | - Susan L. Prescott
- Medical School, University of Western Australia, Nedlands, Perth, WA 6009, Australia
- School of Molecular Life Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
- Joondalup Health Campus, Joondalup, Perth, WA 6027, Australia
- Nova Institute for Health, Baltimore, MD 21231, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- The ORIGINS Project, Telethon Kids Institute, Nedlands, Perth, WA 6009, Australia
| | - Desiree Silva
- Medical School, University of Western Australia, Nedlands, Perth, WA 6009, Australia
- School of Molecular Life Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
- School of Medical and Health Sciences, Edith Cowen University, Joondalup, Perth, WA 6027, Australia
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- The ORIGINS Project, Telethon Kids Institute, Nedlands, Perth, WA 6009, Australia
| | - David Martino
- Telethon Kids Institute, University of Western Australia, Nedlands, Perth, WA 6009, Australia; (K.P.)
- School of Molecular Science, University of Western Australia, Nedlands, Perth, WA 6009, Australia
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Gamez C, Leffler J, Clark S, Corscadden K, Prescott SL, Palmer DJ, Strickland D. Egg-sensitised infants have elevated CD4 + effector memory T regulatory cells from birth. Clin Exp Allergy 2024; 54:34-45. [PMID: 38168058 DOI: 10.1111/cea.14431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND IgE-mediated sensitisation to egg is common in infants. In some cases, the processes leading to egg sensitisation are established in early life, even before introduction to solid foods. The underlying mechanisms remain poorly understood. METHODS We performed detailed immune cell phenotyping of peripheral blood mononuclear cells and determined in vitro cytokine responses following allergen specific and non-specific immune stimulation. To determine if unique immune profiles were linked to early-life egg sensitisation, we compared 92 infants at 4-6 months of age, with (EggCAP+, n = 41) and without (EggCAP-, n = 51) early egg sensitisation. Additionally, 47 cord blood samples were analysed. For a subset of participants (n = 39), matching cord blood mononuclear cells were assessed by flow cytometry to establish the impact of IgE sensitisation on immune developmental trajectories. RESULTS EggCAP+ infants were found to exhibit a unique immune phenotype characterised by increased levels of circulating CD4+ T regulatory cells (Treg), CD4+ effector memory (EM) Treg and increased expression of the IgE receptor, FcεR1, on basophils. The increased CD4+ EM Treg profiles were already present in cord blood samples from EggCAP+ infants. A general Th2-skewing of the immune system was observed based on increased IL-13 production following phytohemagglutinin stimulation and by comparing immune developmental trajectories, EggCAP+ infants displayed an expansion of basophils and reduced levels of CD4- T cells compared to EggCAP- infants. CONCLUSIONS Immunological profiles associated with egg sensitisation are detectable in infant circulation at 4-6 months of age and at birth. Understanding the immune mechanisms underlying early-life sensitisation could provide important insights for future food allergy prevention strategies.
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Affiliation(s)
- Cristina Gamez
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Jonatan Leffler
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Sharon Clark
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Karli Corscadden
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Susan L Prescott
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- The Nova Institute for Health, Baltimore, Maryland, USA
- Family and Community Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Debra J Palmer
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Deborah Strickland
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
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McWilliam V, Netting MJ, Volders E, Palmer DJ. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow's milk allergy. World Allergy Organ J 2023; 16:100830. [PMID: 38020284 PMCID: PMC10656250 DOI: 10.1016/j.waojou.2023.100830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Cow's milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow's milk allergy, it is critical to examine the evidence for and against any form of cow's milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow's milk proteins detectable in human milk cause infant cow's milk allergy symptoms. Current clinical practice recommendations advise a 2-4 week trial of maternal cow's milk dietary elimination for: a) IgE-mediated cow's milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow's milk allergy; and c) infants with moderate to severe eczema/atopic dermatitis, unresponsive to topical steroids and sensitized to cow's milk protein. There should be a clear plan for home reintroduction of cow's milk into the maternal diet for a period of 1 week to determine that the cow's milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow's milk reintroduction. The evidence base to support the use of maternal cow's milk avoidance for the treatment of a breastfed infant with cow's milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow's milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow's milk allergy maternal cow's milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essential.
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Affiliation(s)
- Vicki McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Merryn J. Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Nutrition Department, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Evelyn Volders
- Nutrition, Dietetics & Food, Monash University, Clayton, Vic, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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Palmer DJ, Silva DT, Prescott SL. Feasibility and safety of introducing cashew nut spread in infant diets-A randomized trial. Pediatr Allergy Immunol 2023; 34:e13969. [PMID: 37366200 DOI: 10.1111/pai.13969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND To reduce peanut allergy prevalence, infant feeding guidelines now recommend introducing peanuts in an age-appropriate form (such as peanut butter) as part of complementary feeding. However, due to a lack of randomized trial evidence, most infant feeding and food allergy prevention guidelines do not include tree nuts. The aims of this trial were to determine safety and feasibility of dosage consumption recommendations for infant cashew nut spread introduction. METHODS This is a parallel, three-arm (1:1:1 allocation), single-blinded (outcome assessors), randomized controlled trial. General population term infants were randomized at 6-8 months of age to either a one teaspoon (Intervention 1 n = 59) or increasing dosage regime of one teaspoon at 6-7 months, two teaspoons at 8-9 months, and three teaspoons from 10 months of age onwards (Intervention 2 n = 67) cashew nut spread, both three times per week, or no specific advice on cashew introduction (Control n = 70). At 1 year of age, food challenge proven IgE-mediated cashew nut allergy was assessed. RESULTS Compliance in Intervention 1 (92%) was higher than Intervention 2 (79%), p = .04. Only one infant had delayed (at 5 h) facial swelling and eczema flare to cashew introduction at 6.5 months, but no cashew allergy at 1 year. Only one infant (Control) had cashew allergy at 1 year, and this infant had not been introduced to cashew prior to 12 months of age. CONCLUSION Regular infant consumption of one teaspoon of cashew nut spread three times per week from 6 to 8 months of age was found to be feasible and safe.
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Affiliation(s)
- Debra J Palmer
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Medicine, Crawley, Western Australia, Australia
| | - Desiree T Silva
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Medicine, Crawley, Western Australia, Australia
- Joondalup Health Campus, Joondalup, Western Australia, Australia
- School of Medicine, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Medicine, Crawley, Western Australia, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, New Jersey, USA
- Department of Immunology and Dermatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Palmer DJ, Silva DT, Prescott SL. Maternal peanut and egg consumption during breastfeeding randomized pilot trial. Pediatr Allergy Immunol 2022; 33:e13845. [PMID: 36156821 DOI: 10.1111/pai.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/17/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Desiree T Silva
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Joondalup Health Campus, Joondalup, Western Australia, Australia.,School of Medicine & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia.,inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, New Jersey, USA
| | - Susan L Prescott
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, New Jersey, USA.,Department of Immunology and Dermatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Jones J, Reinke SN, Mousavi-Derazmahalleh M, Palmer DJ, Christophersen CT. Changes to the Gut Microbiome in Young Children Showing Early Behavioral Signs of Autism. Front Microbiol 2022; 13:905901. [PMID: 35966698 PMCID: PMC9371947 DOI: 10.3389/fmicb.2022.905901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
The human gut microbiome has increasingly been associated with autism spectrum disorder (ASD), which is a neurological developmental disorder, characterized by impairments to social interaction. The ability of the gut microbiota to signal across the gut-brain-microbiota axis with metabolites, including short-chain fatty acids, impacts brain health and has been identified to play a role in the gastrointestinal and developmental symptoms affecting autistic children. The fecal microbiome of older children with ASD has repeatedly shown particular shifts in the bacterial and fungal microbial community, which are significantly different from age-matched neurotypical controls, but it is still unclear whether these characteristic shifts are detectable before diagnosis. Early microbial colonization patterns can have long-lasting effects on human health, and pre-emptive intervention may be an important mediator to more severe autism. In this study, we characterized both the microbiome and short-chain fatty acid concentrations of fecal samples from young children between 21 and 40 months who were showing early behavioral signs of ASD. The fungal richness and acetic acid concentrations were observed to be higher with increasing autism severity, and the abundance of several bacterial taxa also changed due to the severity of ASD. Bacterial diversity and SCFA concentrations were also associated with stool form, and some bacterial families were found with differential abundance according to stool firmness. An exploratory analysis of the microbiome associated with pre-emptive treatment also showed significant differences at multiple taxonomic levels. These differences may impact the microbial signaling across the gut-brain-microbiota axis and the neurological development of the children.
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Affiliation(s)
- Jacquelyn Jones
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
- *Correspondence: Jacquelyn Jones
| | - Stacey N. Reinke
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Mahsa Mousavi-Derazmahalleh
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Claus T. Christophersen
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Palmer DJ, Sullivan TR, Campbell DE, Nanan R, Gold MS, Hsu PS, Netting MJ, McWilliam V, Koplin JJ, Perrett KP, Quinn P, O'Sullivan M, Prescott SL, Grivell R, Makrides M. PrEggNut Study: protocol for a randomised controlled trial investigating the effect of a maternal diet rich in eggs and peanuts from <23 weeks' gestation during pregnancy to 4 months' lactation on infant IgE-mediated egg and peanut allergy outcomes. BMJ Open 2022; 12:e056925. [PMID: 35697444 PMCID: PMC9196184 DOI: 10.1136/bmjopen-2021-056925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Clinical studies supported by immunological data indicate early life intervention strategies to be promising in reducing the growing global burden of food allergies. The events that predispose to food allergy, including the induction of allergen-specific immune responses, appear to be initiated early in development. Early exposure to food allergens in utero and via breast milk is likely to be important in initiating oral tolerance. We aim to determine the effectiveness of higher maternal food allergen consumption during pregnancy and lactation on infant food allergy outcomes. METHODS AND ANALYSIS This is a multisite, parallel, two-arm (1:1 allocation), single-blinded (outcome assessors, statistical analyst and investigators), randomised controlled trial. Pregnant women (<23 weeks' gestation) whose (unborn) infants have at least two biological family members (mother, father or siblings) with medically diagnosed allergic disease are eligible to participate. After obtaining written informed consent, pregnant women are randomised to either a high egg and peanut diet (at least 6 eggs and 60 peanuts per week) or standard (low) egg and peanut diet (no more than 3 eggs and 30 peanuts per week). The women are asked to follow their allocated diet from <23 weeks' gestation to 4 months' lactation. The primary outcome is food challenge proven IgE-mediated egg and/or peanut allergy in the infants at 12 months of age. Key secondary outcomes include infant sensitisation to egg and/or peanut and infant eczema. Our target sample size is 2136 women. Analyses will be performed on an intention-to-treat basis according to a pre-specified statistical analysis plan. ETHICS AND DISSEMINATION Ethical approval has been granted from the Women's and Children's Health Network Human Research Ethics Committee (approval number HREC/18/WCHN/42). Trial results will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12618000937213.
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Affiliation(s)
- Debra J Palmer
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dianne E Campbell
- Discipline of Child and Adolescent Health, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Allergy and Immunology; and Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ralph Nanan
- Charles Perkins Center, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael S Gold
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Peter S Hsu
- Discipline of Child and Adolescent Health, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Allergy and Immunology; and Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Merryn J Netting
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Department of Nutrition, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Vicki McWilliam
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten P Perrett
- Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Quinn
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Michael O'Sullivan
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Susan L Prescott
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rosalie Grivell
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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11
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Gamirova A, Berbenyuk A, Levina D, Peshko D, Simpson MR, Azad MB, Järvinen KM, Brough HA, Genuneit J, Greenhawt M, Verhasselt V, Peroni DG, Perkin MR, Warner JO, Palmer DJ, Boyle RJ, Munblit D. Food Proteins in Human Breast Milk and Probability of IgE-Mediated Allergic Reaction in Children During Breastfeeding: A Systematic Review. J Allergy Clin Immunol Pract 2022; 10:1312-1324.e8. [PMID: 35123103 DOI: 10.1016/j.jaip.2022.01.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous reports suggested that food proteins present in human milk (HM) may trigger symptoms in allergic children during breastfeeding, but existing evidence has never been reviewed systematically. OBJECTIVE To assess the probability of food proteins in HM to trigger allergic reactions in infants with IgE-mediated food allergy. METHODS Electronic bibliographic databases (MEDLINE, EMBASE) were systematically searched from inception to November 3, 2021. The data regarding the levels of food proteins detected in HM were extracted and compared with data from the Voluntary Incidental Trace Allergen Labelling (VITAL 3.0) guide to assess the probability of food-allergic individuals to experience immediate type allergic reactions on ingesting HM. RESULTS A total of 32 studies were identified. Fourteen studies assessed excretion of cow's milk proteins into HM, 9 egg, 4 peanut, and 2 wheat; 3 measured levels of cow's milk and egg proteins simultaneously. We found that levels of all food proteins across the studies were much lower than the eliciting dose for 1% of allergic individuals (ED01) in most of the samples. The probability of an IgE-mediated allergic reaction in a food-allergic infant breastfed by a woman consuming the relevant food can be estimated as ≤1:1000 for cow's milk, egg, peanut, and wheat. CONCLUSIONS To our knowledge, this is the first systematic review that assesses and summarizes evidence on food proteins in HM and potential for IgE-mediated allergic reactions. Our data suggest that the probability of IgE-mediated allergic reactions to food proteins in HM is low.
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Affiliation(s)
- Aysylu Gamirova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna Berbenyuk
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria Levina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitrii Peshko
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Melanie R Simpson
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim, Norway
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Kirsi M Järvinen
- Division of Pediatric Allergy and Immunology & Center for Food Allergy, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, United Kingdom; Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Valerie Verhasselt
- School of Molecular Sciences, University of Western Australia, Perth, WA, Australia
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Michael R Perkin
- The Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - John O Warner
- National Institute for Health Research, Collaboration for Leadership in Applied Health Research and Care for NW London, London, United Kingdom; Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Debra J Palmer
- School of Medicine, University of Western Australia, Crawley, WA, Australia; Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Robert J Boyle
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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12
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Rueter K, Siafarikas A, Palmer DJ, Prescott SL. Pre- and Postnatal Vitamin D Status and Allergy Outcomes in Early Childhood. Biomedicines 2022; 10:biomedicines10050933. [PMID: 35625670 PMCID: PMC9139153 DOI: 10.3390/biomedicines10050933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
The dramatic increase in the prevalence of allergic disease in recent decades reflects environmental and behavioural changes that have altered patterns of early immune development. The very early onset of allergic diseases points to the specific vulnerability of the developing immune system to environmental changes and the development of primary intervention strategies is crucial to address this unparalleled burden. Vitamin D is known to have immunomodulatory functions. While allergic disease is multifactorial, associations with reduced sunlight exposure have led to the hypothesis that suboptimal vitamin D levels during critical early periods may be one possible explanation. Interventions to improve vitamin D status, especially in early life, may be the key to allergic disease prevention.
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Affiliation(s)
- Kristina Rueter
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (A.S.); (D.J.P.); (S.L.P.)
- Department of Immunology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
- Correspondence:
| | - Aris Siafarikas
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (A.S.); (D.J.P.); (S.L.P.)
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia
- Department of Endocrinology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- Institute for Health Research, University of Notre Dame, Fremantle 6160, Australia
| | - Debra J. Palmer
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (A.S.); (D.J.P.); (S.L.P.)
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia
| | - Susan L. Prescott
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (A.S.); (D.J.P.); (S.L.P.)
- Department of Immunology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia
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13
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Jones J, Reinke SN, Ali A, Palmer DJ, Christophersen CT. Fecal sample collection methods and time of day impact microbiome composition and short chain fatty acid concentrations. Sci Rep 2021; 11:13964. [PMID: 34234185 PMCID: PMC8263620 DOI: 10.1038/s41598-021-93031-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Associations between the human gut microbiome and health outcomes continues to be of great interest, although fecal sample collection methods which impact microbiome studies are sometimes neglected. Here, we expand on previous work in sample optimization, to promote high quality microbiome data. To compare fecal sample collection methods, amplicons from the bacterial 16S rRNA gene (V4) and fungal (ITS2) region, as well as short chain fatty acid (SCFA) concentrations were determined in fecal material over three timepoints. We demonstrated that spot sampling of stool results in variable detection of some microbial members, and inconsistent levels of SCFA; therefore, sample homogenization prior to subsequent analysis or subsampling is recommended. We also identify a trend in microbial and metabolite composition that shifts over two consecutive stool collections less than 25 h apart. Lastly, we show significant differences in bacterial composition that result from collecting stool samples in OMNIgene·Gut tube (DNA Genotec) or Stool Nucleic Acid Collection and Preservation Tube (NORGEN) compared to immediate freezing. To assist with planning fecal sample collection and storage procedures for microbiome investigations with multiple analyses, we recommend participants to collect the first full bowel movement of the day and freeze the sample immediately after collection.
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Affiliation(s)
- Jacquelyn Jones
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia.
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia.
| | - Stacey N Reinke
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Alishum Ali
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Claus T Christophersen
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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14
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Best KP, Green TJ, Sulistyoningrum DC, Sullivan TR, Aufreiter S, Prescott SL, Makrides M, Skubisz M, O'Connor DL, Palmer DJ. Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study. J Nutr 2021; 151:1553-1560. [PMID: 33851208 DOI: 10.1093/jn/nxab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/14/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. OBJECTIVE We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy. METHODS The cohort consisted of 561 mother-infant pairs from Western Australia. To be eligible the infant had to have a first-degree relative (mother, father, or sibling) with a history of medically diagnosed allergic disease. Maternal venous blood was collected between 36 and 40 wk of gestation. Serum UMFA was measured by LC-tandem MS. Serum total folate was determined using a microbiological method with chloramphenicol-resistant Lactobacillus rhamnosus as the test organism, and was collected between 36 and 40 wk of gestation. UMFA concentrations were measured by tandem MS using stable isotope dilution; folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid-treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization, and medically diagnosed wheeze were assessed at 1 y of age. RESULTS Median (IQR) concentrations for UMFA and serum folate were 1.6 (0.6-4.7) and 53.2 (32.6-74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization, and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes. CONCLUSIONS In this cohort of children at high risk of allergic disease there was no association between maternal UMFA or serum folate concentrations measured in late pregnancy and allergic disease outcomes at 1 y of age.
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Affiliation(s)
- Karen P Best
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Tim J Green
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Dian C Sulistyoningrum
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Thomas R Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Susanne Aufreiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan L Prescott
- The ORIGINS Project, Telethon Kids, Nedlands, Australia.,Department of Immunology, Perth Children's Hospital, Nedlands, Australia.,School of Medicine, The University of Western Australia, Crawley, Australia
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Monika Skubisz
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Debra J Palmer
- School of Medicine, The University of Western Australia, Crawley, Australia.,Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
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15
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Rueter K, Jones AP, Siafarikas A, Chivers P, Prescott SL, Palmer DJ. The Influence of Sunlight Exposure and Sun Protecting Behaviours on Allergic Outcomes in Early Childhood. Int J Environ Res Public Health 2021; 18:ijerph18105429. [PMID: 34069576 PMCID: PMC8161152 DOI: 10.3390/ijerph18105429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 01/22/2023]
Abstract
The dramatic rise in allergic disease has occurred in tandem with recent environmental changes and increasing indoor lifestyle culture. While multifactorial, one consistent allergy risk factor has been reduced sunlight exposure. However, vitamin D supplementation studies have been disappointing in preventing allergy, raising possible independent effects of ultraviolet (UV) light exposure. The aim of this study was to examine whether UV light exposure influences the development of allergic disease in early childhood. Direct sunlight exposure (290-380 nm) in early infancy was measured via UV dosimeters. Outdoor exposure, sun protective behaviours, and allergy outcomes were assessed over the first 2.5 years of life with clinical assessment appointments at 3, 6, 12 and 30 months of age. Children with eczema had less (p = 0.038) direct UV light exposure between 0-3 months of age (median (IQR) 747 (473-1439) J/m2) than children without eczema (median (IQR) 1204 (1717-1843) J/m2); and less outdoor exposure time (7 min/day) between 11 a.m. and 3 p.m. compared to children without eczema (20 min/day, p = 0.011). These associations were seen independent of vitamin D status, and after adjusting for other potential confounders. Whilst we could not find any associations between direct UV light exposure and other allergic disease outcomes, exposure to UV light appears to be beneficial in reducing the risk of eczema development in early childhood. Further research is required to determine optimal levels of UV light exposure while balancing the potential risks.
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Affiliation(s)
- Kristina Rueter
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Department of Immunology and Dermatology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
| | - Anderson P. Jones
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia;
| | - Aris Siafarikas
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia;
- Department of Endocrinology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- Institute for Health Research, The University of Notre Dame Australia, Perth 6160, Australia;
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, Perth 6160, Australia;
- School of Medical and Health Science, Edith Cowan University, Perth 6027, Australia
| | - Susan L. Prescott
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Department of Immunology and Dermatology, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands 6009, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
- The ORIGINS Project, Telethon Kids Institute and Division of Paediatrics, University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia
| | - Debra J. Palmer
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands 6009, Australia;
- Correspondence:
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16
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Gamez C, Metcalfe J, Prescott SL, Palmer DJ. Circulating Epithelial Cell Cytokines Are Associated With Early Onset Atopic Dermatitis. J Investig Allergol Clin Immunol 2021; 32:48-50. [PMID: 33944784 DOI: 10.18176/jiaci.0699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Gamez
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - J Metcalfe
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA Australia.,Perth Children's Hospital, Nedlands, WA, Australia
| | - S L Prescott
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Perth Children's Hospital, Nedlands, WA, Australia.,inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York NJ, USA
| | - D J Palmer
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
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17
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Lai CL, Campbell DE, Palmer DJ, Makrides M, Santner‐Nanan B, Gold M, Tan JW, Valerio C, Nanan R, Prescott SL, Hsu PS. Longitudinal egg-specific regulatory T- and B-cell development: Insights from primary prevention clinical trials examining the timing of egg introduction. Allergy 2021; 76:1385-1397. [PMID: 33040362 DOI: 10.1111/all.14621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Egg allergy affects almost 1 in 10 Australian infants. Early egg introduction has been associated with a reduced risk in developing egg allergy; however, the immune mechanisms underlying this protection remain unclear. OBJECTIVE To examine the role of regulatory immune cells in tolerance induction during early egg introduction. METHODS Cryopreserved peripheral blood mononuclear cells (PBMC) were obtained from infants from 2 randomized controlled trials of early introduction of egg for the primary prevention of egg allergy; BEAT (at 12 months, n = 42) and STEP (at 5 months n = 82; 12 months n = 82) study cohorts. In vitro ovalbumin-stimulated PBMC were analyzed by flow cytometry for presence of ovalbumin-specific regulatory T cells, using activation markers, FoxP3, and IL-10 expression. Ovalbumin-specific regulatory B cells were identified by co-expression of fluorescence-conjugated ovalbumin and IL-10. RESULTS Specific, age-dependent expansion of ovalbumin-specific regulatory T cells was only observed in infants who (a) had early egg introduction and (b) did not have egg allergy at 12 months. This expansion was blunted or impaired in children who did not undergo early egg introduction and in those with clinical egg allergy at 12 months. Infants with egg allergy at 12 months of age also had reduced frequency of ovalbumin-specific regulatory B cells compared to egg-tolerant infants. CONCLUSION Early egg introduction and clinical tolerance to egg were associated with expansion of ovalbumin-specific T and B regulatory cells, which may be an important developmental process for tolerance acquisition to food allergens.
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Affiliation(s)
- Catherine L. Lai
- Department of Allergy and Immunology The Children’s Hospital at Westmead Westmead NSW Australia
- Kids Research Institute The Children’s Hospital at Westmead Westmead NSW Australia
- Discipline of Paediatrics and Child Health The University of Sydney Sydney NSW Australia
- Murdoch Children’s Research Institute Centre for Food Allergy Research (CFAR) Parkville Vic Australia
| | - Dianne E. Campbell
- Department of Allergy and Immunology The Children’s Hospital at Westmead Westmead NSW Australia
- Kids Research Institute The Children’s Hospital at Westmead Westmead NSW Australia
- Discipline of Paediatrics and Child Health The University of Sydney Sydney NSW Australia
- Murdoch Children’s Research Institute Centre for Food Allergy Research (CFAR) Parkville Vic Australia
| | - Debra J. Palmer
- Murdoch Children’s Research Institute Centre for Food Allergy Research (CFAR) Parkville Vic Australia
- Telethon Kids Institute The University of Western Australia Nedlands WA Australia
- School of Medicine The University of Western Australia, Crawley WA Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute SAHMRI Women and Kids Adelaide SA Australia
- School of Medicine University of Adelaide Adelaide SA Australia
| | - Brigitte Santner‐Nanan
- Sydney Medical School Nepean and Charles Perkins Centre Nepean The University of Sydney Kingswood NSW Australia
| | - Michael Gold
- Discipline of Paediatrics School of Medicine University of Adelaide Adelaide SA Australia
| | - John Wei‐Liang Tan
- Department of Allergy and Immunology The Children’s Hospital at Westmead Westmead NSW Australia
| | - Carol Valerio
- Department of Allergy and Immunology The Children’s Hospital at Westmead Westmead NSW Australia
| | - Ralph Nanan
- Sydney Medical School Nepean and Charles Perkins Centre Nepean The University of Sydney Kingswood NSW Australia
| | - Susan L. Prescott
- Murdoch Children’s Research Institute Centre for Food Allergy Research (CFAR) Parkville Vic Australia
- The ORIGINS Project Telethon Kids Institute University of Western AustraliaPerth Children’s Hospital Nedlands WA Australia
- InVIVO Planetary Health of the Worldwide Universities Network (WUN) West New York NJ USA
| | - Peter S. Hsu
- Department of Allergy and Immunology The Children’s Hospital at Westmead Westmead NSW Australia
- Kids Research Institute The Children’s Hospital at Westmead Westmead NSW Australia
- Discipline of Paediatrics and Child Health The University of Sydney Sydney NSW Australia
- Murdoch Children’s Research Institute Centre for Food Allergy Research (CFAR) Parkville Vic Australia
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18
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Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, England
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19
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Gamez C, Metcalfe J, Prescott SL, Palmer DJ. Lower Cord Blood IL-17 and IL-25, but Not Other Epithelial Cell-Derived Cytokines Are Associated with Atopic Dermatitis in Infancy. Int Arch Allergy Immunol 2021; 182:474-478. [PMID: 33412547 DOI: 10.1159/000512919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a growing need for early biomarkers that may predict the development of atopic dermatitis (AD). As alterations in skin barrier may be a primary event in disease pathogenesis, epithelial cell (EC) cytokines expression patterns may be a potential biomarker in early life to target allergy preventive strategies towards "at-risk" infants. OBJECTIVES The aim of this longitudinal investigation was to examine from birth over the course of infancy levels of the EC cytokines: thymic stromal lymphopoietin (TSLP), interleukin (IL)-33, IL-25, and IL-17 in infants at high-risk of AD due to maternal atopy. METHOD We collected (n = 31) cord blood samples from atopic mothers and followed up their infants at 4-6 and 12 months of age for collection of peripheral venous blood samples and diagnosis of AD. TSLP concentration was measured by ELISA after acetone precipitation of the samples. IL-33, IL-25, and IL-17 levels were measured by Luminex. RESULTS Seven infants who developed AD had lower levels of IL-25 and IL-17 at birth compared to the 24 infants who did not develop AD by 12 months of age. CONCLUSIONS Lower cord blood levels of IL-17 and IL-25, but not other EC cytokines, were associated with the onset of AD during infancy. Our results highlight that the in-utero period appears critical, and potential maternal influences on cord blood EC-derived cytokine concentrations requires further exploration.
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Affiliation(s)
- Cristina Gamez
- Telethon Kids Institute, The University of Western Australia, Nedlands, Washington, Australia, .,School of Medicine, The University of Western Australia, Crawley, Washington, Australia,
| | - Jessica Metcalfe
- Telethon Kids Institute, The University of Western Australia, Nedlands, Washington, Australia.,Perth Children's Hospital, Nedlands, Washington, Australia
| | - Susan L Prescott
- Telethon Kids Institute, The University of Western Australia, Nedlands, Washington, Australia.,School of Medicine, The University of Western Australia, Crawley, Washington, Australia.,Perth Children's Hospital, Nedlands, Washington, Australia.,inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, New Jersey, USA
| | - Debra J Palmer
- Telethon Kids Institute, The University of Western Australia, Nedlands, Washington, Australia.,School of Medicine, The University of Western Australia, Crawley, Washington, Australia
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20
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Pretorius RA, Palmer DJ. High-Fiber Diet during Pregnancy Characterized by More Fruit and Vegetable Consumption. Nutrients 2020; 13:nu13010035. [PMID: 33374192 PMCID: PMC7824257 DOI: 10.3390/nu13010035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022] Open
Abstract
Higher dietary fiber intakes during pregnancy may have the potential health benefits of increasing gut microbiome diversity, lowering the risk of glucose intolerance and pre-eclampsia, achieving appropriate gestational weight gain, and preventing constipation. In this observational cohort study, we have assessed the dietary fiber intakes of 804 women in late pregnancy, using a semi-quantitative food frequency questionnaire (SQ-FFQ). Overall, the median (interquartile range) dietary fiber intake was 24.1 (19.0–29.7) grams per day (g/day). Only 237/804 (29.5%) women met the recommended Adequate Intake (AI) of dietary fiber during pregnancy of 28 g/day. Women consuming the highest quartile of fiber intakes (34.8 (IQR 32.1–39.5) g/day) consumed more fruit, especially apples and bananas, than women consuming the lowest quartile of fiber intakes (15.9 (IQR 14.4–17.5) g/day). These women in the highest fiber-intake quartile were older (p < 0.01), more had completed further education after secondary school (p = 0.04), and they also consumed more vegetables (67 g/day) compared to the women in the lowest fiber consumption quartile (17 g vegetables/day). Bread intakes of 39–42 g/day were consistent in quantities consumed across all four fiber-intake quartiles. Our findings suggest that antenatal education advice targeting increased fruit and vegetable consumption before and during pregnancy may be a simple strategy to achieve increased total dietary fiber intakes to reach recommended quantities.
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Affiliation(s)
- Rachelle A. Pretorius
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia;
| | - Debra J. Palmer
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia;
- Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, WA 6009, Australia
- Correspondence: ; Tel.: +61-8-6319-1750
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21
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Venter C, Agostoni C, Arshad SH, Ben-Abdallah M, Du Toit G, Fleischer DM, Greenhawt M, Glueck DH, Groetch M, Lunjani N, Maslin K, Maiorella A, Meyer R, Antonella M, Netting MJ, Ibeabughichi Nwaru B, Palmer DJ, Palumbo MP, Roberts G, Roduit C, Smith P, Untersmayr E, Vanderlinden LA, O'Mahony L. Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology. Pediatr Allergy Immunol 2020; 31:889-912. [PMID: 32524677 PMCID: PMC9588404 DOI: 10.1111/pai.13303] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022]
Abstract
RATIONALE Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring. METHODS We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs. RESULTS We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy. CONCLUSIONS Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.
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Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, University of Colorado School of Medicine, Denver, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Carlo Agostoni
- Pediatria Media Intensità di Cura Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinic, Milan, Italy
| | - S Hasan Arshad
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Centre, Isle of Wight, UK
| | | | - George Du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.,Evelina London, Guy's & St Thomas' Hospital, London, UK
| | - David M Fleischer
- Section of Allergy and Immunology, University of Colorado School of Medicine, Denver, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology, University of Colorado School of Medicine, Denver, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Deborah H Glueck
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Marion Groetch
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nonhlanhla Lunjani
- University of Zurich, Davos, Switzerland.,University of Cape Town, Cape Town, South Africa
| | | | | | | | - Muraro Antonella
- Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera, Università di Padova, Padova, Italy
| | - Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Discipline of Pediatrics, University of Adelaide, Adelaide, SA, Australia
| | | | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Micheala P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, Colorado, USA
| | - Graham Roberts
- The David Hide Asthma and Allergy Centre, Isle of Wight, UK.,Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, Human Development in Health Academic Units, University of Southampton, Southampton, UK
| | - Caroline Roduit
- University Children's Hospital Zurich, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Pete Smith
- School of Medicine, Griffith University, Southport, Australia
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Lauren A Vanderlinden
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
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22
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Johnson BZ, McAlister S, McGuire HM, Palanivelu V, Stevenson A, Richmond P, Palmer DJ, Metcalfe J, Prescott SL, Wood FM, Fazekas de St Groth B, Linden MD, Fear MW, Fear VS. Corrigendum: Pediatric Burn Survivors Have Long-Term Immune Dysfunction With Diminished Vaccine Response. Front Immunol 2020; 11:598646. [PMID: 33163008 PMCID: PMC7581988 DOI: 10.3389/fimmu.2020.598646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Blair Z Johnson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sonia McAlister
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Helen M McGuire
- Ramaciotti Facility for Human Systems Biology and the Charles Perkins Centre, Discipline of Pathology, The University of Sydney, Sydney, NSW, Australia
| | | | - Andrew Stevenson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Peter Richmond
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Debra J Palmer
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Jessica Metcalfe
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Susan L Prescott
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Fiona M Wood
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Health WA, Perth, WA, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology and the Charles Perkins Centre, Discipline of Pathology, The University of Sydney, Sydney, NSW, Australia
| | - Matthew D Linden
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Mark W Fear
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Vanessa S Fear
- Genetic and Rare Diseases, Telethon Kids Institute, Perth, WA, Australia
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23
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Netting MJ, Gold MS, Palmer DJ. Low allergen content of commercial baby foods. J Paediatr Child Health 2020; 56:1613-1617. [PMID: 32797662 DOI: 10.1111/jpc.15047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 11/30/2022]
Abstract
AIM Introduction of allergenic solid foods, especially peanut and hen's egg reduces the risk of food allergy development in early childhood. Ideally, parents will offer their infants home-prepared foods; however, many rely on the availability of convenient ready to purchase infant foods. This audit aimed to assess the major food allergen content of commercial infant foods. METHODS Infant foods available for sale in 2019 in Australia were the focus of this audit. The major food allergens investigated were peanut, tree nuts, hen's egg, cows milk, wheat, fish, shellfish, soy, sesame and lupin. Websites of infant food manufacturers and major supermarkets were used to identify ingredient lists of infant foods available for purchase. Where ingredients listings were unavailable this information was sourced directly from the product labels in the supermarket. RESULTS Fourteen companies were identified, manufacturing over 251 foods specifically for the infants aged less than 1 year of age. Although there were many choices available containing wheat (27 products) and cows milk proteins (73 products), none contained peanut, tree nuts, sesame, shellfish or lupin. CONCLUSIONS Despite infant feeding advice encouraging early introduction to food allergens, of 251 commercial baby foods surveyed only 1% contained egg and none contained peanut, the most common food allergies in young Australian infants. This low food allergen content may be disadvantageous for infants fed mostly commercial infant foods as they are unlikely to be exposed to sufficient amounts of the major food allergens on a regular basis during infancy.
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Affiliation(s)
- Merryn J Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.,Nutrition Department, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Michael S Gold
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.,Department of Allergy and Clinical Immunology, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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24
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Silva DT, Hagemann E, Davis JA, Gibson LY, Srinivasjois R, Palmer DJ, Colvin L, Tan J, Prescott SL. Introducing the ORIGINS project: a community-based interventional birth cohort. Rev Environ Health 2020; 35:281-293. [PMID: 32853171 DOI: 10.1515/reveh-2020-0057] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Objectives Non-communicable diseases (NCDs) pose the greatest threat to human health globally. The dramatic rise in early onset NCDs - such as childhood obesity, the allergy epidemic and an increasing burden of mental ill health in children and youth - reflect the profound early impact of modern environments on developing systems. The ORIGINS Project is a research platform enabling world class investigation of early antecedent pathways to NCDs, and how to curtail these. As well as facilitating strategic long-term research capacity, ORIGINS is a pipeline for short-term productivity through a series of clinical trials, early interventions, mechanistic studies, and targeted research questions to improve maternal and paternal health and the early environment. Methods ORIGINS is a decade-long collaborative initiative between the Joondalup Health Campus (JHC) and the Telethon Kids Institute (TKI) to establish a Western Australian (WA) birth cohort of 10,000 families, enrolled during pregnancy. It is currently funded to follow up participating children and their families to five years of age. Comprehensive data and biological samples are collected from participants at up to 15 different timepoints, from the first antenatal clinic visit. In the process, ORIGINS is creating a major research platform, consisting of an extensive, world class biobank and databank. Of key strength and novelty, ORIGINS includes a series of harmonised nested sub-projects integrated with clinical and diagnostic services and providing real-time feedback to improve the health of individuals and the community. Conclusions At its core, ORIGINS aims to improve the health and quality of life of the next generation through improved pathways to optimise the early environment and reduce adversity by promoting primary prevention, early detection and early intervention. This dynamic, interactive, community-based project not only provides novel research capacity, productivity, collaboration and translational impact on future generations - it is also anticipated to have flow on benefits for community engagement, cohesion and purpose. This will provide a sentinel example for tailored replication in other communities around the world as part of interconnected grass root strategies to improve planetary health.
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Affiliation(s)
- Desiree T Silva
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Erika Hagemann
- Telethon Kids Institute, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Jacqueline A Davis
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
| | - Ravisha Srinivasjois
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
| | - Debra J Palmer
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - Lyn Colvin
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
| | - Jamie Tan
- Telethon Kids Institute, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Perth, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- Joondalup Health Campus, Perth, WA, Australia
- Edith Cowan University, Perth, WA, Australia
- in VIVO Planetary Health , Worldwide Universities Network (WUN), West New York, NJ, USA
- Perth Children's Hospital, Nedlands, WA, Australia
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25
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Clarke MW, Black LJ, Hart PH, Jones AP, Palmer DJ, Siafarikas A, Lucas RM, Gorman S. Corrigendum to "The challenges of developing and optimising an assay to measure 25-hydroxyvitamin D in saliva" [J. Steroid Biochem. Mol. Biol. 194 (2019) 105437]. J Steroid Biochem Mol Biol 2020; 202:105474. [PMID: 31711678 DOI: 10.1016/j.jsbmb.2019.105474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Australia
| | - Lucinda J Black
- Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia; Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia; Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, Perth, Australia.
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26
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Leffler J, Gamez C, Jones AP, Rueter K, Read JF, Siafarikas A, Lim EM, Noakes PS, Prescott SL, Stumbles PA, Palmer DJ, Strickland DH. In infants with sufficient vitamin D status at birth, vitamin D supplementation does not impact immune development. Pediatr Allergy Immunol 2020; 31:686-694. [PMID: 32248591 DOI: 10.1111/pai.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Low vitamin D levels have been associated with allergic diseases. Vitamin D has potent immunomodulatory properties, but the mechanisms remain unclear. We have investigated the effect of oral vitamin D supplementation on circulating immune cell phenotypes in infants. METHOD A double-blinded randomised controlled trial was conducted to investigate the effect of oral vitamin D supplementation (400 IU/d) on eczema and immune development. A subset of 78 infants was included in this analysis. Phenotypic analysis of immune cell subsets was performed using flow cytometry. RESULTS Vitamin D supplementation resulted in median 25(OH)D levels of 80.5 vs 59.5 nmol/L in the placebo group at 3 months of age (P = .002) and 87.5 vs 77 nmol/L at 6 months of age (P = .08). We observed significant changes in immune cell composition from birth (cord blood) to 6 months of age. Vitamin D supplementation did not impact these changes, nor did immune cell composition correlate with plasma 25(OH)D levels. Through exploratory analysis, we identified possible associations with eczema development and increased abundance of naïve CD4- T cells at birth, as well as associations with basophils, iNKT and central memory CD4+ T cells, and altered expression patterns of IgE receptor (FcεR1) on monocytes and dendritic cells with eczema at 6 months. CONCLUSIONS Vitamin D supplementation in infants who were vitamin D sufficient at birth did not affect developmental changes in immune cells during the first 6 months of life. However, immune cell profiles at birth and at 6 months of age were associated with early life eczema.
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Affiliation(s)
- Jonatan Leffler
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Cristina Gamez
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Kristina Rueter
- School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Immunology Department, Perth Children's Hospital, Nedlands, WA, Australia
| | - James F Read
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
| | - Ee-Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - Paul S Noakes
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia.,School of Medicine, The University of Notre Dame, Fremantle, WA, Australia
| | - Susan L Prescott
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia.,Immunology Department, Perth Children's Hospital, Nedlands, WA, Australia
| | - Philip A Stumbles
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia.,School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Deborah H Strickland
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
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27
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Johnson BZ, McAlister S, McGuire HM, Palanivelu V, Stevenson A, Richmond P, Palmer DJ, Metcalfe J, Prescott SL, Wood FM, Fazekas de St Groth B, Linden MD, Fear MW, Fear VS. Pediatric Burn Survivors Have Long-Term Immune Dysfunction With Diminished Vaccine Response. Front Immunol 2020; 11:1481. [PMID: 32793203 PMCID: PMC7385079 DOI: 10.3389/fimmu.2020.01481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/08/2020] [Indexed: 01/04/2023] Open
Abstract
Epidemiological studies have demonstrated that survivors of acute burn trauma are at long-term increased risk of developing a range of morbidities. The mechanisms underlying this increased risk remain unknown. This study aimed to determine whether burn injury leads to sustained immune dysfunction that may underpin long-term morbidity. Plasma and peripheral blood mononuclear cells were collected from 36 pediatric burn survivors >3 years after a non-severe burn injury (<10% total body surface area) and from age/sex-matched non-injured controls. Circulating cytokine and vaccine antibody levels were assessed using multiplex immunoassays and cell profiles compared using a panel of 40 metal-conjugated antibodies and mass cytometry. TNF-α (1.31-fold change from controls), IL-2 (1.18-fold), IL-7 (1.63-fold), and IFN-γ (1.18-fold) were all significantly elevated in the burn cohort. Additionally, burn survivors demonstrated diminished antibody responses to the diphtheria, tetanus, and pertussis vaccine antigens. Comparisons between groups using unsupervised clustering identified differences in proportions of clusters within T-cells, B-cells and myeloid cells. Manual gating confirmed increased memory T-regulatory and central memory CD4+ T-cells, with altered expression of T-cell, B-cell, and dendritic cell markers. Conclusions: This study demonstrates a lasting change to the immune profile of pediatric burn survivors, and highlights the need for further research into post-burn immune suppression and regulation.
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Affiliation(s)
- Blair Z Johnson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sonia McAlister
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Helen M McGuire
- Ramaciotti Facility for Human Systems Biology and the Charles Perkins Centre, Discipline of Pathology, The University of Sydney, Sydney, NSW, Australia
| | | | - Andrew Stevenson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Peter Richmond
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Debra J Palmer
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Jessica Metcalfe
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Susan L Prescott
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Centre for Allergy and Immunology Research, Telethon Kids Institute, Perth, WA, Australia
| | - Fiona M Wood
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Department of Health WA, Perth, WA, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology and the Charles Perkins Centre, Discipline of Pathology, The University of Sydney, Sydney, NSW, Australia
| | - Matthew D Linden
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Mark W Fear
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Vanessa S Fear
- Genetic and Rare Diseases, Telethon Kids Institute, Perth, WA, Australia
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Rueter K, Jones AP, Siafarikas A, Lim EM, Prescott SL, Palmer DJ. In "High-Risk" Infants with Sufficient Vitamin D Status at Birth, Infant Vitamin D Supplementation Had No Effect on Allergy Outcomes: A Randomized Controlled Trial. Nutrients 2020; 12:nu12061747. [PMID: 32545250 PMCID: PMC7353265 DOI: 10.3390/nu12061747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022] Open
Abstract
Lower vitamin D status at birth and during infancy has been associated with increased incidence of eczema and food allergies. The aim of this study was to investigate the effect of early infancy vitamin D supplementation on allergic disease outcomes in infants at “hereditary risk” of allergic disease, but who had sufficient vitamin D levels at birth. Here, we report the early childhood follow-up to 2.5 years of age of “high-risk” infants who participated in a double-blinded, randomized controlled trial. For inclusion in this trial, late gestation (36–40 weeks) maternal 25-hydroxyvitamin D levels needed to be ≥50 nmol/L. Infants were randomized to either oral vitamin D supplementation of 400 IU/day (n = 97) or a placebo (n = 98) for the first six months of life. Vitamin D levels and allergic disease outcomes were followed up. There were no statistically significant differences in incidence of any medically diagnosed allergic disease outcomes or allergen sensitization rates between the vitamin D-supplemented and placebo groups at either 1 year or at 2.5 years of age. In conclusion, for “allergy high-risk” infants who had sufficient vitamin D status at birth, early infancy oral vitamin D supplementation does not appear to reduce the development of early childhood allergic disease.
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Affiliation(s)
- Kristina Rueter
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- InVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
| | - Anderson P. Jones
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
| | - Aris Siafarikas
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
| | - Ee-Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia;
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia
| | - Susan L. Prescott
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- InVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), 6010 Park Ave, West New York, NJ 07093, USA
- The ORIGINS Project, Telethon Kids Institute and Division of Paediatrics, University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Debra J. Palmer
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (K.R.); (A.S.); (S.L.P.)
- Telethon Kids Institute, University of Western Australia, 15 Hospital Avenue, Nedlands, WA 6009, Australia;
- Correspondence: ; Tel.: +61-8-6319-1750
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Verhasselt V, Genuneit J, Metcalfe JR, Tulic MK, Rekima A, Palmer DJ, Prescott SL. Ovalbumin in breastmilk is associated with a decreased risk of IgE-mediated egg allergy in children. Allergy 2020; 75:1463-1466. [PMID: 31808162 DOI: 10.1111/all.14142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/01/2019] [Accepted: 11/21/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Valerie Verhasselt
- School of Molecular Sciences University of Western Australia Perth WA Australia
- inVIVO Planetary Health of the Worldwide Universities Network (WUN) West New York NJ USA
| | - Jon Genuneit
- inVIVO Planetary Health of the Worldwide Universities Network (WUN) West New York NJ USA
- Pediatric Epidemiology Department of Pediatrics University of Leipzig Medical Center Leipzig Germany
| | - Jessica R. Metcalfe
- Perth Children's Hospital Perth Australia
- Telethon Kids Institute University of Western Australia Perth WA Australia
| | - Meri K. Tulic
- inVIVO Planetary Health of the Worldwide Universities Network (WUN) West New York NJ USA
- Centre Méditerranéen de Médecine Moléculaire (C3M)‐INSERM U1065 Université Côte d'Azur Nice France
| | - Akila Rekima
- School of Molecular Sciences University of Western Australia Perth WA Australia
| | - Debra J. Palmer
- Telethon Kids Institute University of Western Australia Perth WA Australia
| | - Susan L. Prescott
- inVIVO Planetary Health of the Worldwide Universities Network (WUN) West New York NJ USA
- Centre Méditerranéen de Médecine Moléculaire (C3M)‐INSERM U1065 Université Côte d'Azur Nice France
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Abstract
IMPORTANCE Sales of specialized formula for managing cow's milk allergy (CMA) have increased, triggering concern that attribution of common infant symptoms, such as crying, vomiting, and rashes, to CMA may be leading to overdiagnosis, which could undermine breastfeeding. OBJECTIVE To understand whether CMA guideline recommendations might promote CMA overdiagnosis or undermine breastfeeding. EVIDENCE REVIEW We reviewed recommendations made in CMA guidelines and critically appraised 2 key recommendations. First, we reviewed relevant literature summarizing whether maternal or infant dietary exclusion of cow's milk is effective for managing common infant symptoms. Second, we reviewed published data on breastmilk composition and thresholds of reactivity in CMA to estimate the probability that cow's milk protein in human breastmilk can trigger symptoms in infants with CMA. We also documented the level of commercial involvement in CMA guidelines. FINDINGS We reviewed 9 CMA guidelines published from 2012 to 2019. Seven suggest considering CMA as a cause of common infant symptoms. Seven recommend strict maternal cow's milk exclusion for managing common symptoms in breastfed infants. We found CMA proven by food challenge affects approximately 1% of infants, while troublesome crying, vomiting, or rashes are each reported in 15% to 20% of infants. We found clinical trials do not provide consistent support for using maternal or infant cow's milk exclusion to manage common symptoms in infants without proven CMA. We estimated that for more than 99% infants with proven CMA, the breastmilk of a cow's milk-consuming woman contains insufficient milk allergen to trigger an allergic reaction. Three CMA guidelines were directly supported by formula manufacturers or marketing consultants, and 81% of all guideline authors reported a conflict of interest with formula manufacturers. CONCLUSIONS AND RELEVANCE Recommendations to manage common infant symptoms as CMA are not evidence based, especially in breastfed infants who are not directly consuming cow's milk. Such recommendations may cause harm by undermining confidence in breastfeeding.
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Affiliation(s)
- Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London, England.,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Michael R Perkin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, England
| | - Debra J Palmer
- Telethon Kids Institute, The University of Western Australia, Western Australia, Australia
| | - Katie J Allen
- Murdoch Children's Research Institute, The University of Melbourne, Victoria, Australia
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, England.,Centre for Evidence-Based Dermatology, University of Nottingham, Nottingham, England
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Rekima A, Bonnart C, Macchiaverni P, Metcalfe J, Tulic MK, Halloin N, Rekima S, Genuneit J, Zanelli S, Medeiros S, Palmer DJ, Prescott S, Verhasselt V. A role for early oral exposure to house dust mite allergens through breast milk in IgE-mediated food allergy susceptibility. J Allergy Clin Immunol 2020; 145:1416-1429.e11. [PMID: 31954775 DOI: 10.1016/j.jaci.2019.12.912] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Successful prevention of food allergy requires the identification of the factors adversely affecting the capacity to develop oral tolerance to food antigen in early life. OBJECTIVES This study sought to determine whether oral exposure to Dermatophagoides pteronyssinus through breast milk affects gut mucosal immunity with long-term effects on IgE-mediated food allergy susceptibility. METHODS Gut immunity was explored in 2-week-old mice breast-fed by mothers exposed to D pteronyssinus, protease-inactivated D pteronyssinus, or to PBS during lactation. We further analyzed oral tolerance to a bystander food allergen, ovalbumin (OVA). In a proof-of-concept study, Der p 1 and OVA levels were determined in 100 human breast milk samples and the association with prevalence of IgE-mediated egg allergy at 1 year was assessed. RESULTS Increased permeability, IL-33 levels, type 2 innate lymphoid cell activation, and Th2 cell differentiation were found in gut mucosa of mice nursed by mothers exposed to D pteronyssinus compared with PBS. This pro-Th2 gut mucosal environment inhibited the induction of antigen-specific FoxP3 regulatory T cells and the prevention of food allergy by OVA exposure through breast milk. In contrast, protease-inactivated D pteronyssinus had no effect on offspring gut mucosal immunity. Based on the presence of Der p 1 and/or OVA in human breast milk, we identified groups of lactating mothers, which mirror the ones found in mice to be responsible for different egg allergy risk. CONCLUSIONS This study highlights an unpredicted potential risk factor for the development of food allergy, that is, D pteronyssinus allergens in breast milk, which disrupt gut immune homeostasis and prevents oral tolerance induction to bystander food antigen through their protease activity.
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Affiliation(s)
- Akila Rekima
- School of Molecular Sciences, University of Western Australia, Perth, Australia
| | - Chrystelle Bonnart
- Institut National de la Santé et de la Recherche Médicale, U1220, Toulouse, France
| | | | - Jessica Metcalfe
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Meri K Tulic
- EA6302 Immune Tolerance, Université de Nice Sophia-Antipolis, Nice, France; Institut National de la Santé et de la Recherche Médicale, U1065, Mediterranean Centre for Molecular Medicine, Team 12, Nice, France; inVIVO Global Network, Research Group of the Worldwide Universities Network, West New York, NJ
| | - Nicolas Halloin
- EA6302 Immune Tolerance, Université de Nice Sophia-Antipolis, Nice, France
| | - Samah Rekima
- Institut Biologie Valrose, Université Côte d'Azur, Institut National de la Santé et de la Recherche Medicale, Centre National de la Recherche Scientifique, Nice, France
| | - Jon Genuneit
- inVIVO Global Network, Research Group of the Worldwide Universities Network, West New York, NJ; Pediatric Epidemiology, Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany
| | - Samantha Zanelli
- EA6302 Immune Tolerance, Université de Nice Sophia-Antipolis, Nice, France
| | - Samara Medeiros
- EA6302 Immune Tolerance, Université de Nice Sophia-Antipolis, Nice, France; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Perth, Australia; inVIVO Global Network, Research Group of the Worldwide Universities Network, West New York, NJ
| | - Susan Prescott
- Telethon Kids Institute, University of Western Australia, Perth, Australia; inVIVO Global Network, Research Group of the Worldwide Universities Network, West New York, NJ; Perth Childrens Hospital, Perth, Australia; School of Medicine, University of Western Australia, Crawley, Australia
| | - Valerie Verhasselt
- School of Molecular Sciences, University of Western Australia, Perth, Australia; inVIVO Global Network, Research Group of the Worldwide Universities Network, West New York, NJ.
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Rueter K, Black LJ, Jones A, Bulsara M, Clarke MW, Gamez C, Lim EM, Palmer DJ, Prescott SL, Siafarikas A. Analytical Bias in the Measurement of Plasma 25-Hydroxyvitamin D Concentrations in Infants. Int J Environ Res Public Health 2020; 17:ijerph17020412. [PMID: 31936279 PMCID: PMC7014414 DOI: 10.3390/ijerph17020412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 01/16/2023]
Abstract
Hypovitaminosis D is prevalent worldwide; however, analytical bias in the measurement of circulating 25-hydroxyvitamin D (25(OH)D) concentrations may affect clinical treatment decisions and research. We performed parallel plasma 25(OH)D analyses using the Abbott Architect i2000 chemiluminescent immunoassay (CIA) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for paired samples from the same infants at 3 (n = 69), 6 (n = 79) and 12 months (n = 73) of age. To test agreement, we used Lin’s concordance correlation coefficient and corresponding 95% confidence interval, Bland–Altman’s limits of agreement, and Bradley–Blackwood (BB) test. Agreement was high at 3 months (coefficient between difference and mean −0.076; BB F = 0.825; p = 0.440), good at 12 months (−0.25; BB F = 2.41; p = 0.097) but missing at 6 months of age (−0.39; BB F = 12.30; p < 0.001). Overall, 18 infants had disparate results based on the cut-off point for vitamin D deficiency (25(OH)D < 50 nmol/L), particularly at three months, with seven (10%) infants deficient according to CIA but not LC–MS/MS, and four (6%) deficient by LC–MS/MS but not CIA. To our knowledge, this is the first study to show that the reported 25(OH)D concentration may be influenced by both age and assay type. Physicians and researchers should be aware of these pitfalls when measuring circulating 25(OH)D concentrations in infants and when developing treatment plans based on measured vitamin D status.
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Affiliation(s)
- Kristina Rueter
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
- Perth Children’s Hospital, Department of Paediatric Immunology, Perth 6009, Australia
- inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, NJ 07093, USA
- Correspondence:
| | - Lucinda J. Black
- School of Public Health, Curtin University, Perth 6102, Australia;
| | - Anderson Jones
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle 6160, Australia;
| | - Michael W. Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth 6009, Australia;
| | - Cristina Gamez
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
| | - Ee M. Lim
- Sir Charles Gairdner Hospital, Department of Endocrinology, Perth 6009, Australia;
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands 6009, Australia
| | - Debra J. Palmer
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Susan L. Prescott
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
- Perth Children’s Hospital, Department of Paediatric Immunology, Perth 6009, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Aris Siafarikas
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth 6009, Australia; (A.J.); (C.G.); (D.J.P.); (S.L.P.); (A.S.)
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Institute for Health Research, University of Notre Dame, Fremantle 6160, Australia;
- Perth Children’s Hospital, Department of Paediatric Endocrinology and Diabetes, Perth 6009, Australia
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Clarke MW, Black LJ, Hart PH, Jones AP, Palmer DJ, Siafarikas A, Lucas RM, Gorman S. The challenges of developing and optimising an assay to measure 25-hydroxyvitamin D in saliva. J Steroid Biochem Mol Biol 2019; 194:105437. [PMID: 31352025 DOI: 10.1016/j.jsbmb.2019.105437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/29/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
Accurately detecting vitamin D deficiency (defined as concentration in blood of 25-hydroxyvitamin D (25(OH)D), <20 ng/mL) is important for both clinicians and researchers. Drawing blood may be difficult in some populations, such as infants and children. We thus explored the development of a method to measure 25(OH)D concentrations in saliva, using a liquid chromatography tandem mass spectrometry (LC-MS/MS) assay. Using 25(OH)D3 standards spiked into synthetic saliva, we generated a standard curve with high correlation (r = 0.999, Pearson's); the intra-assay and inter-assay variation were ≤3.2% and ≤13.2% (CV%), respectively. Passive collection of saliva via drooling into glass or polypropylene tubes yielded higher levels of 25(OH)D3 than chewing on a synthetic swab. Chewing gum for at least 4 min reduced saliva levels of 25(OH)D3. Differences in the levels of 25(OH)D3 in saliva between the passive drooling and stimulated swab-chewing methods were normalised by adjusting for measured levels of vitamin D binding protein in saliva. Freezing samples immediately, or after 24 h of refrigeration did not affect 25(OH)D3 levels. When saliva levels of 25(OH)D3 were averaged from samples collected daily for three consecutive days, for which an additional centrifugation step was performed after samples were defrosted (to remove mucin), there was a positive (but non-significant) correlation between 25(OH)D3 levels in saliva and serum (r = 0.57, p = 0.24, Pearson's) with significant correlations (r ≥ 0.88, p < 0.05) observed after further adjusting for saliva flow rate. The time of day of the collection made little difference to 25(OH)D3 levels measured in saliva. In conclusion, we have developed an LC-MS/MS assay that accurately measures saliva 25(OH)D3 levels, which correlated with serum levels. However, for a measurement that correlates with serum 25(OH)D it may be necessary to average results from saliva collected on three consecutive days, and adjust for differences in saliva flow rate. This would increase costs, and combined with the processing requirements for samples, could limit the applicability of this assay to large cohort and field studies.
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Affiliation(s)
- Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Australia
| | - Lucinda J Black
- Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia; Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia; Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Shelley Gorman
- Telethon Kids Institute, University of Western Australia, Perth, Australia.
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Pretorius RA, Bodinier M, Prescott SL, Palmer DJ. Maternal Fiber Dietary Intakes during Pregnancy and Infant Allergic Disease. Nutrients 2019; 11:nu11081767. [PMID: 31374861 PMCID: PMC6722741 DOI: 10.3390/nu11081767] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022] Open
Abstract
Maternal diet during pregnancy plays a likely role in infant immune development through both direct nutrient specific immunomodulatory effects and by modulating the composition and metabolic activity of the maternal gut microbiome. Dietary fibers, as major substrates for microbial fermentation, are of interest in this context. This is the first study to examine maternal intakes of different fiber sub-types and subsequent infant allergic disease. In an observational study of 639 mother–infant pairs (all infants had a family history of allergic disease) we examined maternal intakes of total fiber, soluble fiber, insoluble fiber, resistant starch, and prebiotic fiber, by a semi-quantitative food frequency questionnaire at 36–40 weeks’ gestation. Infants attended an allergy clinical assessment at 12 months of age, including skin prick testing to common allergens. Higher maternal dietary intakes of resistant starch were associated with reduced doctor diagnosed infant wheeze, adjusted odds ratio (aOR) 0.68 (95% CI 0.49, 0.95, p = 0.02). However, in contrast, higher maternal intakes of resistant starch were associated with higher risk of parent reported eczema aOR 1.27 (95% CI 1.09, 1.49, p < 0.01) and doctor diagnosed eczema aOR 1.19 (95% CI 1.01, 1.41, p = 0.04). In conclusion, maternal resistant starch consumption was differentially associated with infant phenotypes, with reduced risk of infant wheeze, but increased risk of eczema.
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Affiliation(s)
- Rachelle A Pretorius
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia
| | - Marie Bodinier
- INRA Pays de la Loire, UR 1268 Biopolymers Interactions Assemblies, rue de la géraudière, BP 71627, Cedex 3, 44316 Nantes, France
| | - Susan L Prescott
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands 6009, Western Australia, Australia
| | - Debra J Palmer
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia.
- Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands 6009, Western Australia, Australia.
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Hagemann E, Colvin L, Gibson LY, Miller SJ, Palmer DJ, Srinivas Jois R, Silva DT, Prescott SL. The ORIGINS Project. Current Topics in Environmental Health and Preventive Medicine 2019. [DOI: 10.1007/978-981-13-2194-8_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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36
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Rueter K, Jones AP, Siafarikas A, Lim EM, Bear N, Noakes PS, Prescott SL, Palmer DJ. Direct infant UV light exposure is associated with eczema and immune development. J Allergy Clin Immunol 2018; 143:1012-1020.e2. [PMID: 30366577 DOI: 10.1016/j.jaci.2018.08.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Suboptimal vitamin D levels during critical periods of immune development have emerged as an explanation for higher rates of allergic diseases associated with industrialization and residing at higher latitudes. OBJECTIVE We sought to determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development. METHODS By using a double-blind randomized controlled trial, newborn infants were randomized to receive vitamin D supplementation (400 IU/d) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light (290-380 nm) exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age. RESULTS At 3 (P < .01) and 6 (P = .02) months of age, vitamin D levels were greater for the vitamin D-supplemented group than the placebo group, but there was no difference in eczema incidence between groups. Infants with eczema were found to have had less UV light exposure (median, 555 Joules per square meter [J/m2; interquartile range, 322-1210 J/m2]) compared with those without eczema (median, 998 J/m2 [interquartile range, 676-1577 J/m2]; P = .02). UV light exposure was also inversely correlated with IL-2, GM-CSF, and eotaxin production to Toll-like receptor ligands. CONCLUSION This study is the first to demonstrate an association between greater direct UV light exposures in early infancy with lower incidence of eczema and proinflammatory immune markers by 6 months of age. Our findings indicate that UV light exposure appears more beneficial than vitamin D supplementation as an allergy prevention strategy in early life.
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Affiliation(s)
- Kristina Rueter
- School of Medicine, University of Western Australia, Crawley, Australia; Princess Margaret Hospital, Subiaco, Australia; inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, NJ
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Aris Siafarikas
- School of Medicine, University of Western Australia, Crawley, Australia; Princess Margaret Hospital, Subiaco, Australia; Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Ee-Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Australia
| | - Paul S Noakes
- School of Medicine, University of Western Australia, Crawley, Australia; Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Susan L Prescott
- School of Medicine, University of Western Australia, Crawley, Australia; Princess Margaret Hospital, Subiaco, Australia; inVIVO Planetary Health, Group of the Worldwide Universities Network (WUN), West New York, NJ; Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Debra J Palmer
- School of Medicine, University of Western Australia, Crawley, Australia; Telethon Kids Institute, University of Western Australia, Subiaco, Australia.
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Best KP, Sullivan TR, Palmer DJ, Gold M, Martin J, Kennedy D, Makrides M. Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood - a longitudinal analysis of long-term follow-up of a randomized controlled trial. World Allergy Organ J 2018; 11:10. [PMID: 29977437 PMCID: PMC6003086 DOI: 10.1186/s40413-018-0190-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic disease in childhood. Due to the nature of the atopic march, investigation of any effects of this prenatal intervention may be most informative when consistently assessed longitudinally during childhood. Methods Follow-up of children (n = 706) with familial risk of allergy from the Docosahexaenoic Acid to Optimize Mother Infant Outcome (DOMInO) trial. The intervention group received fish oil capsules (900 mg of ω-3 LCPUFA) daily from <21 weeks' gestation until birth; the control group received vegetable oil capsules without ω-3 LCPUFA. This new longitudinal analysis reports previously unpublished data collected at 1 and 3 years of age. The allergic disease symptom data at 1, 3 and 6 years of age were consistently reported by parents using the "International Study of Asthma and Allergies in Childhood" (ISAAC) questionnaire. Sensitization was determined by skin prick test to age specific, common allergen extracts. Results Changes over time in symptoms of allergic disease with sensitization (IgE-mediated) and sensitization did not differ between the groups; interaction p = 0.49, p = 0.10, respectively. Averaged across the 1, 3 and 6-year assessments, there were no significant effects of prenatal ω-3 LCPUFA supplementation on IgE-mediated allergic disease symptoms (adjusted relative risk 0.88 (95% CI 0.69, 1.12), p = 0.29) or sensitization (adjusted relative risk 0.97 (95% CI 0.82, 1.15), p = 0.76). Sensitization patterns to common allergens were consistent with the atopic march, with egg sensitization at 1 year strongly associated with house dust mite sensitization at 6 years, (p < 0.0001). Discussion Although there is some evidence to suggest that maternal supplementation with 900mg ω-3 LCPUFA has a protective effect on early symptoms of allergic disease and sensitization in the offspring, we did not observe any differences in the progression of disease over time in this longitudinal analysis. Further investigation into the dose and timing of ω-3 LCPUFA supplementation, including long-term follow up of children using consistent outcome reporting, is essential to determine whether this intervention may be of benefit as a primary prevention strategy for allergic disease. Conclusion Maternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization throughout childhood from 1 to 6 years. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN); DOMInO trial ACTRN12605000569606, early childhood allergy follow up ACTRN12610000735055 and 6-year allergy follow up ACTRN12615000498594.
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Affiliation(s)
- K P Best
- 1Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia.,2School of Medicine, University of Adelaide, Adelaide, South Australia Australia.,7South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
| | - T R Sullivan
- 3School of Public Health, University of Adelaide, Adelaide, South Australia Australia
| | - D J Palmer
- 4School of Medicine, University of Western Australia, Nedlands, Western Australia 6009 Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia 6008 Australia
| | - M Gold
- 2School of Medicine, University of Adelaide, Adelaide, South Australia Australia
| | - J Martin
- 6Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, North Adelaide, South Australia Australia
| | - D Kennedy
- 2School of Medicine, University of Adelaide, Adelaide, South Australia Australia.,6Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, North Adelaide, South Australia Australia
| | - M Makrides
- 1Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia.,2School of Medicine, University of Adelaide, Adelaide, South Australia Australia
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Palmer DJ, Prescott SL, Makrides M. Reply. J Allergy Clin Immunol 2018; 141:460-461. [PMID: 29146011 DOI: 10.1016/j.jaci.2017.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Debra J Palmer
- School of Medicine, The University of Western Australia, Crawley, Australia; Telethon Kids Institute, University of Western Australia, Subiaco, Australia.
| | - Susan L Prescott
- School of Medicine, The University of Western Australia, Crawley, Australia; Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Medicine, University of Adelaide, Women's and Children's Health Network, North Adelaide, Australia
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Affiliation(s)
| | - Susan L. Prescott
- School of Medicine, University of Western Australia, Crawley, Australia
- Origins Project, Telethon Kids Institute, University of Western Australia, Subiaco, Australia
- The in-FLAME Global Network, Worldwide Universities Network (WUN), West New York, NJ, USA
| | - Debra J. Palmer
- School of Medicine, University of Western Australia, Crawley, Australia
- Origins Project, Telethon Kids Institute, University of Western Australia, Subiaco, Australia
- The in-FLAME Global Network, Worldwide Universities Network (WUN), West New York, NJ, USA
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Rueter K, Black L, Bulsara M, Clark M, Gamez C, Lim EM, Jones A, Palmer DJ, Prescott SL, Siafarikas A. P74: CHEMILUMINESCENT IMMUNOASSAY (CIA) AND LIQUID CHROMATOGRAPHY-TANDEM MASS SPECTOMETRY ASSAY (LC/MS-MS) METHODOLOGY FOR THE DETERMINATION OF VITAMIN D STATUS IN INFANTS AT HIGH RISK FOR DEVELOPING ALLERGIC DISEASES: IS THERE ANY ANALYTICAL BIAS? Intern Med J 2017. [DOI: 10.1111/imj.74_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Rueter
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Princess Margaret Hospital for Children; Perth Australia
- Telethon Kids Institute; University of Western Australia; Australia
| | - L Black
- Curtin University; Perth Australia
| | - M Bulsara
- Institute of Health Research; University of Notre Dame; Fremantle Australia
| | - M Clark
- Centre for Metabolomics; University of Western Australia; Australia
| | - C Gamez
- Telethon Kids Institute; University of Western Australia; Australia
| | - EM Lim
- Endocrinology Department, Sir Charles Gardiner Hospital; Perth Australia
| | - A Jones
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Telethon Kids Institute; University of Western Australia; Australia
| | - DJ Palmer
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Telethon Kids Institute; University of Western Australia; Australia
| | - SL Prescott
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Princess Margaret Hospital for Children; Perth Australia
- Telethon Kids Institute; University of Western Australia; Australia
| | - A Siafarikas
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Princess Margaret Hospital for Children; Perth Australia
- Telethon Kids Institute; University of Western Australia; Australia
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Palmer DJ, Sullivan TR, Gold MS, Prescott SL, Makrides M. Association Between Family Characteristics and the Effect of Timing of Regular Egg Introduction in Infant Egg Allergy. JAMA Pediatr 2017; 171:489-490. [PMID: 28346598 DOI: 10.1001/jamapediatrics.2016.4978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Western Australia, Australia
| | - Thomas R Sullivan
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael S Gold
- School of Medicine, University of Adelaide, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Susan L Prescott
- School of Paediatrics and Child Health, The University of Western Australia, Western Australia, Australia
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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42
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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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43
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Venter C, Brown KR, Maslin K, Palmer DJ. Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring. Pediatr Allergy Immunol 2017; 28:135-143. [PMID: 27864894 DOI: 10.1111/pai.12682] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/28/2022]
Abstract
As the prevalence of allergic disease dramatically rises worldwide, prevention strategies are increasingly being considered. Given the potential modulatory effect of nutritional factors on disease, altering maternal diet during pregnancy and/or lactation has been considered in preventing allergic disease in offspring. Although there are a number of observational studies that have examined possible associations between maternal diet and allergic outcomes in offspring, interventional trials are limited. Furthermore, there is a paucity of studies that have prospectively studied maternal dietary intake as well as measuring maternal and infant biologic samples (blood, urine, breast milk) and their relation to allergic outcomes in infants. There is also a particular need to define terminology such as 'fruit and vegetables intake', 'healthy diet', and 'diet diversity' in order to make studies comparable. In this review, we discuss current evidence of maternal dietary factors during pregnancy and/or lactation that may play a role in the offspring developing allergic disease, including factors such as overall dietary intake patterns, specific whole food consumption (fish, fruit and vegetables, and common allergic foods), and individual immunomodulatory nutrient intakes. Additionally, we discuss the limitations of previous studies and propose improvements to study design for future investigation.
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Affiliation(s)
- Carina Venter
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kari R Brown
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kate Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Debra J Palmer
- School of Paediatrics and Child Health, Princess Margaret Hospital, University of Western Australia, Perth, WA, Australia
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McStay CL, Prescott SL, Bower C, Palmer DJ. Maternal Folic Acid Supplementation during Pregnancy and Childhood Allergic Disease Outcomes: A Question of Timing? Nutrients 2017; 9:nu9020123. [PMID: 28208798 PMCID: PMC5331554 DOI: 10.3390/nu9020123] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/03/2017] [Indexed: 12/17/2022] Open
Abstract
Since the early 1990s, maternal folic acid supplementation has been recommended prior to and during the first trimester of pregnancy, to reduce the risk of infant neural tube defects. In addition, many countries have also implemented the folic acid fortification of staple foods, in order to promote sufficient intakes amongst women of a childbearing age, based on concerns surrounding variable dietary and supplementation practices. As many women continue to take folic acid supplements beyond the recommended first trimester, there has been an overall increase in folate intakes, particularly in countries with mandatory fortification. This has raised questions on the consequences for the developing fetus, given that folic acid, a methyl donor, has the potential to epigenetically modify gene expression. In animal studies, folic acid has been shown to promote an allergic phenotype in the offspring, through changes in DNA methylation. Human population studies have also described associations between folate status in pregnancy and the risk of subsequent childhood allergic disease. In this review, we address the question of whether ongoing maternal folic acid supplementation after neural tube closure, could be contributing to the rise in early life allergic diseases.
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Affiliation(s)
- Catrina L McStay
- Department of Health Western Australia, Perth 6004, Western Australia, Australia.
| | - Susan L Prescott
- School of Paediatrics and Child Health, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Members of the in-FLAME International Inflammation Network, Perth 6000, Western Australia, Australia.
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
| | - Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Telethon Kids Institute, The University of Western Australia, Subiaco 6008, Western Australia, Australia.
- Members of the in-FLAME International Inflammation Network, Perth 6000, Western Australia, Australia.
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Metcalfe JR, Marsh JA, D'Vaz N, Geddes DT, Lai CT, Prescott SL, Palmer DJ. Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial. Clin Exp Allergy 2016; 46:1605-1613. [PMID: 27562481 DOI: 10.1111/cea.12806] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is limited understanding of how maternal diet affects breastmilk food allergen concentrations, and whether exposure to allergens through this route influences the development of infant oral tolerance or sensitization. OBJECTIVE To investigate how maternal dietary egg ingestion during early lactation influences egg protein (ovalbumin) levels detected in human breastmilk. METHODS In a randomized controlled trial, women were allocated to a dietary group for the first six weeks of lactation: high-egg diet (> 4 eggs per week), low-egg diet (one-three eggs per week) or an egg-free diet. Breastmilk samples were collected at 2, 4 and 6 weeks of lactation for the measurement of ovalbumin. The permeability of the mammary epithelium was assessed by measuring the breastmilk sodium : potassium ratio. Egg-specific IgE and IgG4 were measured in infant plasma at 6 weeks, and prior to the introduction of egg in solids at 16 weeks. RESULTS Average maternal egg ingestion was associated with breastmilk ovalbumin concentration. Specifically, for each additional egg ingested per week, there was an average 25% increase in ovalbumin concentration (95% CI: 5-48%, P = 0.01). Breastmilk ovalbumin concentrations were significantly higher in the 'high-egg' group (> 4 eggs per week) compared with the 'egg-free' group (P = 0.04). However, one-third of women had no breastmilk ovalbumin detected. No detectable associations were found between mammary epithelium permeability and breastmilk ovalbumin concentrations. Infant plasma egg-specific IgG4 levels were also positively associated with maternal egg ingestion, with an average 22% (95% CI: 3-45%) increase in infant egg-specific IgG4 levels per additional egg consumed per week (P = 0.02). CONCLUSIONS AND CLINICAL RELEVANCE Increased maternal egg ingestion is associated with increased breastmilk ovalbumin, and markers of immune tolerance in infants. These results highlight the potential for maternal diet to benefit infant oral tolerance development during lactation.
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Affiliation(s)
- J R Metcalfe
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - J A Marsh
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Mathematics & Statistics, The University of Western Australia, Perth, WA, Australia
| | - N D'Vaz
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - D T Geddes
- School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA, Australia
| | - C T Lai
- School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA, Australia
| | - S 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
| | - D J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
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Rueter K, Jones A, Siafarikas A, Lim EM, Prescott SL, Palmer DJ. ASCIA-P55: THE INFLUENCE OF VITAMIN D AND UV-LIGHT EXPOSURE ON THE DEVELOPING IMMUNE PHENOTYPE IN INFANCY. Intern Med J 2016. [DOI: 10.1111/imj.55_13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kristina Rueter
- School of Paediatrics and Child Health; University of Western Australia
- Princess Margaret Hospital for Children; Perth Australia
- Telethon Kids Institute; University of Western Australia
| | - Anderson Jones
- School of Paediatrics and Child Health; University of Western Australia
- Telethon Kids Institute; University of Western Australia
| | - Aris Siafarikas
- School of Paediatrics and Child Health; University of Western Australia
- Princess Margaret Hospital for Children; Perth Australia
| | - Ee M Lim
- Endocrinology Department; Sir Charles Gardner Hospital; Perth Australia
| | - Susan L. Prescott
- School of Paediatrics and Child Health; University of Western Australia
- Princess Margaret Hospital for Children; Perth Australia
- Telethon Kids Institute; University of Western Australia
| | - Debra J. Palmer
- School of Paediatrics and Child Health; University of Western Australia
- Telethon Kids Institute; University of Western Australia
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47
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Palmer DJ. Timing of Introduction of Solids and Early-Onset Allergic Disease. Curr Pediatr Rep 2016. [DOI: 10.1007/s40124-016-0106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Palmer DJ, Sullivan TR, Gold MS, Prescott SL, Makrides M. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2016; 139:1600-1607.e2. [PMID: 27554812 DOI: 10.1016/j.jaci.2016.06.052] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ideal age to introduce egg into the infant diet has been debated for the past 2 decades in the context of rising rates of egg allergy. OBJECTIVE We sought to determine whether regular consumption of egg protein from age 4 to 6 months reduces the risk of IgE-mediated egg allergy in infants with hereditary risk, but without eczema. METHODS Infants aged 4 to 6 months were randomly allocated to receive daily pasteurized raw whole egg powder (n = 407) or a color-matched rice powder (n = 413) to age 10 months. All infants followed an egg-free diet and cooked egg was introduced to both groups at age 10 months. The primary outcome was IgE-mediated egg allergy defined by a positive pasteurized raw egg challenge and egg sensitization at age 12 months. RESULTS There was no difference between groups in the percentage of infants with IgE-mediated egg allergy (egg 7.0% vs control 10.3%; adjusted relative risk, 0.75; 95% CI, 0.48-1.17; P = .20). A higher proportion of participants in the egg group stopped taking the study powder because of a confirmed allergic reaction (25 of 407 [6.1%] compared with 6 of 413 [1.5%]). Egg-specific IgG4 levels were substantially higher in the egg group at 12 months (median, 1.22 mgA/L vs control 0.07 mgA/L; P < .0001). CONCLUSIONS We found no evidence that regular egg intake from age 4 to 6 months substantially alters the risk of egg allergy by age 1 year in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry.
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Affiliation(s)
- Debra J Palmer
- School of Paediatrics and Child Health, the University of Western Australia (M561), Perth, Australia; Women's & Children's Health Research Institute, Adelaide, Australia.
| | - Thomas R Sullivan
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Michael S Gold
- School of Medicine, University of Adelaide, Women's and Children's Health Network, Adelaide, Australia
| | - Susan L Prescott
- School of Paediatrics and Child Health, the University of Western Australia (M561), Perth, Australia; Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Maria Makrides
- Women's & Children's Health Research Institute, Adelaide, Australia; School of Medicine, University of Adelaide, Women's and Children's Health Network, Adelaide, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
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Rueter K, Prescott SL, Palmer DJ. Nutritional approaches for the primary prevention of allergic disease: An update. J Paediatr Child Health 2015; 51:962-9; quiz 968-9. [PMID: 26135523 DOI: 10.1111/jpc.12951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 12/20/2022]
Abstract
The dramatic rise in early childhood allergic diseases indicates the specific vulnerability of the immune system to early life environmental changes. Dietary changes are at the centre of lifestyle changes that underpin many modern inflammatory and metabolic diseases, and therefore are an essential element of prevention strategies. Although modern dietary changes are complex and involve changing patterns of many nutrients, there is also an interest in the early life effects of specific nutrients including polyunsaturated fatty acids, oligosaccharides (soluble fibre), antioxidants, folate and other vitamins that have documented effects on immune function as well as metabolism. A better understanding of nutritional programming of immune health, nutritional epigenetics and the biological processes sensitive to nutritional exposures in early life may lead to dietary strategies that provide more tolerogenic conditions during early immune programming and reduce the burden of many inflammatory diseases, not just allergy.
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Affiliation(s)
- Kristina Rueter
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Susan L Prescott
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Debra J Palmer
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Abstract
A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema.
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Affiliation(s)
- Debra J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, PO Box D184, Princess Margaret Hospital, Perth WA 6001, Australia.
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