ChiroACCESS Article



Infant Feeding and the Relationship to Asthma, Allergic Reactions and Allergic Sensitization in Children



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ChiroACCESS Editorial Staff

  

ChiroACCESS



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December 10, 2009

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There is a great deal of consistency in the recommendations to provide only breast milk during the first four to six months of infant feeding.  There has been some controversy regarding when to introduce solid food and what foods are appropriate to minimize allergies later in life.  There have been several studies published this year that provide more evidence to guide feeding recommendations.

There has been some controversy regarding when to introduce solid food and what foods are appropriate to minimize allergies later in lifeA 2009 guideline (see the abstract below) and several cohort studies this past year provide a better understanding of the relationship between delays in introducing solid foods in a child’s diet and the development of asthma and allergic sensitization.  The most recent Finnish study (Dec. 2009) supports many similar findings of a 2008 German study.  Both studies utilized birth cohorts of infants to track feeding practices and followed up to assess the development of allergic sensitization when the same children reached the age of 5 to 6.  “Eggs, oats, and wheat remained the most important foods related to sensitization to food allergens, whereas potatoes and fish were the most important foods associated with inhalant allergic sensitization”. 

The relationship between the introduction of solid foods to various allergic conditions is a direct one.  Past the normal 4-6 month breast feeding period, the greater the delay in introducing solid foods produces a greater risk of asthma and issues associated with allergic sensitization. Chiropractors often provide nutritional information and many provide pediatric care.  Some manage asthma and other allergic conditions.  It is important for the profession to keep abreast of these nutritional recommendations as they may serve as a means of primary prevention to the rise in asthma and allergy related conditions. 

Allergy prevention.

Dtsch Arztebl Int. 2009 Sep;106(39):625-31. Epub 2009 Sep 25.

Muche-Borowski C, Kopp M, Reese I, Sitter H, Werfel T, Schäfer T.
Cathleen.Borowski@gmx.de

BACKGROUND: Evidence-based primary prevention of allergic conditions is important in view of their increasing prevalence in Western industrialized countries.

METHODS: The Cochrane and Medline databases were searched for relevant scientific publications that appeared from February 2003 to May 2008. Articles in the reference lists of recent reviews were also considered, and experts were directly asked for their opinions. The retrieved publications were screened for relevance by evaluation of the title and abstract, and then by evaluation of the entire text. Each study chosen for inclusion was assigned an evidence grade as well as a grade for study quality relating to its potential for bias (low or high). The revised recommendations were then formally accepted by a consensus of representatives of medical specialist societies and other organizations, including a patient self-help group.

RESULTS: The search initially yielded 4556 results out of which 217 articles (4 Cochrane reviews, 14 meta-analyses, 19 randomized clinical trials, 135 cohort studies, and 45 case-control studies) were chosen for inclusion and critical appraisal. No major changes ensued in the existing recommendations to avoid exposure to tobacco smoke, breast-feed for 4 months (or use hypoallergenic formulas), avoid a mould-promoting indoor climate, avoid exposure to furry pets (particularly cats), and vaccinate according to the current recommendations of the Standing Committee on Vaccination of the Robert Koch Institute (Ständige Impfkommission, STIKO). Neither the delayed introduction of solid food nor the avoidance of potent dietary allergens is recommended as a means of primary prevention. New recommendations were issued regarding fish consumption (by the mother while breastfeeding and nursing, and by the infant as solid food), avoidance of overweight, and reduction of exposure to air pollutants. CONCLUSIONS: This updated guideline serves as an aid in giving patients current, evidence-based recommendations for allergy prevention.

Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years.

Pediatrics. 2009 Dec 7.

Nwaru BI, Erkkola M, Ahonen S, Kaila M, Haapala AM, Kronberg-Kippilä C, Salmelin R, Veijola R, Ilonen J, Simell O, Knip M, Virtanen SM.
Tampere School of Public Health, University of Tampere, Finland.

Objective: The goal was to examine the relationship between age at the introduction of solid foods during the first year of life and allergic sensitization in 5-year-old children.

Methods: We analyzed data from the Finnish Type 1 Diabetes Prediction and Prevention nutrition study, a prospective, birth cohort study. We studied 994 children with HLA-conferred susceptibility to type 1 diabetes mellitus for whom information on breastfeeding, age at the introduction of solid foods, and allergen-specific immunoglobulin E levels at 5 years was available. The association between age at the introduction of solid foods and allergic sensitization was analyzed by using logistic regression.

Results: The median duration of exclusive breastfeeding was 1.8 months (range: 0-10 months). After adjustment for potential confounders, late introduction of potatoes (>4 months), oats (>5 months), rye (>7 months), wheat (>6 months), meat (>5.5 months), fish (>8.2 months), and eggs (>10.5 months) was significantly directly associated with sensitization to food allergens. Late introduction of potatoes, rye, meat, and fish was significantly associated with sensitization to any inhalant allergen. In models that included all solid foods that were significantly related to the end points, eggs, oats, and wheat remained the most important foods related to sensitization to food allergens, whereas potatoes and fish were the most important foods associated with inhalant allergic sensitization. We found no evidence of reverse causality, taking into account parental allergic rhinitis and asthma. Conclusion: Late introduction of solid foods was associated with increased risk of allergic sensitization to food and inhalant allergens.

Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA.

Pediatrics. 2008 Jan;121(1):e44-52.

Zutavern A, Brockow I, Schaaf B, von Berg A, Diez U, Borte M, Kraemer U, Herbarth O, Behrendt H, Wichmann HE, Heinrich J; LISA Study Group.
GSF-National Research Center for Environment and Health, Institute of Epidemiology, 85764 Neuherberg, Germany.

OBJECTIVE: Current prophylactic feeding guidelines recommend a delayed introduction of solids for the prevention of atopic diseases. This study investigates whether a delayed introduction of solids (past 4 or 6 months) is protective against the development of eczema, asthma, allergic rhinitis, and food or inhalant sensitization at the age of 6 years.

METHODS: Data from 2073 children in the ongoing LISA birth cohort study were analyzed at 6 years of age. Multivariate logistic regression analyses were performed for all children and for children without skin or allergic symptoms within the first 6 months of life to take into account reverse causality.

RESULTS: A delayed introduction of solids (past 4 or 6 months) was not associated with decreased odds for asthma, allergic rhinitis, or sensitization against food or inhalant allergens at 6 years of age. On the contrary, food sensitization was more frequent in children who were introduced to solids later. The relationship between the timing of solid food introduction and eczema was not clear. There was no protective effect of a late introduction of solids or a less diverse diet within the first 4 months of life. However, in children without early skin or allergic symptoms were considered, eczema was significantly more frequent in children who received a more diverse diet within the first 4 months.

CONCLUSIONS: This study found no evidence supporting a delayed introduction of solids beyond 4 or 6 months for the prevention of asthma, allergic rhinitis, and food or inhalant sensitization at the age of 6 years. For eczema, the results were conflicting, and a protective effect of a delayed introduction of solids cannot be excluded. Positive associations between late introduction of solids and food sensitization have to be interpreted with caution. A true protective effect of a delayed introduction of solids on food sensitization seems unlikely.
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