Cumulative Incidence Of Eczema Research Articles

Maternal dietary patterns during pregnancy and the risk of infantile eczema during the first year of life: a cohort study in northeast China

BackgroundThere are few studies on the relationship between diet during pregnancy and infantile eczema and the conclusions are inconsistent. The aim of the present study was to explore the impact of dietary patterns during pregnancy on infantile eczema.MethodsA total of 495 mother–child pairs from a prospective cohort in Shenyang, China was recruited. Information on maternal dietary intake during pregnancy was assessed with a validated self-administered food frequency questionnaire. The data of infantile eczema was assessed using a structured questionnaire. Factor analysis to derive dietary patterns. The relationship between the dietary pattern and infantile eczema was examined by the logistic regression analysis.ResultsThe cumulative incidence of eczema in 6 months and 12 months in northeast China was 45.7% and 57.8%, respectively. Three dietary patterns were identified. There was a tendency for an expose-response relationship between the maternal high-protein dietary pattern during pregnancy and the risk of infantile eczema within 12 months (P for trend = 0.023): the adjusted odds ratio (95% confidence interval) in the Q1, Q2, Q3, Q4 were 1.00 (reference), 1.63 (0.96–2.76), 1.81 (1.06–3.06), and 1.87 (1.09–3.20), respectively. No association between Western and plant-based patterns during pregnancy and infantile eczema within 12 months was found. Infantile eczema within 6 months was not associated with any of the three dietary patterns.ConclusionThe maternal high-protein pattern during pregnancy may be a risk factor for infantile eczema during the first year of life.

Skin care interventions in infants for preventing eczema and food allergy.

Skin care interventions in infants for preventing eczema and food allergy.

Long-Term Ambient Air Pollution and Childhood Eczema in the United States.

Long-Term Ambient Air Pollution and Childhood Eczema in the United States.

Effect of Early Infant Probiotic Supplementation on Eczema, Asthma, and Rhinitis at 7 Years of Age.

We previously reported the initial results of the Trial of Infant Probiotic Supplementation (TIPS) study to determine if daily administration of a probiotic, Lactobacillus rhamnosus GG (LGG), during the first 6 months of life to children at high risk for allergic disease because of asthma in a parent can decrease their cumulative incidence of eczema.1 To date, the TIPS study is the only of its type performed in the United States.urour initial report, when all children were at least 2 years of age, we noted no effect on the incidence of eczema. We now present additional results, with the participants at least 7 years of age, on the cumulative incidence of eczema, asthma, and rhinitis.The TIPS study is a randomized, double-masked, parallel-arm, controlled trial designed to evaluate the effectiveness of daily LGG supplementation for the first 6 months of life to decrease the incidence of eczema, a potential early marker of asthma.1 For this analysis, we used physician-diagnosed asthma and physician-diagnosed rhinitis as secondary outcomes.To determine the effects of LGG on cumulative incidence of study outcomes, we performed modified intention-to-treat analyses with all participants who received treatment in the study arm to which they had been randomly assigned. We used survival analysis approaches to estimate Kaplan-Meier curves for each treatment group. We used nonparametric log-rank tests to determine differences between treatment groups and failure plots to visualize the cumulative probability of experiencing each outcome during follow-up.We used separate Cox proportional hazards regression models to compare the incidence of each outcome between the intervention and control groups, adjusting for mode of delivery and breastfeeding duration. Breastfeeding duration (in months up to 12) was treated as a time-dependent covariate.All analyses were performed using SAS version 9.4 software (SAS Institute Inc, Cary, NC). P < .05 was set for statistical significance. The protocol was approved by the Albert Einstein College of Medicine Institutional Review Board.Over the 7-year follow-up, 49 (53%) of 92 intervention and 54 (59%) of 92 control participants remained in the study for an overall 56% retention rate. Eczema was diagnosed in 78 participants, asthma in 32, and rhinitis in 15. The mean follow-up time was 5.7 years (median, 7 years). Incidence of eczema was high during infancy but low thereafter. In contrast, incidence rates for asthma and rhinitis were constant during childhood. Although the initial cumulative incidence seemed to favor the intervention in the early years of life for eczema and asthma, this trajectory was not sustained. The results showed no difference in the primary or secondary outcomes (Fig 1). Main findings from the Cox proportional hazards regression model are presented in Table 1. Cesarean delivery was associated with a greater incidence of rhinitis, with a hazard ratio (HR) of 3.33 (95% confidence interval [CI], 1.21–9.21).This follow-up report reveals that early infant LGG supplementation does not affect the cumulative incidence of eczema, asthma, and rhinitis at 7 years of age. Kalliomäki et al2 reported that early LGG supplementation decreases the likelihood of eczema and wheezing; however, their LGG supplementation occurred through both postnatal infant and prenatal maternal supplementation. The effect of LGG supplementation may only be discernable in infants born into high-risk scenarios because of altered gastrointestinal microbiota development3,4 (eg, cesarean delivery, lack of breast milk exposure); however, few TIPS study infants were exclusively fed formula or were cesarean delivered. Although LGG supplementation in infants is associated with significant increases in the similarity of the infant gut microbiota and metabolome to that of an infant at low risk for allergic disease, it does so only for the 6-month period in which LGG is administered.5 It is possible that probiotic supplementation to the mother during pregnancy and/or the infant for a longer period may be more effective.The results presented in Table 1 reveal that breastfeeding may increase the risk of eczema (HR, 11.97); however, the CIs are extremely wide (95% CI, 6.81–21.02), suggesting an unstable estimate. In addition, the effect of breastfeeding is not consistent, as there is no association with asthma or rhinitis incidence; therefore, we cannot clearly interpret this result. There is the potential of a type II error, as the TIPS study was designed to have 80% power to detect an HR <0.66, corresponding with a 10% absolute reduction in the 2-year cumulative incidence of eczema.Despite these limitations of the results, we can build on our earlier report regarding eczema. For this population of infants at higher risk for allergic disease, we cannot support the use of early infant LGG probiotic supplementation for the prevention of eczema, asthma, or rhinitis.

Maternal Dietary Protein Patterns During Pregnancy and the Risk of Infant Eczema: A Cohort Study.

Background: Previous studies have suggested that maternal dietary protein was associated with allergic diseases in offspring, but few studies have evaluated the influence of dietary protein patterns. This study aimed to explore the prospective association between maternal dietary protein patterns during pregnancy and the risk of infant eczema.Methods: A total of 713 mother-child pairs from a prospective cohort in Guangzhou, China were recruited. Maternal dietary protein was estimated using a validated face-to-face food frequency questionnaire at 20–28 weeks' gestation from 2017 to 2018. Dietary protein patterns were calculated based on the sources of protein. The data of infant eczema was assessed at 6 months of age using the symptom questionnaire of eczema. Logistic regression was carried out to examine the associations between maternal dietary protein patterns and infant eczema.Results: The cumulative incidence of infant eczema at 6 months of age was 51.19%. Mothers of infants with eczema consumed more protein from poultry source during pregnancy than mothers of infants without eczema, while no statistical differences were observed in maternal intakes of protein from cereals and tubers, vegetables, fruits, red meat, fish and seafood, eggs, dairy, soybean, and nuts and seeds. Four dietary protein patterns were identified and termed poultry, plant, dairy and eggs, and red meat and fish. The cumulative incidence of eczema was 61.2, 45.8, 48.0, 51.4% for these four patterns, respectively. Compared to the poultry dietary pattern, the plant pattern and the dairy and eggs pattern were associated with a reduced risk of infant eczema, and the adjusted odds ratios (95% confidence interval) were 0.572 (0.330–0.992), 0.478 (0.274–0.837), respectively. No such association was observed for the red meat and fish dietary protein pattern.Conclusion: This is the first study that focused on the association between maternal dietary protein during pregnancy from a whole-diet perspective and infant eczema. Compared with the poultry dietary protein pattern, the maternal plant pattern and the dairy and eggs pattern during pregnancy were associated with a reduced risk of infant eczema.

Partially Hydrolyzed Whey Protein: A Review of Current Evidence, Implementation, and Further Directions

Background: Human milk is known to be the best nutrition for infants as it provides many health benefits. For non-breastfed infants, cow's milk based infant formula is the most optimal option to provide the needed nutrition. However, approximately 2-5% of all formula-fed infants experience cow’s milk allergy during their first year of life. Partially hydrolyzed whey formula (pHF-W) have been widely recommended to prevent the development of allergic disease in infants. However, according to epidemiological data, approximately half of the infants developing allergy are not part of the at-risk group.Objectives and Methods: This article aims to review the effects of pHF-W in preventing allergy, especially atopic disease, in all non-breastfed infants, as well as the safety aspect of pHF-W if used as routine formula. The role of pHF-W in the management of functional gastro-intestinal (GI) disorders is also reviewed.Results: Several clinical studies showed that pHF-W decrease the number of infants with eczema. The strongest evidence is provided by the 15-year follow up of the German Infant Nutritional Intervention study which showed reduction in the cumulative incidence of eczema and allergic rhinitis in pHF-W (OR 0.75, 95% CI 0.59-0.96 for eczema; OR 0.67, 95% CI 0.47-0.95 for allergic rhinitis) and casein extensively hydrolysed formula group (OR 0.60, 95% CI 0.46-0.77 for eczema; OR 0.59, 95% CI 0.41-0.84 for allergic rhinitis), compared to CMF as a control, after 15 years of follow-up. pHF-W was also found to be beneficial in the management of functional GI disorders such as regurgitation, constipation and colic.Conclusions: The use of pHF-W in allergic infants has been recommended in various guidelines across the countries, as a primary prevention of allergic disease. One pHF-W has been approved by the US FDA and the European Commission's European Food Safety Authority (EFSA) for its safety and suitability as a routine infant formula for all healthy infants. According to the data obtained in the management of functional GI disorders, pHF-W is better tolerated than formula with intact protein. Further studies assessing the effect of routine use of pHF-W in a larger population of non-breastfed infants should also be conducted, in order to observe any potential harm and to determine the benefit and cost-effectiveness ratio.

Skin care interventions in infants for preventing eczema and food allergy.

Skin care interventions in infants for preventing eczema and food allergy.

Skincare interventions in infants for preventing eczema and food allergy

Skincare interventions in infants for preventing eczema and food allergy

Association between attendance of day care centres and increased prevalence of eczema in the German birth cohort study LISAplus

Day care centre attendance is much more common in East than in West Germany. Although there is evidence that early day care might be protective against atopic diseases, several studies have shown a higher prevalence of childhood eczema in East Germany compared to West Germany. To compare prevalence and cumulative incidence of eczema in a birth cohort study in East and West Germany and to identify risk factors that are associated with eczema, which might explain regional differences. We used data from the ongoing population-based birth cohort study Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany Plus the influence of traffic emissions and genetics. In 1997, 3097 children from study areas in East and West Germany were recruited. Cumulative incidence and 1-year prevalences of eczema up to the age of 6 years were determined from yearly questionnaires. Cox regression and generalized estimating equations/logistic regression were used to quantify regional differences and to identify risk factors that might explain them. Prevalence and incidence of eczema were higher in children living in East Germany than those living in West Germany. We identified 11 risk factors that showed significant regional differences. From these factors, only 'day care attendance during the first 2 years of life' was significantly associated with eczema (odds ratio 1.56, 95% confidence interval CI 1.31-1.86). The regional differences in eczema could be explained by differences in early day care utilization. Day care centre attendance is associated with an increased prevalence and incidence of eczema. Regional differences in eczema prevalence could be explained by regional differences in utilization of early day care.

Impact of early feeding on childhood eczema: development after nutritional intervention compared with the natural course – the GINIplus study up to the age of 6 years

Nutritional intervention with hydrolysed infant formulas has been shown efficacious in preventing eczema in children predisposed to allergy. However, this preventive effect has never been related to the natural course of eczema in children with or without a family history of allergy. The aim of this study therefore was to compare the course of eczema in predisposed children after nutritional intervention to the natural course of eczema. The prospective German birth cohort study GINIplus includes a total of 5991 children, subdivided into interventional and non-interventional groups. Children with a familial predisposition for allergy whose parents agreed to participate in the prospective, double-blind intervention trial (N=2252) were randomly assigned at birth to one of four formulas: partially or extensively hydrolysed whey, extensively hydrolysed casein (eHF-C) or standard cow's milk formula. Children with or without familial predisposition represented the non-interventional group (N=3739). Follow-up data were taken from yearly self-administered questionnaires from 1 up to 6 years. The outcome was physician-diagnosed eczema and its symptoms. The cumulative incidence of eczema in predisposed children with or without nutritional intervention was compared with that of non-predisposed children who did not receive intervention. Cox regression was used to adjust for confounding. Predisposed children without nutritional intervention had a 2.1 times higher risk for eczema [95% confidence interval (CI) 1.6-2.7] than children without a familial predisposition. The risk was smaller with nutritional intervention even levelling out to 1.3 (95% CI 0.9-1.9) in children fed eHF-C formula. Although direct comparability is somewhat restricted, the data demonstrate that early intervention with hydrolysed infant formulas can substantially compensate up until the age of 6 years for an enhanced risk of childhood eczema due to familial predisposition to allergy.

Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double‐blind, randomized, placebo‐controlled trial

Controversy exists regarding the preventive effect of probiotics on the development of eczema or atopic dermatitis. We investigated whether supplementation of probiotics prevents the development of eczema in infants at high risk. In a randomized, double-blind, placebo-controlled trial, 112 pregnant women with a family history of allergic diseases received a once-daily supplement, either a mixture of Bifidobacterium bifidum BGN4, B. lactis AD011, and Lactobacillus acidophilus AD031, or placebo, starting at 4-8 wks before delivery and continuing until 6 months after delivery. Infants were exclusively breast-fed during the first 3 months, and were subsequently fed with breastmilk or cow's milk formula from 4 to 6 months of age. Clinical symptoms of the infants were monitored until 1 yr of age, when the total and specific IgE against common food allergens were measured. A total of 68 infants completed the study. The prevalence of eczema at 1 yr in the probiotic group was significantly lower than in the placebo group (18.2% vs. 40.0%, p=0.048). The cumulative incidence of eczema during the first 12 months was reduced significantly in probiotic group (36.4% vs. 62.9%, p=0.029); however, there was no difference in serum total IgE level or the sensitization against food allergens between the two groups. Prenatal and postnatal supplementation with a mixture of B. bifidum BGN4, B. lactis AD011, and L. acidophilus AD031 is an effective approach in preventing the development of eczema in infants at high risk of allergy during the first year of life.

Probiotics in prevention of IgE-associated eczema: A double-blind, randomized, placebo-controlled trial

An altered microbial exposure may underlie the increase of allergic diseases in affluent societies. Probiotics may alleviate and even prevent eczema in infants. To prevent eczema and sensitization in infants with a family history of allergic disease by oral supplementation with the probiotic Lactobacillus reuteri. Double-blind, randomized, placebo-controlled trial, which comprised 232 families with allergic disease, of whom 188 completed the study. The mothers received L reuteri ATCC 55730 (1 x 10(8) colony forming units) daily from gestational week 36 until delivery. Their babies then continued with the same product from birth until 12 months of age and were followed up for another year. Primary outcome was allergic disease, with or without positive skin prick test or circulating IgE to food allergens. The cumulative incidence of eczema was similar, 36% in the treated versus 34% in the placebo group. The L reuteri group had less IgE-associated eczema during the second year, 8% versus 20% (P = .02), however. Skin prick test reactivity was also less common in the treated than in the placebo group, significantly so for infants with mothers with allergies, 14% versus 31% (P = .02). Wheeze and other potentially allergic diseases were not affected. Although a preventive effect of probiotics on infant eczema was not confirmed, the treated infants had less IgE-associated eczema at 2 years of age and therefore possibly run a reduced risk to develop later respiratory allergic disease. Probiotics may reduce the incidence of IgE-associated eczema in infancy.