Abstract
BackgroundThe role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children.MethodsThe Infant Feeding Practices Study II conducted by the CDC and US-FDA enrolled pregnant women and collected infant feeding information using nine repeated surveys. Participants were re-contacted after 6 years. Food allergy data were collected at 4, 9, 12, and 72 months. In total, 1387 participants had complete infant feeding pattern data for 6 months and information on food allergy symptoms and doctors’ diagnosed food allergy. Feeding patterns constituted six groups: 3-months of feeding at breast followed by mixed feeding, 3-months of breast milk and bottled milk followed by mixed feeding, 1-month of feeding at breast followed by mixed feeding, 6-months of mixed feeding i.e., concurrent feeding of breast milk, bottled milk and formula, 2–3 months of formula followed by formula and solid food, and formula and solid food since the first month. To estimate risks of food allergy, we used linear mixed models, controlling for potential confounders.ResultsOf the 328 children with food allergy symptoms in infancy and at 6 years, 52 had persistent symptoms from infancy. Children exposed to mixed feeding had a higher risk of food allergy symptoms (Risk Ratio [RR] 1.54; 95% Confidence Interval [CI] 1.04, 2.29) compared to 3-months of feeding at breast adjusted for confounding. No statistically significant risk of infant feeding patterns was found for doctors’ diagnosed food allergy. Paternal allergy posed a higher risk for food allergy symptoms (RR 1.36; 95% CI 1.01, 1.83). Prenatal maternal smoking increased the risk for doctors’ diagnosed food allergy (RR 2.97; 95% CI 1.53, 5.79).ConclusionsAnalysis of this prospective birth cohort suggest that introduction of multiple feeding source may lead to food allergy symptoms. Future efforts are needed to determine acceptable approaches to improve the ascertainment of food allergy in children and the role of infant feeding.
Highlights
The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods
Mother-infant pairs were excluded from the study if (i) mother or the infant had a medical condition at birth that would impede feeding, (ii) the infants’ gestational age was < 35 weeks, (iii) the birth weight of the infant was < 5 lb., (iv) infant was not a singleton, and (v) infant was treated in intensive care for more than 3 days
Among those children with symptoms and those diagnosed with a food allergy we investigated what tests were performed for the diagnosis of food allergy using, “If your baby was tested or examined for food allergy, what method was used?,” or “What testing method was used by a doctor to check for a food allergy? (Year 6).”
Summary
The role of infant feeding for food allergy in children is unclear and studies have not addressed simultaneous exposures to different foods. The goal of this study was to analyze existing data on feeding practices that represent realistic exposure and assess the risk of food allergy symptoms and food allergy in children. Food allergy has been on rise in developed countries [1, 2]. Between 1997 and 2007, the prevalence of food allergy has increased from 3.9% to approximately 5.0% in the United States (U.S.) [3]. In 2016, a cross sectional study of 333,200 children up to 5 years of age reported provider-diagnosed food allergy prevalence to be 6.7% [5]. Children with food allergy are at an increased risk for asthma and wheezing [4]. Regarding prevalence, comorbidities, and costs, effective methods of prevention and treatment are of substantial value
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