The Protective Effect of Cheese Consumption at 18 Months on Allergic Diseases in the First 6 Years

Abstract

To evaluate whether cheese consumption is associated with allergic disease. The hypothesis was based on the notion that cheese is a food potentially rich in microbial diversity, and immune tolerance to allergens is associated with the quantity and diversity of the microbes that constitute the gut microbiota.The study included 1133 children from a prospective birth cohort, Protection Against Allergy: Study in Rural Environment, that included children from rural areas from 5 European countries (Austria, Finland, France, Germany, and Switzerland). Pregnant women were recruited during their third trimester of pregnancy. Participants were divided into 2 groups: the farm group, in which women were exposed to livestock, and the reference group, which consisted of women living in rural areas but not living on a farm.Mothers answered questionnaires in their third trimester of pregnancy and when the children were 2, 12, 18, and 24 months of age, then yearly up until the age of 6. Between the ages of 3 and 12 months old and again at 18 months old, food diaries were collected to identify which foods had been introduced. Food- and inhalant-specific immunoglobulin E were measured at 1, 4.5, and 6 years old. The type of cheese, brand, and frequency of cheese consumption were recorded. A cheese diversity score was calculated on the basis of the number of cheese types consumed at 18 months of age. Logistic regression analysis was used to determine if protective effects against atopic diseases were associated with cheese consumption, cheese consumption frequency, and cheese diversity.Introduction of cheese by the age of 18 months was found to have a significant protective effect on atopic dermatitis (odds ratio [OR] = 0.51 [95% confidence interval (CI): 0.29–0.90], P = .02) and food allergy (OR = 0.32 [95% CI: 0.15–0.71], P = .004) at 6 years of age. This contrasts with the lack of protective effect of cheese consumption on asthma, allergic rhinitis, or atopic sensitization. Additionally, increasing cheese diversity had a significantly reduced risk of atopic dermatitis (OR = 0.64 [95% CI: 0.48–0.85], P = .002) and food allergy (OR = 0.55 [95% CI: 0.33–0.92], P = .02). Children who ate cheese 1 to 6 times a week were at lower risk for food allergy. Increased risk for rhinitis was found in children who never consumed cheese or ate cheese less than once weekly.In addition to the introduction of cheese at 18 months of age, the type of cheese and frequency of consumption had a protective effect against atopic dermatitis and food allergy at 6 years of age.As atopic diseases increase in frequency, interest in the prevention of development of atopy also grows. This study is unique in that it evaluated the introduction and consumption of cheese, a food with potentially rich microbial diversity, and applied the “hygiene hypothesis” to evaluate its effect on allergic disease. Further studies may elucidate the long-term effects of cheese consumption in children of different ages and may provide a recommendation to aid in the prevention of some forms of atopic disease in pediatric patients.