Lower Risk Of Eczema Research Articles

Saliva contact during infancy and allergy development in school-age children.

Parent-child saliva contact during infancy might stimulate the child's immune system for effective allergy prevention. However, few studies have investigated its relation to allergy development in school-age children. We sought to investigate the relationship between parent-child saliva contact during infancy and allergy development at school age. We performed a large multicenter cross-sectional study involving Japanese school children and their parents. The self-administered questionnaires including questions from the International Study of Asthma and Allergies in Childhood were distributed to 3570 elementary and junior high school children in 2 local cities. Data were analyzed for the relationship between saliva contact during infancy (age <12 months) and the risk of allergy development, specifically eczema, allergic rhinitis, and asthma. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org. The valid response rate was 94.7%. The mean and median age of children was 10.8± 2.7 and 11 (interquartile range, 9-13) years, respectively. Saliva contact via sharing eating utensils during infancy was significantly associated with a lower risk of eczema (odds ratio, 0.53; 95% CI, 0.34-0.83) at school age. Saliva contact via parental sucking of pacifiers was significantly associated with a lower risk of eczema (odds ratio, 0.24; 95% CI, 0.10-0.60) and allergic rhinitis (odds ratio, 0.33; 95% CI, 0.15-0.73), and had a borderline association with the risk of asthma in school-age children. Saliva contact during infancy may reduce the risk of developing eczema and allergic rhinitis in school-age children.

Use of partially hydrolysed formula in infancy and incidence of eczema, respiratory symptoms or food allergies in toddlers from the ELFE cohort.

Partially hydrolyzed formulas (pHF) are recommended in non-breastfed infants with familial history of allergy to prevent allergy development. However, recent meta-analysis does not provide strong support for their protective effect. The present work assesses the links between 2-month infant formula use and the incidence of eczema, respiratory symptoms, or food allergies (FA) up to 2years of age. The nationwide ELFE birth cohort is a population-based study from mainland France. Infant feeding (breast milk only, partially hydrolyzed formula with [pHF-HA] or without a hypoallergenic label [pHF-non-HA], and non-hydrolyzed formula [Nhf]) was reported at 2months. Eczema, FA, and respiratory symptoms such as wheezing and asthma were reported at 2months, 1year, and 2years. Infants with prior FA at 2months were excluded from analyses. Among 11720 infants, those who received only breast milk at 2months were at lower risk of eczema at 1year than those who received nHF (OR[95% CI]=0.78[0.65-0.94] in non-at-risk infants; 0.86[0.75-0.98] in at-risk infants). The use of pHF-HA, compared with nHF, at 2months was related to higher risk of wheezing at 1year in at-risk infants (1.68[1.24-2.28]) and higher risk of FA at 2years both in non-at-risk infants (3.78[1.52-9.41]) and in at-risk infants (2.31[1.36-3.94]). In this nationwide study, pHF-HA use was not associated with a lower risk of any of the studied outcomes. Quite the reverse, it was associated with a higher risk of wheezing and FA. This should be confirmed in further studies.

Breastfeeding duration modifies the effect of smoking during pregnancy on eczema from early childhood to adolescence.

Cigarette smoke contains compounds similar to coal tar, an ancient remedy of eczema. Some studies have reported protective effects of maternal gestational smoking on offspring eczema; however, others have shown no or increased risks. Similarly, studies linking breastfeeding duration and eczema have demonstrated contradictory findings. No study has yet investigated combined effects of these two factors on eczema. Since tobacco compounds can pass to offspring via breast milk, we investigated their combined effects on eczema development from childhood to adolescence. We obtained information regarding gestational smoking, exclusive breastfeeding duration, and eczema at ages 1-or-2, 4, 10, and 18years from the Isle of Wight (IOW) birth cohort, UK. Using generalized estimating equations, we assessed the interaction of gestational smoking and residual exclusive breastfeeding duration (Resid-BF-duration, obtained by regressing the latter on maternal smoking) on eczema over time adjusting for confounders. For the three transition periods of 1-or-2 to 4years, 4-10, and 10-18years, we estimated risks of persistent, incident, and remitting eczema associated with the interaction using repeated measurements. If the mother smoked during gestation, longer Resid-BF-duration was associated with a lower risk of eczema, compared to if she did not smoke. The risk ratios (95% CI) if the mother smoked during gestation and exclusively breastfed for at least 3, 9, 15, 21weeks are 0.7 (0.6, 1.7), 0.6 (0. 4, 0.9), 0.5 (0.3, 0.8), and 0.4 (0.2, 0. 8), respectively. Additionally, in all three transition periods, the risk of persistent eczema was lower with longer Resid-BF-duration if the mother smoked during gestation. Results suggest a protective effect of gestational smoking combined with longer duration of exclusive breastfeeding on early-onset persistent eczema. Future studies should examine underlying biological mechanisms. Prolonged breastfeeding should be encouraged even if the mother smoked during gestation.

Prenatal exposure to TCDD and atopic conditions in the Seveso second generation: a prospective cohort study

Background2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a toxic environmental contaminant that can bioaccumulate in humans, cross the placenta, and cause immunological effects in children, including altering their risk of developing allergies. On July 10, 1976, a chemical explosion in Seveso, Italy, exposed nearby residents to a high amount of TCDD. In 1996, the Seveso Women’s Health Study (SWHS) was established to study the effects of TCDD on women’s health. Using data from the Seveso Second Generation Health Study, we aim to examine the effect of prenatal exposure to TCDD on the risk of atopic conditions in SWHS children born after the explosion.MethodsIndividual-level TCDD was measured in maternal serum collected soon after the accident. In 2014, we initiated the Seveso Second Generation Health Study to follow-up the children of the SWHS cohort who were born after the explosion or who were exposed in utero to TCDD. We enrolled 677 children, and cases of atopic conditions, including eczema, asthma, and hay fever, were identified by self-report during personal interviews with the mothers and children. Log-binomial and Poisson regressions were used to determine the association between prenatal TCDD and atopic conditions.ResultsA 10-fold increase in 1976 maternal serum TCDD (log10TCDD) was not significantly associated with asthma (adjusted relative risk (RR) = 0.93; 95% CI: 0.61, 1.40) or hay fever (adjusted RR = 0.99; 95% CI: 0.76, 1.27), but was significantly inversely associated with eczema (adjusted RR = 0.63; 95% CI: 0.40, 0.99). Maternal TCDD estimated at pregnancy was not significantly associated with eczema, asthma, or hay fever. There was no strong evidence of effect modification by child sex.ConclusionsOur results suggest that maternal serum TCDD near the time of explosion is associated with lower risk of eczema, which supports other evidence pointing to the dysregulated immune effects of TCDD.

Higher maternal serum concentrations of nicotinamide and related metabolites in late pregnancy are associated with a lower risk of offspring atopic eczema at age 12 months.

Evidence that atopic eczema partly originates in utero is increasing, with some studies linking the risk of developing the condition with aspects of maternal diet during pregnancy. Nicotinamide, a naturally occurring nutrient that is maintained through the dietary intakes of vitamin B3 and tryptophan, has been used in the treatment of some skin conditions including atopic eczema. To examine the relation of maternal serum concentrations of nicotinamide and related tryptophan metabolites to the risk of atopic eczema in the offspring. Within the UK Southampton Women Survey, infantile atopic eczema at ages 6 and 12 months was ascertained (modified UK Working Party Criteria for the Definition of Atopic Dermatitis). Maternal serum levels of kynurenine, kynurenic acid, anthranilic acid, tryptophan, nicotinamide and N1-methylnicotinamide were measured in late pregnancy by mass spectrometry (n = 497) and related to the odds ratio of infantile atopic eczema. Maternal nicotinamide and related metabolite concentrations were not associated with offspring atopic eczema at age 6 months. Higher concentrations of nicotinamide and anthranilic acid were, however, associated with a lower risk of eczema at age 12 months (odds ratios 0.69, 95% CI 0.53-0.91/SD change, P = 0.007 and 0.63, 0.48-0.83, P = 0.001, respectively). The associations were robust to adjustment for potentially confounding variables. This is the first study linking maternal serum concentrations of nicotinamide and related metabolites to the risk of atopic eczema in the offspring. The findings point to potentially modifiable maternal influences on this complex and highly prevalent condition.

Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood.

There are few studies addressing the impact of maternal vitamin D status on the vitamin D levels in offspring, their sensitization to common allergens and atopic disease development. Children aged 0 through 4 yr from a birth cohort in the Prediction of Allergies in Taiwanese Children (PATCH) study were enrolled. Time series of serum 25-hydroxyvitamin D (25(OH)D) levels were measured in maternal blood before delivery, cord blood, and at age 1.5, 3, and 4 using an electrochemiluminescence-based assay. Specific IgE antibodies against food and inhalant allergens were measured at 6 months, and 1, 1.5, 2, 3, and 4 yr of age. A total of 164 mother-child pairs from a birth cohort were recruited in this study. The mean levels of maternal 25(OH)D were 23.2 ± 7.7 ng/ml with a high (up to 80%) prevalence of insufficient vitamin D status (< 30 ng/ml). A significant correlation was seen between maternal and cord blood 25(OH)D levels (p < 0.001), and a persistent lower 25(OH)D level was found in children born to mothers with deficient 25(OH)D levels. Deficient maternal 25(OH)D levels (<20 ng/ml) appeared to be associated with a higher prevalence of allergen sensitization before age 2. Higher maternal 25(OH)D levels were significantly associated with lower risk of eczema (OR 0.12; 95% CI 0.02-0.63; p = 0.012) and asthma (OR 0.22; 95% CI 0.06-0.92; p = 0.038) at age 4. Low maternal 25(OH)D levels appear not only to be associated with an increase in the prevalence of allergic sensitization but also the risk of eczema and asthma in early childhood.

Combined effects of prenatal medication use and delivery type are associated with eczema at age 2 years.

Separately, prenatal antibiotics and Caesarian delivery have been found to be associated with increased risk of allergic diseases. It is not clear whether these factors may modify the effect of each other. To assess whether the associations between delivery types and eczema, sensitization and total IgE at age 2years were modified by maternal use of prenatal medications. Prenatal charts of women enrolled in the WHEALS birth cohort were reviewed for delivery mode and medications prescribed and administered throughout their entire pregnancy, including systemic antibiotics and vaginally applied antifungal medications. The associations between the delivery mode and select medications and, eczema, sensitization (≥1 of 10 allergen-specific IgE ≥0.35 IU/mL) and total IgE at age 2years were assessed. There was a lower risk of eczema among vaginally vs. c-section born children (relative risk adjusted for race=aRR=0.77, 95% CI 0.56, 1.05). Although not statistically significantly different, this association was stronger among the subset of children born vaginally to a mother who did not use systemic antibiotics or vaginal antifungal medications (aRR=0.69, 95% CI 0.44, 1.08) compared to those born vaginally to mothers who used systemic antibiotics or vaginal antifungals (aRR=0.81, 95% CI 0.57, 1.14). A protective association between vaginal birth and sensitization (aRR=0.86, 95% CI 0.72, 1.03) was similar for those children born vaginally to a mother who did not (aRR=0.87, 95% CI 0.69, 1.10) and who did (RR=0.85, 95% CI 0.70, 1.04) use systemic antibiotics or vaginal antifungal medications. There were no associations with total IgE. Children born vaginally had lower risk of eczema and sensitization compared with those born via c-section; however, the protective association with eczema may be slightly weakened when mothers took systemic antibiotics or vaginally applied medications during pregnancy.

Birthweight and the risk of atopic diseases: the ISAAC Phase III study.

The association between birthweight and asthma, eczema and rhinoconjunctivitisis conflicting. To examine the association between birthweight and symptoms of asthma, eczema and rhinoconjunctivitis. Parents or guardians of children aged 6–7 yr completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several risk factors, including birthweight. There were 162,324 children from 60 centres in 26 countries. Low birthweight(<2.5 kg) was associated with an increased risk of symptoms of asthma (current wheeze odds ratio = 1.20; 95% confidence interval = 1.12–1.30). Low birthweight was associated with a lower risk of eczema ever. Low birthweight was not associated with rhinoconjunctivitis. Large babies (birthweight ≥4.5 kg) were not associated with any of these outcomes. This study has confirmed that low birthweight is a risk factor for symptoms of asthma, but not for rhinoconjunctivitis. The findings for eczema are equivocal.

Postnatal Fish Oil Supplementation in High-Risk Infants to Prevent Allergy: Randomized Controlled Trial

Relative deficiency of dietary omega 3 polyunsaturated fatty acids (n-3 PUFA) has been implicated in the rising allergy prevalence in Westernized countries. Fish oil supplementation may provide an intervention strategy for primary allergy prevention. The objective of this study was to assess the effect of fish oil n-3 PUFA supplementation from birth to 6 months of age on infant allergic disease. In a double-blind randomized controlled trial, 420 infants at high atopic risk received a daily supplement of fish oil containing 280 mg docosahexaenoic acid and 110 mg eicosapentaenoic acid or a control (olive oil), from birth to age 6 months. PUFA levels were measured in 6-month-old infants' erythrocytes and plasma and their mothers' breast milk. Eczema, food allergy, asthma and sensitization were assessed in 323 infants for whom clinical follow-up was completed at 12 months of age. At 6 months of age, infant docosahexaenoic acid and eicosapentaenoic acid levels were significantly higher (both P < .05) and erythrocyte arachidonic acid levels were lower (P = .003) in the fish oil group. Although n-3 PUFA levels at 6 months were associated with lower risk of eczema (P = .033) and recurrent wheeze (P = .027), the association with eczema was not significant after multiple comparisons and there was no effect of the intervention per se on the primary study outcomes. Specifically, between-group comparisons revealed no differences in the occurrence of allergic outcomes including sensitization, eczema, asthma, or food allergy. Postnatal fish oil supplementation improved infant n-3 status but did not prevent childhood allergic disease.

Maternal fatty acid status in pregnancy and childhood atopic manifestations: KOALA Birth Cohort Study

Prevalence of atopic disorders has increased rapidly, but aetiological factors responsible for this increase are still largely unknown. Prenatal exposure to a pro-inflammatory fatty acid status is hypothesized although little research has been carried out. To investigate whether prenatal fatty acid exposures are associated with atopy in childhood. In the KOALA Birth Cohort Study, maternal blood samples (n=1275) at 34-36 weeks of pregnancy were assayed for n-6 and n-3 long-chain polyunsaturated fatty acids (LCPs). The full spectrum of offspring atopic manifestations (wheeze, asthma, allergic rhinoconjunctivitis, eczema, atopic dermatitis, allergic sensitization, and high total IgE) until the age of 6-7 years was assessed by repeated parental questionnaires and measurements of total and specific IgE. Associations of maternal fatty acid status with child atopic outcomes were analysed using multivariable logistic regression and generalized estimating equations for repeated measurements. High ratio of maternal n-6 vs. n-3 LCPs was associated with a lower risk of eczema in the child (P for trend 0.012). More specifically, we found a decreased risk of eczema in the first 7 months of life with increasing arachidonic acid levels (P for trend 0.013). No associations were found between maternal fatty acids and offspring airway-related atopic manifestations, sensitization, or high total IgE. The development of atopic disorders in early childhood is associated with prenatal exposure to n-6 vs. n-3 fatty acids, but with inconsistencies between different manifestations. Further exploration of associations with maternal diet and genetic variants in genes regulating fatty acid metabolism are required. This study shows that the influence of prenatal exposure to fatty acids on the risk of eczema in the child is limited to the first year of life.

Breast-feeding Duration and Infant Atopic Manifestations, by Maternal Allergic Status, in the First 2 Years of Life (KOALA Study)

Snijders BEP, Thijs C, Dagnelie PC, et al. J Pediatr. 2007;151(4):347–351 PURPOSE OF THE STUDY. To investigate the potential effect of modification by maternal allergic status on the relationship between breastfeeding duration and infant atopic manifestations in the first 2 years of life. STUDY POPULATION. Data from 2705 infants of the KOALA Birth Cohort Study (Netherlands) were analyzed. METHODS. The data were collected by repeated questionnaires at 34 weeks’ gestation and 3, 7, 12, and 24 months postpartum. Total and specific immunoglobulin E measurements were taken on venous blood samples collected during home visits when the infants were 2 years of age. Relationships were analyzed by using logistic regression analysis. RESULTS. Longer duration of breastfeeding was associated with a lower risk for eczema in infants of mothers without allergy or asthma (Ptrend = .01) and slightly lower risk in those of mothers with allergy but no asthma (Ptrend = .14). There was no such association for asthmatic mothers (Ptrend = .87). Longer breastfeeding duration decreased the risk of recurrent wheeze independent of maternal allergy (Ptrend = .02) or asthma (Ptrend = .06) status. CONCLUSIONS. The findings show that the relationship between breastfeeding and infant eczema in the first 2 years of life is modified by maternal allergic status. The protective effect of breastfeeding on recurrent wheeze may be associated with protection against respiratory infections. REVIEWER COMMENTS. The role of diet in preventing and treating atopic disease has been and continues to be an active area of clinical research. Snijders et al found that a longer duration of breastfeeding was associated with a lower risk of eczema in infants of mothers without allergy or asthma. There was a slight effect in mothers with allergy but no asthma, yet no such relationship was observed for asthmatic mothers. It is interesting to note that no effect modification of maternal allergy/asthma on infant IgE or allergen sensitization was observed. Finally, longer breastfeeding reduced the risk of recurrent wheezing independent of maternal allergic or asthma status, which the authors speculated may be the effect of reduced numbers of respiratory infections. Overall, these findings do support the role of breastfeeding in prevention of atopy, and additional studies are needed to better define the influence of maternal and infant diets during this time frame.

Atopy and Duration of Breastfeeding Revisited

Atopy and Duration of Breastfeeding Revisited

The Role of Furry Pets in Eczema

To systematically search, summarize, and critically appraise the literature to examine whether pet exposure in early life is associated with an increased risk of eczema. We searched MEDLINE (1950 to June 2006) supplemented by citation lists in retrieved articles and contact with researchers. No language restrictions were imposed. Cohort studies were sufficiently similar to allow pooled analysis. Meta-analysis was not possible for cross-sectional studies owing to differences in methods and populations. Incidence or prevalence of eczema. Evidence from longitudinal studies showed that previous exposure to cats (pooled odds ratio [OR], 0.76; 95% confidence interval [CI], 0.62-0.92), dogs (pooled OR, 0.68; 95% CI, 0.53-0.87), or "any furry pet" (pooled OR, 0.79; 95% CI, 0.74-0.84) is associated with a lower risk of eczema. However, in the only cohort study adjusted for avoidance behavior, this "protective effect" disappeared (for cats: OR, 0.80; 95% CI, 0.33-1.97). Stratified analysis by family history in 2 birth cohort studies showed that dog exposure was protective in patients with atopic families. For cats, 1 study showed reduced risk in atopic families only; the other study showed no effect. Eight cross-sectional studies evaluated past pet exposure; a protective effect was seen in 3 studies for cat, dog, or any pet; no study demonstrated an increased risk. There was no clear evidence that early pet exposure is associated with increased risks of subsequent eczema. We found some evidence of a possible protective effect of early pet exposure, but this might be explained by avoidance behavior in high-risk families.