May 1, The age when infants are introduced to solid foods has varied greatly .. CM Relationship of diet in the development of atopy in infancy Clin. We examined the relationship of diet to the development of atopic manifestations in a group of infants with an immediate family history of atopy, followed. Sep 1, Supplement: Influence of Diet on Infection and Allergy in Infants as longitudinal epidemiological studies of the development of atopic diseases Germany ( Multicenter Allergy Study), a dose-response relationship could be.
In addition, the association with a positive family history for atopy and asthma in first degree relatives becomes more and more obvious 3.
Relationship of diet in the development of atopy in infancy.
Can early exposure to infections be protective? One of the hypotheses that has attracted much interest is that a decline in certain childhood infections or a lack of exposure to infectious agents during the first years of life, which is associated with smaller families in the middle-class environment of industrialized countries, could be causal for the recent epidemic in atopic disease and asthma 4.
Although this area is obviously very complex, several pieces of information appear to support this hypothesis. Studies from several countries provide indirect evidence for the hypothesis that early exposure to viral or mycobacterial 5 infections, although triggering lower airway symptoms during early life 6 — 9may have long-lasting protective effects; children who were born into families with several, particularly older, siblings have been found to have a reduced risk of allergic sensitization and asthma at school age Studies in children who had attended daycare centers during infancy support this concept Infections have long-lasting, nonspecific, systemic effects on the nature of the immune response to antigens and allergens.
For example, recovery from natural measles infection reduces the incidence of atopy and allergic responses to house dust mites to one-half that in vaccinated children.12 Infant Nutrition Do's & Don'ts - Baby Development
Obviously, the fact that certain infections are inducing a systemic and nonspecific switch to T-helper cell 1 Th1 activities could be responsible for an inhibition of the development of atopy during childhood.
Although these observations on the relationship between immune responses to infectious agents and atopic sensitization and disease expression are stimulating and challenging, conclusions regarding the relevance for the atopic march should be drawn with care. In different parts of the world, completely different infectious agents have been addressed in different study settings.
Exposure to endotoxin The role of endotoxin exposure as a possible element of atopy prevention in early life has recently been discussed 13 Endotoxins consist of a family of molecules called lipopolysaccharides and are an intrinsic part of the outer membrane of gram-negative bacteria.
Lipopolysaccharides and other bacterial wall components, which can also be found abundantly in stables where pigs, cattle, and poultry are kept, engage with antigen presenting cells via cluster of differentiation-legation strong interleukin 12 responses.
Strategies for Atopy Prevention | The Journal of Nutrition | Oxford Academic
Interleukin 12, in turn, is regarded as an obligatory signal for the maturation of naive T cells into TH2-type cells. Endotoxin concentrations were recently found to be highest in stables of farming families and also in dust samples from kitchen floors and mattresses in rural areas in Southern Germany and Switzerland.
These findings support the hypothesis that environmental exposure to endotoxin and other bacterial wall components is an important protective determinant regarding the development of atopic diseases. Indeed, endotoxin levels in samples of dust from children's mattress have recently been found to be inversely related to the occurrence of hay fever, atopic asthma, and atopic sensitization 8.
Options for alimentary prevention Measures for primary prevention are aimed at a population that is still healthy but at risk of the disease. Unfortunately, all predictors investigated so far are insufficient in sensitivity and specificity. Although the extent of a preventive effect of breast-feeding remains controversial, several other beneficial aspects justify the recommendation for exclusive breast-feeding for at least 4 mo.
If breast milk is not sufficiently available during the first 3—4 d, water is recommended. Solid foods should be introduced to the diet after mo 4. An avoidance of exposure to tobacco smoke should be guaranteed, particularly during pregnancy and infancy. Because children with a positive family history for atopy in first degree relatives have been shown to be more susceptible for allergic sensitization and the manifestation of atopy and asthma, additional measures for primary prevention have been studied during the last decade for this high-risk group.
The majority of studies aimed at prevention during pregnancy indicate that there is no real evidence for a protective effect of any maternal exclusion diet during that time. The effect of maternal avoidance of potential food allergens milk, eggs, and fish while breast-feeding seems at best to be marginal. If maternal breast milk is not sufficient, the use of hydrolyzed infant formulas for atopy prevention has been extensively studied over the years.
Some studies indicate that extensively hydrolyzed formulas in combination with avoidance of cow milk proteins and solid foods for at least 4 mo in children with a positive family history of atopy have some preventive effect 15but this is related to the food proteins that were avoided and cannot be considered as a long-lasting prevention of atopic manifestations of the skin or the airways in general. Recently, extensively and partially hydrolyzed formulas with moderately reduced allergenicity have been investigated in a large randomized prospective study German Infant Nutrition Intervention Study.
Compared with standard infant formulas, hydrolyzed feeding resulted in reduced incidence of atopic dermatitis in infancy Another option for alimentary prevention that was proposed more recently is the supplementation of infant formula with probiotics such as lactobacilli Initial studies from Finland suggested that the supplementation with certain lactobacilli strains to the diet of high-risk infants might not only modulate the intestinal flora but also reduce the incidence of atopic dermatitis during the first years of life.
Unfortunately, this interesting observation was not consistently confirmed by follow-up studies; therefore, further trials will be necessary to clarify whether there are long-term clinical effects that are possibly associated with a downregulation of IgE responses in infants.
Even more recently, it was proposed that the supplementation of oligosaccharides to an infant formula might have more consistent immunomodulatory effects. In experimental animals, the so-called prebiotics have been demonstrated to result in an upregulation of TH1 and downregulation of TH2 responses together with IgE antibody responses.
In humans, the addition of prebiotic oligosaccharides has been shown to result in remarkable changes of the intestinal flora. Counseling parents is further complicated by the fact that, despite recommendations to the contrary, many parents continue to feed their infants solids before the age of 4 months.
We also reviewed the bibliographies of relevant articles to identify additional studies. We used a key-word search because it was more robust than alternative literature searches using MeSH headings or key words of specific allergic conditions. We designed this systematic review to follow a number of inclusion and exclusion criteria. We included randomized controlled trials and case-control and cohort studies.
We chose to include cohort studies because some, but not all, of these cohort studies have been cited in feeding recommendations. We immediately eliminated articles that did not examine the relationship between the introduction of solid foods to infants and the development of any of the following allergic diseases: We did not include outcomes that frequently are due to nonallergic causes such as cough, respiratory illness, or vomiting in order to avoid type II error.
Therefore, studies were included only if they met all of the following criteria: If a citation could not be excluded based on the title or abstract, then the entire article was reviewed.
After articles that clearly did not meet the inclusion criteria were excluded, 2 of us B. We did not blind authors to the titles, authors, or journal publication of the articles.
We defined duplicate publications as multiple original articles that reported identical outcomes measured on the same population during the same period. For duplicate publications, we included the first published article unless minor differences between publications existed. In this latter case, we included the publication that provided the most information.
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Results Literature search Our literature search identified article titles. Thirty-nine articles required joint review by 3 of us B. None of these 39 articles was a randomized controlled trial. We found 2 sets 4 articles of duplicate publications.