Soup Kettle Topics: Maternal and Infant Considerations

Title: Effect of Maternal Immunotherapy on Immediate Skin Test Reactivity, Specific Rye I Igg and Ige Antibody, and Total Ige of the Children
Author: Glovsky, M. M.; Ghekiere, L.; Rejzek, E.; (Date: Jul, 1991)
Journal: Ann Allergy; V. 67; Issue: 1; Pages: 21-4

Abstract: The effect of specific immunotherapy during pregnancy was studied in 14 children, 3 to 12 years after delivery. Fourteen additional children from the same allergic mothers, in whom immunotherapy was not given during the pregnancy, served as controls. The immediate skin test response to grass allergens of the children of mothers given immunotherapy. Levels of rye I IgG and total IgE were lower in the sera of children born to mothers who received immunotherapy (not statistically significant) than their control cohorts. Paired cord blood and maternal blood samples drawn at delivery showed similar levels of rye I IgG, indicating that blocking antibody freely crosses the placenta. This evidence indicates that immunotherapy during pregnancy may have an inhibitory effect on immediate skin reactivity to grass allergens in some of the offspring. Whether tolerance to other allergens can be induced in children by maternal immunotherapy remains to be determined.
Notes: Journal Article
Author Address: Kaiser Foundation Hospitals, Los Angeles, California.

Title: Atopy in Childhood and Diet in Infancy. A Nine-Year Follow-up Study. I. Clinical Manifestations
Author: Poysa, L.; Korppi, M.; Remes, K.; Juntunen-Backman, K.; (Date: Mar-Apr, 1991)
Journal: Allergy Proc; V. 12; Issue: 2; Pages: 107-11

Abstract: A national program for the prevention of atopy in children has been in progress in Finland since 1979. Its aim is to prevent or at least to reduce atopic symptoms in childhood. Since the start of the program we have followed a group of 119 children with and without a family history of atopy. Half the atopy-prone children kept to the diet intended to prevent atopy, i.e., breast-feeding prolonged up to age 3 months and introduction of solid food and formulae based on cow’s milk after age 3 months. All children were examined at ages 5 and 10 years. In addition to clinical examination and interview, skin-prick tests using eight common inhalant allergens were performed. At age 9 to 10 years, 38 of the 119 children (32%) exhibited at least one atopic illness (bronchial asthma, allergic rhinitis, allergic conjunctivitis, atopic eczema or food allergy). Forty percent of children with family histories of atopy had atopic illness, independent of diet in infancy. The occurrence of atopic manifestations in the children of nonatopic families was 21%. Only half the children who had atopic symptoms at age 12 months had symptoms 9 years later. Asthma, allergic rhinitis, and positive skin-prick test results at age 5 years, however, correlated well with the subsequent occurrence of respiratory allergy. Our observations indicate that the preventive measures in early infancy intended to reduce the risk of atopy had no influence on atopic manifestations 9 years later.
Notes: Journal Article
Author Address: Department of Paediatrics, Kuopio University Central Hospital, Finland.

Title: Atopic Sensitization During the First Year of Life in Relation to Long Chain Polyunsaturated Fatty Acid Levels in Human Milk
Author: Duchen, K.; Yu, G.; Bjorksten, B.; (Date: Oct, 1998)
Journal: Pediatr Res; V. 44; Issue: 4; Pages: 478-84

Abstract: The levels of the long chain polyunsaturated n-6 and n-3 fatty acids (PUFA) were studied in colostrum and mature milk of 29 atopic and 29 nonatopic mothers and related to sensitization in their babies during the first 12 mo of life. The levels of alpha-linolenic acid (LNA) were lower (0.96 versus 1.23 weight percentage, p < 0.01) and the levels of dihomo-gamma-linoleic acid were higher (0.36 versus 0.31 weight percentage, p < 0.05) in mature milk from mothers of atopic babies (n = 24) compared with mothers of nonatopic babies (n = 34). The total n-3 levels and the ratio of n-6 PUFA/n-3 PUFA were similar in colostrum of all mothers and then decreased significantly in mature milk (p < 0.001), particularly in milk given to atopic babies. The levels of the n-6 fatty acids arachidonic acid, C22:4, and C22:5 n-6 correlated in milk samples from nonatopic mothers (r = 0.61-0.97, p < 0.05 to p < 0.001) but were largely absent in colostrum and mature milk from atopic mothers. In contrast, LNA and eicosapentaenoic levels correlated in colostrum from the atopic mothers (r = 0.61-0.88) regardless of atopic sensitization in the infants, whereas LNA correlated to C20:4 n-3 in colostrum from nonatopic mothers of nonatopic infants. Furthermore, the levels of the n-3 fatty acid C20:4 n-3 correlated significantly to all n-6 fatty acids, except linoleic acid (r = 0.64-0.79, all p < 0.01) in mature milk from nonatopic mothers of nonsensitized children. Low levels of LNA and total n-3 long chain polyunsaturated fatty acids, in mature milk from the mothers, appear to be associated with atopic sensitization early in life, as well as disturbed relationships between the n-3 fatty acid 20:4 and the n-6 fatty acids particularly in mature milk. On the other hand, disturbed relationships within the individual fatty acids in the n-6 series in human milk reflected the atopic status in the mothers. The variations in the lipid composition of human milk could in part explain some of the controversies regarding the protective effects of breast-feeding against allergy.
Notes: Journal Article
Author Address: Department of Paediatrics, Linkoping University, Sweden.

Title: Exposure to Cow’s Milk During the First 3 Months of Life Is Associated with Increased Levels of Igg Subclass Antibodies to Beta-Lactoglobulin to 8 Years
Author: Jenmalm, M. C.; Bjorksten, B.; (Date: Oct, 1998)
Journal: J Allergy Clin Immunol; V. 102; Issue: 4 Pt 1; Pages: 671-8

Abstract: BACKGROUND: Exposure to allergens early in life influences the development of allergen-specific immune responses. In animal models, the development of tolerance to proteins delivered to the gastrointestinal and the respiratory mucosa is influenced by age and genetic background. Late introduction of cow’s milk in infants is associated with slower increase and lower peak IgG antibody responses to milk during early childhood, but the long-term effects have not been investigated, nor is the relation to atopic disease later in life clear. OBJECTIVE: The purpose of this study was to investigate the development of IgG subclass antibodies to beta-lactoglobulin in relation to early exposure to cow’s milk, atopic heredity, and the development of atopic disease. METHODS: IgG subclass antibodies to beta-lactoglobulin were analyzed by ELISA at birth, at 6 and 18 months, and at 8 years in 96 children followed prospectively. RESULTS: The levels of IgG subclass antibodies to beta-lactoglobulin peaked in early childhood and then declined up to 8 years of age. Exposure to cow’s milk during the first 3 months of life was associated with high IgG subclass antibody levels to beta-lactoglobulin up to 8 years, particularly in children with maternal atopy. Children with atopic symptoms and sensitivity to allergens often had high levels of IgG4 antibodies to beta-lactoglobulin at 8 years of age, even if they were not exposed to cow’s milk during the first 3 months of life. Furthermore, atopic dermatitis was associated with high levels of IgG subclass antibodies to beta-lactoglobulin in early childhood. CONCLUSIONS: IgG subclass antibody levels to milk peak during early infancy, with particularly high levels in children with atopic dermatitis, and decline thereafter. Exposure to cow’s milk during early infancy has long-lasting effects on the humoral antigen-specific responses, indicating less effective tolerance-inducing mechanisms in the intestinal mucosa during the first months of life.
Notes: Journal Article
Author Address: Department of Health and Environment, Faculty of Health, Linkoping University, Sweden.

Title: Fatty Acid Composition in Colostrum and Mature Milk from Non-Atopic and Atopic Mothers During the First 6 Months of Lactation
Author: Yu, G.; Duchen, K.; Bjorksten, B.; (Date: Jul, 1998)
Journal: Acta Paediatr; V. 87; Issue: 7; Pages: 729-36

Abstract: The fatty acid composition of total lipids was analysed in colostrum and mature human milk samples obtained at 1, 3, 4 and 6 months from 17 non-atopic and at 1 and 3 months from 17 atopic mothers. The relative levels of linoleic acid and alpha-linolenic acid increased up to 3 months after delivery and then declined. In contrast, the levels of their metabolites were higher in colostrum than in mature milk. The levels of dihomo-gamma-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid were all lower in atopic than non-atopic mothers in milk samples obtained after 1 month of lactation (all p < 0.05). The ratio of total n-6 to n-3 long-chain polyunsaturated fatty acids (LCP) in milk at 1 and 3 months was higher in atopic than non-atopic mothers (all p < 0.05). Lower levels of the monounsaturated fatty acids (MUFA) were also observed in atopic mothers, as compared to non-atopic mothers. In the non-atopic mothers, the levels of individual n-6 LCP correlated and also correlated with n-3 LCP in colostrum and early mature milk (r = 0.60-0.92, all p < 0.01). These correlations within n-6 and between n-6 and n-3 LCP were mostly absent in atopic mothers. The findings suggest that the LCP metabolism in human milk is disturbed in atopic mothers, as indicated by the lower relative levels of some LCP at 1 month, higher ratios of n-6 to n-3 LCP and poor correlations between the levels of the various compounds during the first 3 months of lactation.
Notes: Journal Article
Author Address: Department of Health and Environment, Linkoping University, Sweden.

Title: Allergy Priming Early in Life
Author: Bjorksten, B.; (Date: Jan 16, 1999)
Journal: Lancet; V. 353; Issue: 9148; Pages: 167-8

Notes: Comment
Journal Article
Author Address: Department of Health and Environment, University Hospital, Linkoping, Sweden.

Title: The Intrauterine and Postnatal Environments
Author: Bjorksten, B.; (Date: Dec, 1999)
Journal: J Allergy Clin Immunol; V. 104; Issue: 6; Pages: 1119-27

Abstract: Pregnancy is associated with a strong skewing toward T(H)2 cytokine pattern, which enables the survival of the fetus, including fetal allergen-specific immune responses. The postnatal maturation of the immune system which is characterized by the development of a balanced T(H)1/T(H)2 immunity is genetically determined and modified by the environment. The process seems to proceed at a slower rate in atopic than in nonatopic infants. There is a close immunologic interaction between the mother and her offspring through the breast milk. Individual variations in the composition of human milk may explain the controversy with regard to the possible allergy-preventive effects of breast-feeding. Recurrent respiratory infections have been suggested to enhance immune deviation. The microbial flora are a more likely source, however, because they are a major driving force in the maturation of the immune system. Changes in its composition, as a consequence of an altered lifestyle and diet, may play a role in the higher prevalence of allergy. So far, primary prevention of allergy has failed. Future studies should therefore focus on factors enhancing immune deviation (ie, “success” factors) rather than on “risk” factors. The intestinal microflora is one of these factors that deserves closer analysis.
Notes: Journal Article
Review, Tutorial
Author Address: Division of Paediatrics, Department of Health and Environment, Linkoping University, Linkoping, Sweden.

Title: Allergen-Specific T-Cell Memory
Author: Gray, D.; (Date: Apr 3, 1999)
Journal: Lancet; V. 353; Issue: 9159; Pages: 1187-8

Notes: Comment

Title: Relationship between Fetal Growth and the Development of Asthma and Atopy in Childhood
Author: Leadbitter, P.; Pearce, N.; Cheng, S.; Sears, M. R.; Holdaway, M. D.; Flannery, E. M.; Herbison, G. P.; Beasley, R.; (Date: Oct, 1999)
Journal: Thorax; V. 54; Issue: 10; Pages: 905-10

Abstract: BACKGROUND: A study was undertaken to investigate the relationship between birth anthropometric measures and the subsequent development of asthma, airway hyperresponsiveness, and atopy in later childhood. METHODS: A longitudinal study was performed on 734 subjects (71%) from a cohort of children born in Dunedin, New Zealand in 1972-73. The birth anthropometric measures were available from hospital records and the main outcome measures of reported asthma, skin prick tests, and methacholine hyperresponsiveness were measured at the age of 13 years, while the serum total IgE was measured at 11 years. RESULTS: After adjustment for other factors, infants with a larger head circumference at birth tended to have higher serum total IgE at 11 years of age (p = 0.02) but IgE was not associated significantly with birth length or birth weight. The adjusted odds ratio for raised serum IgE (>150 IU/ml) in infants with a head circumference of 37 cm or more was 3.4 (95% CI 1.4 to 7.9). In contrast, recent asthma symptoms were positively associated with birth length (p = 0. 04) but not with head circumference. The adjusted odds ratio for asthma in the previous two years in infants with a birth length of 56 cm or more was 6.4 (95% CI 2.0 to 19.8). Infants with a birth weight of less than 3.0 kg had an odds ratio for reported asthma of 0.2 (95% CI 0.0-0.6). There were no significant associations of any of the birth parameters with skin prick positivity, reported hay fever, or eczema. CONCLUSIONS: These results suggest that increased fetal growth is related to an increased risk of asthma and atopy in childhood. The precision of the findings is limited by the small numbers in the extreme categories of each birth parameter, but the results are consistent with intrauterine programming of the developing respiratory and immune systems.
Notes: Journal Article
Author Address: Wellington Asthma Research Group, Department of Medicine, Wellington School of Medicine, P.O. Box 7343, Wellington, New Zealand.

Title: Development of Allergen-Specific T-Cell Memory in Atopic and Normal Children
Author: Prescott, S. L.; Macaubas, C.; Smallacombe, T.; Holt, B. J.; Sly, P. D.; Holt, P. G.; (Date: Jan 16, 1999)
Journal: Lancet; V. 353; Issue: 9148; Pages: 196-200

Abstract: BACKGROUND: In the past 20-30 years, there has been an increase in prevalence of allergic respiratory diseases, particularly amongst children. This study is a prospective analysis of the postnatal maturation of T-helper cell (Th) responses to aeroallergens in atopic and non-atopic infants. METHODS: We measured mononuclear-cell proliferative and cytokine responses to specific allergens and tetanus toxoid in blood samples from atopic and non-atopic infants every 6 months from birth to 2 years of age. Cytokine analyses of responses to housedust-mite allergen used ELISA and reverse-transcriptase PCR. We also measured responses to Fel d1 (cat allergen) and tetanus toxoid. FINDINGS: Samples from 18 atopic and 13 non-atopic infants showed low-level Th2-skewed allergen-specific responses at birth, with little accompanying specific interferon-gamma production. Neonatal Th2 responses were lower in the atopic group than in the non-atopic group; the differences were significant for interleukin-4 (mRNA: beta-actin ratio 0.48 [SE 0.15] vs 0.15 [0.06], p=0.049), interleukin-6 (4750 [48] vs 1352 [51] pg/mL culture fluid, p=0.003), interleukin-10 (1162 [228] vs 485 [89], p=0.015), and interleukin-13 (7.1 [0.9] vs 0.9 [0.3], p=0.008). There was rapid suppression of Th2 responses during the first year of life in non-atopic children, but there was consolidation of responses in atopic children, associated with defective neonatal interferon-gamma production. INTERPRETATION: The continuation of fetal allergen-specific Th2 responses during infancy is a defining feature of the inductive phase of atopic disease, and is associated with decreased capacity for production of the Th1 cytokine interferon y by atopic neonates. These findings provide a plausible mechanism for persistence of the fetal Th2 responses during early childhood in atopic individuals and subsequent expression of disease.
Notes: Journal Article
Author Address: Division of Cell Biology, TVW Telethon Institute for Child Health Research, West Perth, WA, Australia.

Title: Influence of Parental Smoking on Respiratory Symptoms During the First Decade of Life: The Tucson Children’s Respiratory Study
Author: Stein, R. T.; Holberg, C. J.; Sherrill, D.; Wright, A. L.; Morgan, W. J.; Taussig, L.; Martinez, F. D.; (Date: Jun 1, 1999)
Journal: Am J Epidemiol; V. 149; Issue: 11; Pages: 1030-7

Abstract: Compelling evidence suggests a causal relation between exposure to parental cigarette smoking and respiratory symptoms during childhood. Still, the roles of prenatal versus postnatal parental smoking need clarification. In this study, the authors assessed the effects of passive smoking on respiratory symptoms in a cohort of over 1,000 children born during 1980-1984. The children were enrolled in the Tucson Children’s Respiratory Study in Tucson, Arizona, and were followed from birth to age 11 years. The population was generally middle class and consisted of two main ethnic groups, non-Hispanic Whites (75%) and Hispanics (20%), reflecting Tucson’s population. Information on parental smoking and on wheeze and cough in their children was elicited from parents by using questionnaires at five different surveys. Data were analyzed both cross-sectionally and by using the generalized estimation equation approach, a longitudinal mixed-effects model. The best-fitting model indicated that maternal prenatal but not postnatal smoking was associated with current wheeze (odds ratio = 2.3, 95% confidence interval 1.4-3.8) independently of a family history of asthma, socioeconomic factors, and birth weight. This effect was time dependent and significant only below age 3 years; although independent of gender, the association was stronger for girls (odds ratio = 3.6, 95% confidence interval 1.6-8.0). Cough was not associated with parental smoking during the first decade of life. This transitory effect of maternal prenatal smoking on wheezing could be due to changes that affect the early stages of lung development.
Notes: Journal Article
Author Address: Department of Pediatrics, College of Medicine, Pontificia Universidade Catolica RS, Porto Alegre, Brazil.

Title: Maternal Smoking During Pregnancy, Environmental Tobacco Smoke Exposure and Childhood Lung Function
Author: Gilliland, F. D.; Berhane, K.; McConnell, R.; Gauderman, W. J.; Vora, H.; Rappaport, E. B.; Avol, E.; Peters, J. M.; (Date: Apr, 2000)
Journal: Thorax; V. 55; Issue: 4; Pages: 271-6

Abstract: BACKGROUND: Exposure to environmental tobacco smoke (ETS) during childhood and in utero exposure to maternal smoking are associated with adverse effects on lung growth and development. METHODS: A study was undertaken of the associations between maternal smoking during pregnancy, exposure to ETS, and pulmonary function in 3357 school children residing in 12 Southern California communities. Current and past exposure to household ETS and exposure to maternal smoking in utero were assessed by a self-administered questionnaire completed by parents of 4th, 7th, and 10th grade students in 1993. Standard linear regression techniques were used to estimate the effects of in utero and ETS exposure on lung function, adjusting for age, sex, race, Hispanic ethnicity, height, weight, asthma, personal smoking, and selected household characteristics. RESULTS: In utero exposure to maternal smoking was associated with reduced peak expiratory flow rate (PEFR) (-3.0%, 95% CI -4.4 to -1.4), mean mid expiratory flow (MMEF) (-4.6%, 95% CI -7.0 to -2.3), and forced expiratory flow (FEF(75)) (-6.2%, 95% CI -9.1 to -3.1), but not forced expiratory volume in one second (FEV(1)). Adjusting for household ETS exposure did not substantially change these estimates. The reductions in flows associated with in utero exposure did not significantly vary with sex, race, grade, income, parental education, or personal smoking. Exposure to two or more current household smokers was associated with reduced MMEF (-4.1%, 95% CI -7.6 to -0. 4) and FEF(75) (-4.4%, 95% CI -9.0 to 0.4). Current or past maternal smoking was associated with reductions in PEFR and MMEF; however, after adjustment for in utero exposure, deficits in MMEF and FEF(75) associated with all measurements of ETS were substantially reduced and were not statistically significant. CONCLUSIONS: In utero exposure to maternal smoking is independently associated with decreased lung function in children of school age, especially for small airway flows.
Notes: Journal Article
Author Address: Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, California 90033, USA.

Title: Maternal Diet Rich in Saturated Fat During Breastfeeding Is Associated with Atopic Sensitization of the Infant
Author: Hoppu, U.; Kalliomaki, M.; Isolauri, E.; (Date: Sep, 2000)
Journal: Eur J Clin Nutr; V. 54; Issue: 9; Pages: 702-5

Abstract: OBJECTIVE: To investigate the impact of maternal diet during breastfeeding on atopic sensitization of infants at risk. DESIGN: Prospective cohort study. SETTING: Turku University Central Hospital, Finland. SUBJECTS AND METHODS: Altogether 114 infants with a family history of atopic disease were followed during their first year of life. The mothers completed a 4 day food record during breastfeeding just before the infants were 3 months old. Atopic sensitization of the infants was determined by a positive skin prick test result at 12 months. RESULTS: Positive skin prick test reactivity to at least one antigen was detected in 27/114 (24%) infants at 12 months. The energy intake of the mothers was low, mean 8.0 MJ/day (95% CI 7.7-8. 3), and the proportion of energy derived from fat was high, mean 36. 6 E% (95% CI 35.6-37.6). Atopic mothers had a higher intake of total fat and saturated fat and a lower intake of carbohydrate as a percentage of total energy intake than non-atopic mothers; P=0.017, P=0.050, P=0.004 respectively. Maternal intake of saturated fat during breastfeeding was associated with atopic sensitization of the infant, OR=1.16 (95% CI 1.001-1.36); P=0.048 irrespective of the maternal atopic status. CONCLUSIONS: Our results show that an unbalanced maternal diet during breastfeeding may be a risk factor underlying the later development of atopic sensitization of the infant regardless of maternal atopic disease. The observation thus extends findings implying that early nutrition programmes the subsequent health of the child to the risk of developing atopic disease. SPONSORSHIP: Academy of Finland and National Technology Agency.
Notes: Journal Article
Author Address: Department of Paediatrics, University of Turku, Turku, Finland.

Title: Breastfeeding and Atopic Sensitisation
Author: Kalliomaki, M.; Isolauri, E.; 2000)
Journal: Adv Exp Med Biol; V. 478; Pages: 389-90

Notes: Journal Article
Author Address: Department of Paediatrics, Turku University Hospital, Finland.

Title: Atopy, Lung Function, and Obstructive Airways Disease after Prenatal Exposure to Famine
Author: Lopuhaa, C. E.; Roseboom, T. J.; Osmond, C.; Barker, D. J.; Ravelli, A. C.; Bleker, O. P.; van der Zee, J. S.; van der Meulen, J. H.; (Date: Jul, 2000)
Journal: Thorax; V. 55; Issue: 7; Pages: 555-61

Abstract: BACKGROUND: Associations have been found between a large head size at birth and atopy, and between low birth weight and obstructive airways disease. A study was undertaken of people born around the time of the Dutch famine in 1944-5 to determine the effects of maternal malnutrition during specific periods of gestation on the prevalence of obstructive airways disease and atopy. METHODS: Nine hundred and twelve people aged about 50, born at term between November 1943 and February 1947 in Amsterdam, were asked about their medical history. Lung function was measured in 733 and serum concentrations of total IgE and specific IgE against mite, pollen and cat were measured in 726. Those exposed in late, mid, and early gestation (exposed participants) were compared with those born before or conceived after the famine (non-exposed participants). RESULTS: Exposure to famine during gestation affected neither the concentrations of total or specific IgE nor lung function values. The prevalence of obstructive airways disease was increased in people exposed to famine in mid gestation (odds ratio adjusted for sex 1.7, 95% confidence interval (CI) 1.1 to 2.6) and tended to be higher in those exposed in early gestation (odds ratio 1.5, 95% CI 0. 9 to 2.6). CONCLUSIONS: The observed increase in the prevalence of obstructive airways disease in people exposed to famine in mid and early gestation was not parallelled by effects on IgE concentrations or lung function. The link between exposure to famine in mid and early gestation and obstructive airways disease in adulthood suggests that fetal lungs can be permanently affected by nutritional challenges during periods of rapid growth.
Notes: Journal Article
Author Address: Department of Pulmonology, Academic Medical Center, University of Amsterdam, The Netherlands.

Title: Low Birth Weight and Preterm Delivery as Risk Factors for Asthma and Atopic Dermatitis in Young Adult Males
Author: Steffensen, F. H.; Sorensen, H. T.; Gillman, M. W.; Rothman, K. J.; Sabroe, S.; Fischer, P.; Olsen, J.; (Date: Mar, 2000)
Journal: Epidemiology; V. 11; Issue: 2; Pages: 185-8

Abstract: Gestational factors have been hypothesized to play a role in the susceptibility to asthma and atopic dermatitis. We examined whether fetal growth was associated with asthma and atopic dermatitis separately in a population of 4,795 male conscripts born between 1973 and 1975 in Denmark. The prevalence of asthma was 4.7%. The prevalence odds ratio of asthma in conscripts with a birth weight below 2,501 g was 1.5 (95% confidence interval = 0.7-3.1) compared with conscripts with a birth weight of 3,001-3,500 g, adjusted for gestational age and potential confounders. The adjusted prevalence odds ratio among conscripts born before 34 gestational weeks was 0.8 (95% confidence interval = 0.3-2.0) compared with conscripts born at term. The prevalence of atopic dermatitis was 1.0%. The prevalence odds ratio of atopic dermatitis among those with a birth weight below 2,501 g was 3.0 (95% confidence interval = 0.8-11.9) compared with those whose birth weight was between 3,001 and 3,500 g. Men whose gestational age had been below 34 weeks had an adjusted prevalence odds ratio of 0.3 (95% confidence interval = 0.0-3.1). These findings indicate that fetal growth retardation rather than preterm delivery of male infants is the main gestational factor underlying the associations but does not explain the apparent increase over time of asthma or atopic diseases.
Notes: Journal Article
Author Address: Department of Internal Medicine M, Aalborg Hospital, Denmark.

Title: Parental Factors Affecting Respiratory Function During the First Year of Life
Author: Young, S.; Sherrill, D. L.; Arnott, J.; Diepeveen, D.; LeSouef, P. N.; Landau, L. I.; (Date: May, 2000)
Journal: Pediatr Pulmonol; V. 29; Issue: 5; Pages: 331-40

Abstract: In a prospective, longitudinal, population-based cohort study of familial and environmental influences on the development of wheezing respiratory illness in early childhood, we identified infant length, weight, gender, and exposure to maternal cigarette smoking as significant determinants of lung function during the first year of life. A cohort of 237 infants (106 females: 131 males) was evaluated, and 496 lung function measurements were made between the ages of 1-12 months. Respiratory function was assessed using the rapid thoracic compression technique to obtain maximum expiratory flow at functional residual capacity (V’maxFRC). Parental history of asthma and smoking habits during pregnancy were obtained by questionnaire. Data were analyzed using a longitudinal random effects model. Infants with a parental history of asthma and/or in utero passive smoke exposure were compared to a reference group of infants who had no parental history of asthma and in whom neither parent smoked pre- or postnatally. Boys were found to have a consistently lower V’maxFRC (-21.05 mL.s(-1)) throughout the first year of life in comparison to girls (P < 0.05). Maternal smoking during pregnancy was associated with a lower V’maxFRC in both genders in comparison to unexposed infants (P < 0.05). V’maxFRC was unaffected by parental history of asthma. Gender-specific normative equations for V’maxFRC throughout the first year of life were derived for the infant cohort as a whole and also for subgroups of infants, based on parental asthma and smoking history. We conclude that lung function during the first year of life differs between genders and is adversely affected by in utero passive tobacco smoke exposure. Gender-specific predictive equations for V’maxFRC should be used during infancy.
Notes: Journal Article
Author Address: Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.

Title: Breast Milk–Immunomodulatory Signals against Allergic Diseases
Author: Hoppu, U.; Kalliomaki, M.; Laiho, K.; Isolauri, E.; 2001)
Journal: Allergy; V. 56 Suppl 67; Pages: 23-6

Abstract: Breastfeeding holds a key position with regard to the increasing burden of allergic diseases in the industrialized countries. Not only does it provide the infant with nutrients for growth and development, it also confers immunological protection during a critical period in life, when the infant’s own defense mechanisms are immature. A delicate balance of stimulatory, even inflammatory, maturational signals, together with a myriad of anti-inflammatory compounds, is transferred from mother to infant via breastfeeding. Breastfeeding mothers, however, do not constitute a uniform group. The composition of breast milk shows marked individual variation and so, consequently, does the success of breastfeeding in reducing the risk of disease. Recent clinical studies indicate that the potential of breastfeeding to counteract allergic disease may be promoted by dietary means. While uncoordinated elimination diets result in a risk of general nutritional inadequacy or deficiency of essential single nutrients, a balanced diet following current dietary recommendations, specifically containing fresh fruits and vegetables (antioxidants) and fat of predominantly vegetable origin, may be associated with a lower incidence of atopy in the infant. As early nutrition appears to program the subsequent health of the child, the importance of the maternal dietary composition during breastfeeding should be emphasized. In future, an improved understanding of the mechanisms of this programming may offer specific therapeutic modalities for the prevention of allergic disease.
Notes: Journal Article
Review, Tutorial
Author Address: Department of Paediatrics, University of Turku, Turku, Finland.

Title: Development of Cow’s Milk Allergy in Breast-Fed Infants
Author: Jarvinen, K. M.; Suomalainen, H.; (Date: Jul, 2001)
Journal: Clin Exp Allergy; V. 31; Issue: 7; Pages: 978-87

Notes: Journal Article
Review, Tutorial
Author Address: Helsinki University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland.

Title: Polyunsaturated Fatty Acids in Maternal Diet, Breast Milk, and Serum Lipid Fatty Acids of Infants in Relation to Atopy
Author: Kankaanpaa, P.; Nurmela, K.; Erkkila, A.; Kalliomaki, M.; Holmberg-Marttila, D.; Salminen, S.; Isolauri, E.; (Date: Jul, 2001)
Journal: Allergy; V. 56; Issue: 7; Pages: 633-8

Abstract: BACKGROUND: The increased consumption of n-6 polyunsaturated fatty acids (PUFA) has been shown to coincide with the increased prevalence of atopic diseases. We aimed to investigate whether maternal diet and atopic status influence the PUFA composition of breast milk and the serum lipid fatty acids of infants. METHODS: Maternal diet was assessed by a food questionnaire. The PUFA composition of breast milk obtained at 3 months from 20 allergic and 20 healthy mothers and of their infants’ (10 atopic and 10 nonatopic/group of mothers) serum lipids was analyzed. RESULTS: Although no differences in maternal PUFA intake were observed, the breast milk of allergic mothers contained less gamma-linolenic acid (18:3 n-6) than that of healthy mothers. Similarly, atopic infants had less gamma-linolenic acid in phospholipids than healthy infants, although n-6 PUFA were elevated in other serum lipid fractions in atopic infants. The serum lipid fatty acids in atopic infants did not correlate with those in maternal breast milk. CONCLUSION: Our results suggest that dietary n-6 PUFA are not as readily transferred into breast milk or incorporated into serum phospholipids, but may be utilized for other purposes, such as eicosanoid precursors, in allergic/atopic individuals. Subsequently, high dietary proportions of n-6 PUFA, or reduced proportions of regulatory PUFA, such as gamma-linolenic acid and n-3 PUFA, may be a risk factor for the development of atopic disease.
Notes: Journal Article
Author Address: Departments of Biochemistry and Food Chemistry, and Pediatrics, University of Turku, Turku, Finland.

Title: Factors Influencing the Relation of Infant Feeding to Asthma and Recurrent Wheeze in Childhood
Author: Wright, A. L.; Holberg, C. J.; Taussig, L. M.; Martinez, F. D.; (Date: Mar, 2001)
Journal: Thorax; V. 56; Issue: 3; Pages: 192-7

Abstract: BACKGROUND: The relationship between infant feeding and childhood asthma is controversial. This study tested the hypothesis that the relation between breast feeding and childhood asthma is altered by the presence of maternal asthma. METHODS: Healthy non-selected newborn infants (n = 1246) were enrolled at birth. Asthma was defined as a physician diagnosis of asthma plus asthma symptoms reported on > or = 2 questionnaires at 6, 9, 11 or 13 years. Recurrent wheeze (> or = 4 episodes in the past year) was reported by questionnaire at seven ages in the first 13 years of life. Duration of exclusive breast feeding was based on prospective physician reports or parental questionnaires completed at 18 months. Atopy was assessed by skin test responses at the age of 6 years. RESULTS: The relationship between breast feeding, asthma, and wheeze differed with the presence or absence of maternal asthma and atopy in the child. After adjusting for confounders, children with asthmatic mothers were significantly more likely to have asthma if they had been exclusively breast fed (OR 8.7, 95% CI 3.4 to 22.2). This relationship was only evident for atopic children and persisted after adjusting for confounders. In contrast, the relation between recurrent wheeze and breast feeding was age dependent. In the first 2 years of life exclusive breast feeding was associated with significantly lower rates of recurrent wheeze (OR 0.45, 95% CI 0.2 to 0.9), regardless of the presence or absence of maternal asthma or atopy in the child. Beginning at the age of 6 years, exclusive breast feeding was unrelated to prevalence of recurrent wheeze, except for children with asthmatic mothers in whom it was associated with a higher odds ratio for wheeze (OR 5.7, 95% CI 2.3 to 14.1), especially if the child was atopic. CONCLUSION: The relationship between breast feeding and asthma or recurrent wheeze varies with the age of the child and the presence or absence of maternal asthma and atopy in the child. While associated with protection against recurrent wheeze early in life, breast feeding is associated with an increased risk of asthma and recurrent wheeze beginning at the age of 6 years, but only for atopic children with asthmatic mothers.
Notes: Journal Article
Author Address: Respiratory Sciences Center, Arizona Health Sciences Center and Department of Pediatrics and Steele Memorial Children’s Research Center, University of Arizona, Tucson, Arizona, USA.

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