INTESTINAL DYSFUNCTION AND SENSITISATION TO DIETARY ANTIGENS DURING EXCLUSIVE BREASTFEEDING-A CHALLENGE FOR THE MANAGEMENT OF ATOPIC DERMATTTIS

Abstract

Allergic diseases are increasing in prevalence and severity even in breastfed infants. Sensitisation to dietary antigens comprises the initial manifestation of allergy, which may be amenable to preventive and therapeutic exploitation. We studied 21 infants in whom moderate or severe atopic eczema had begun during exclusive breastfeeding. At mean 6 months of age, we evaluated the extent and severity of atopic eczema, and measured the concentrations of faecal α-1 antitrypsin and tumor necrosis factor-α, and performed lactulose/mannitol permeability test and bacterial cultures of faeces. Two groups of patients were identified: after onset of symptoms 9/21 were assigned to an amino acid based formula, while 12/21 continued breastfeeding. The mean duration of exclusive breastfeeding was comparable between the groups, (3.8 months) while the total duration of breastfeeding was significantly different, (5 months versus 8 months). The clinical score of atopic eczema (SCORAD) was improved in the amino acid formula group and the concentration of faecal α-1 antitrypsin (mg/g) decreased. Table shows the data in median (upper and lower quartiles) for patients received either the amino acid formula or breastfed. Specific IgE to dietary antigens was more elevated in the breastfed than in the amino acid formula group. However, normal intestinal permeability and an inhibitory effect on intestinal inflammation was detected in both groups alike. Intestinal bacterial flora was normal in the breastfed group while in the amino acid formula group Candida albicans (two cases), Staphylococcus aureus (two cases) and Clostridium difficile (three cases) were cultured. These results indicate that breastfeeding protects the intestine's microecology and permeability barrier but does not prevent aberrant protein transfer in the gut and immune responses to dietary antigens. In conclusion considering that atopy associates with impaired antigen transfer and dysregulation of IgE synthesis, prolonged breastfeeding of atopic infants harbors a considerable risk of sensitisation to multiple allergens via breast milk.