Development of childhood allergy in infants fed breast, soy, or cow milk

Experience with an elimination diet in children with atopic dermatitis

In order to define possible food-provoking factors, we placed twenty-nine children with chronic atopic dermatitis on an elimination diet. The children remained on their normal diet for 2 weeks followed by 2 weeks on the elimination diet. Foods were then re-introduced at the rate of a new one every 2 days in an attempt to identify foods exacerbating eczema. Thirteen children (45%) completed the elimination diet and seven of these were improved on parental assessment of sleeplessness, itchiness and area of eczema. Five were improved on the dermatologist's assessment. Only two children were able to identify foods provoking their eczema. Sixteen children (55%) failed to complete the elimination diet. Eight felt it was too strict, while eight did not return for follow-up. From our experience, dietary manipulation in older children with chronic atopic dermatitis offers only limited long-term therapeutic gains.

Does infant feeding affect the risk of allergy?

For nearly 50 years the hypothesis has been debated that withholding cows' milk from babies reduces the risk of allergic disease. Numerous studies have been conducted of varying design, size, and quality, and with conflicting results. Evidence tends to favour the hypothesis, but the only firm conclusion that can be drawn is that random controlled trials with blind assessment are needed to settle the issue.

Breast feeding, eczema, asthma, and hayfever

The association of breast feeding with rates of atopic illness during the first five years of life was assessed in a national study of 13 135 children studied during the first week and at age 5 years. Eczema was reported more often in children who had been breast fed; this relationship persisted even after allowance was made for social and family factors influencing the likelihood both of breast feeding and of eczema; the other factors most significantly associated with rates of eczema were parental history of eczema or asthma and advantaged family socioeconomic status. A similar, but less pronounced, positive association of breast feeding with reported hayfever became non-significant after adjustment for intervening factors. Rates of reported asthma were not influenced by breast feeding. "Any wheezing" including asthma was reported more often in children who had not been breast fed, but this association disappeared after adjustment for parental asthma and maternal smoking. Breast feeding does not appear to protect against these atopic diseases. The positive association with reported eczema might relate to accuracy of diagnosis or to associated influences not considered in the analysis; alternatively, it might be due to (recent) environmental contaminants crossing in breast milk, causing eczema in the child.

Prophylaxis of atopic disease by six months' total solid food elimination. Evaluation of 135 exclusively breast-fed infants of atopic families

One hundred and thirty-five infants of atopic parents were exclusively breast-fed for 6 months without any cow's milk based supplements. Of these infants 70 received no nourishment except breast milk during the 6 months, and 65 were started on solid foods at the age of 3 months. The diet of all the infants was similar during 6 to 12 months of age. The children were examined at the age of one year. In the exclusive breast milk group atopic eczema and food allergy were less frequent than in the solid food group. The results suggest that total solid food elimination for the first 6 months of life, in addition to exclusive breast milk feeding, is prophylactic for atopic disease in children who are at hereditary risk.

Asthma and infant diet

The relationship of milk diet and solid feeding practices during the first 4 months of life to rates of early childhood asthma was studied prospectively in a birth cohort of 1110 children. The results of the analysis showed no significant association between rates of asthma and breast feeding or solid feeding practices. This was true for children both of asthmatic and non-asthmatic parentage. It is concluded that there is no evidence to indicate that early breast feeding had any detectable effect on the risk of subsequent asthma in this birth cohort. However, the possibility still remains that breast feeding may have a prophylactic effect for children from highly atopic families.

Food allergy in Finnish children aged 1 to 6 years

Food allergy was studied in a total of 866 Finnish children aged 1, 2, 3 and 6 years in the Helsinki region. The diagnosis was based on history as well as on elimination and challenge performed at home concerning fish, citrus fruit and eggs. The prevalence of food allergy was 19% at one year of age, increased to a peak of 27% at three years, and thereafter decreased to 8% at six years of age. The most common allergenic foods were citrus fruit, tomato, eggs, strawberry and fish. A positive history of food allergy could be confirmed by challenge in about half of the cases in the younger age groups and in 100% at six years of age. The data indicate that food allergy is common in Finnish children.

Food for the suckling: revolution and development

The 1970's saw a renaissance in child nutrition, a major revision of infant feeding practice and substantial changes in food for the suckling. Many more babies are breast fed, those who are not receive an infant formula specifically designed for this period of life, and solid foods are no longer introduced in the early weeks. These changes have contributed to the improvement in the suckling's health, particularly the reduction in neonatal tetany, and in deaths from gastroenteritis. Developments in the 1980's should improve our knowledge of breast milk and its properties, advisable intakes of specific nutrients and their interrelationships, and the immunology of infant feeding. Meanwhile, practice will be directed towards the enhancement of successful lactation, the processing of donor human milk, the establishment of standards for infant formulas and the special problems of the low birth weight baby.

Comparison of breast, cow, and soy feedings in the prevention of onset of allergic disease: a 15-year prospective study

It has been reported that the feeding of cow's milk may enhance the development of atopy in predisposed infants. A prospective study following children from birth through 15 years of age in a private pediatric practice was designed to determine if the food ingested during the first months of life is related to the development of atopy in the offspring of allergic families. Each of 328 children with a positive family history of allergy was assigned to one of three groups according to the feeding preference of the parents: 48 were fed breast milk; 79 soy-based formula; and 201, cow's milk formula. All groups had egg, citrus, tomato, and wheat restrictions as well as inhalant allergen avoidance. These were compared to a control group of 580 children with no family history of allergy. Breast fed infants were found to have approximately one-half the incidence of atopy of cow's milk or soy formula fed infants from atopic families when followed for up to 15 years. Soy feeding produced no advantage over cow's milk in the prophylaxis of allergic disease. There was a three-fold increase in clinically apparent atopic disease in offspring of allergic families when compared to controls but only a two-fold increase if the infant was breast fed. These results support the hypothesis that breast feeding and delay of exposure to known allergens may reduce the frequency of clinical allergic disease in the offspring of allergic families.

Risk factors in childhood eczema

The cumulative rate of childhood eczema during the first three years was studied in a birth cohort of 1265 New Zealand infants. A parental history of eczema was the strongest predictor of rates of childhood eczema but parental asthma was also related to childhood eczema. Children exposed to an early diverse solid-food diet also had increased risks of eczema, but there was no evidence to suggest that breast-feeding practices had any effect on rates of eczema. Analysis of the data suggested that the apparent association between exclusive breast-feeding and reduced rates of eczema reported in previous studies may be because exclusively breast-fed infants were not exposed to early solid feeding rather than to any beneficial effect of breast milk itself.

IgE screening in 1701 newborn infants and the development of atopic disease during infancy

IgE screening was done using the Phadebas IgE PRIST technique on the cord blood of 1701 newborn infants. Of these 8.3% developed obvious or probable atopic disease, predominantly atopic dermatitis and bronchial asthma, during the first 18 months of life. Of infants with a family history of atopic disease 10.5% developed such illness; the corresponding figure for infants with an initially high IgE concentration was 70%. Atopic disease developed in 73% of infants with a high IgE concentration in cord blood and a family history, but in only 3% of infants with a low IgE and no family history. A high IgE concentration in cord blood was associated with a high IgE and a positive radioallergosorbent test at between ages 18 and 24 months more often than was a low initial IgE level, indicating that in man as in animals there are high and low IgE responders already genetically coded at birth. IgE screening in cord blood is recommended if there is obvious atopy in both parents or if severe atopic disease if present in a sibling or in one parent.

Atopic dermatitis

Atopic dermatitis is a chronically relapsing inflammatory skin disease with altered immune and pharmacologic responses. Elevated serum IgE probably reflects defective immune regulation. Various other cellular immune defects rise and fall exacerbations and remissions of skin inflammation. Increased responsiveness to cholinergic and alpha adrenergic agents may relate to abnormalities of cyclic nucleotide regulation. Recent observations of abnormal cyclic adenosine monophosphate (cAMP)-phosphodiesterase activity in atopic dermatitis may provide new insights into the pathogenesis and treatment of the disease.

IgE antibody levels to ingested soya protein determined in a normal adult population

Levels of soy protein-specific IgE were measured in a normal adult population (seventy-four males, and fifteen females) who ingested soya-containing and control diets during two 4-week periods. Increases in soya-specific IgE were observed for some individuals following ingestion of the soya-containing diet, and for the female group the increase in soya-specific IgE was statistically significant (P = 0.02). The increase of soya-specific IgE was small and led to lower levels than that associated with adverse effects. The increase in soya-specific IgE in the female group was accompanied by a significant increase (P = 0.02) in total immunoglobulin A. Changes in the level of soy-specific haemagglutinating antibody, soya-specific IgG, IgA and IgM as measured by ELISA and the immunoconglutinin titre could not be related to ingestion of the soya-containing diet.

Morphometric and immunohistochemical study of jejunal biopsies from children with intestinal soy allergy

A morphometric and immunohistochemical restudy was made of jejunal biopsy specimens from 5 patients with soy allergy and the results obtained were compared to those from specimens taken before soy feeding and to those at a later time. All the patients had had previous cow's milk allergy with malabsorption. Gastrointestinal symptoms presented within two weeks of starting the soy based formula but in two patients the symptoms were mild and these patients were able to continue soy feeding. Jejunal biopsy specimens taken within 3 days from the reaction to soy showed villous atrophy associated with crypt hyperplasia and an increased cell renewal rate. Also, these specimens showed an inflammatory reaction in the lamina propria and in the epithelium, and the numbers of IgA- and IgM-containing cells were increased. Later, when the soy proteins were eliminated, the morphology of the jejunum improved and the cell numbers were reduced to normal. The intestinal damage and the local immune reaction caused by soy proteins are similar to those seen in cow's milk allergy with malabsorption. The immunological mechanisms operating in these diseases are thought to be the cause of these changes.

Eczema and infant diet

The relationship between prenatal atopy, breast-feeding, early solid food diet and the rate of eczema was studied in a birth cohort of 2-year-old children. Rates of eczema varied significantly with parental atopy and solid feeding: children of atopic parents given solid food during the first 4 months had over two-and-a-half times the rate of eczema of children not given solid food and who had non-atopic parents. Further, rates of eczema increased in almost direct proportion to the number of different types of solid food that the child had been given during the first 4 months. Breast-feeding had no significant effect on rates of eczema. The results suggest that both parental atopy and diversity in early diet are factors which contribute towards rates of childhood eczema.

Do breast-feeding and delayed introduction of solid foods protect against subsequent atopic eczema?

Previous studies relating infant feeding to subsequent atopic eczema have had methodologic flaws that include insensitive study designs, nonblind observation, and failure to control for confounding variables. To avoid these flaws, we conducted a case-control study of 636 patients attending a dermatology clinic. The dermatologic problem in each patient was classified as atopic eczema (case), dermatologic condition unrelated to atopy (control), or dermatologic condition with questionable relation to atopy (uncertain). The feeding history was ascertained later, along with family history and demographic data, by an assistant blind both to the question under study and to the case vs control status of each subject. Breast-feeding was not associated with any reduction in the estimated relative risk of developing atopic eczema. No significant relationship was found among the cases between severity of disease and breast-feeding nor between age of onset of disease and duration of breast-feeding or age at introduction of solid foods. Even when breast-feeding was redefined as "pure" and exclusive (no nonhuman milk or solids) for greater than or equal to 2 months, no protective effect was uncovered. We conclude that breast-feeding and delayed introduction of solids do not protect against atopic eczema, and that previous claims of protective effects were based on data probably biased by nonblinding and important confounders.

Clinical manifestations of allergy related to breast and cows' milk feeding

The frequency of allergic manifestations in the first year of life was studied. The prevalence of allergic signs affecting the skin and respiratory tract in infants who had been started on breast feeding was compared with the prevalence of such signs in infants started on cows' milk formulae. The relationship of allergy to family history was investigated. Eczema and rhinitis were found to be present as often in the initially breast-fed group as in the initially cows' milk-fed group. Bottle-fed infants developed asthma and bronchitis more often than their breast-fed counterparts. Infants of allergic parents exhibited more allergy than those from non-allergic families, and this difference was particularly pronounced for asthma or bronchitis. Breast feeding gave some protection against the development of respiratory tract allergies in infants of non-allergic parents. Among the infants with a positive family history of allergy, fewer with eczema or chronic rhinitis were found in the initially breast-fed group group but this did not achieve statistical significance.

Comparison of cord blood immunoglobulin E concentrations and maternal allergy for the prediction of atopic diseases in infancy

Total serum IgE levels were determined in 136 newborns and their mothers and in 54 of their fathers, using the paper radioimmunosorbent test (PRIST) technique. IgE specific antibodies for house dust (Dermatophagoides pteronyssinus), orchard grass, timothy grass, and cow's milk were measured with the radioallergosorbent test (RAST). One hundred thirty-three RAST assays were negative in newborns, and in three cases RAST for cow's milk was positive. Cord blood IgE ranged from 0 to 5.5 IU/ml (mean 0.32 +/- 0.54 IU/ml); levels were significantly (p less than 0.05) higher when maternal IgE was over 100 IU/ml and when mothers had received progesterone therapy during the pregnancy. Salbutamol administration or tobacco smoking during pregnancy did not influence newborn IgE. A clinical follow-up study was conducted in 83 infants for 9 mo. Nine infants developed definite atopic disease, and possible allergic diseases were noted in eight other infants. The IgE level at birth appeared to be more predictive for the development of allergy in infancy than the family history.

Does dietary elimination in infancy prevent or only postpone a food allergy? A study of fish and citrus allergy in 375 children

In a study of fish and citrus allergy these foods were strictly avoided in 177 children up to 1 year of age, whereas 152 children had started taking fish before age 6 months and 145 children had started taking citrus fruits beofre 3 months. Both fish and citrus allergy, defined by a positive challenge, were found at age 3 years in a similar frequency (about 3%) in children with and without the first-year elimination. The results suggest that food allergy in childhood can be postponed but not prevented by dietary elimination in infancy.

A prospective study of cow's milk protein intolerance in Swedish infants

1 079 of 1 548 newborn infants were followed during their first year. 328 were prospectively contacted once a month. 751 were followed up at child welfare clinics. Altogether 20 were diagnosed as being cow's milk protein intolerant (1.9%). Symptoms from the gastrointestinal tract and the skin predominated. Only 2 had respiratory symptoms. Ten had their symptoms within one week after the introduction of cow's milk, 3 of them at their first cow's milk-containing meal. A further 4 already had symptoms when fed only human milk. The others (6 infants) showed symptoms after more than one week on a cow's milk containing diet. Before 2 years of age, 13 had recovered. Twelve of the cow's milk protein intolerant infants also showed adverse reactions to other foods, soy-protein intolerance being the most common (7 infants). A family history of allergy was found in 35% (116) of the 328 infants and in 70% (14) of those with cow's milk protein intolerance.

Soy versus cow's milk in infants with a biparental history of atopic disease: development of atopic disease and immunoglobulins from birth to 4 years of age

Forty-eight children with a biparental history of atopic disease were followed from birth to 4 years of age. One group was fed soy and the other cow's milk from weaning to 9 months of age. Two-thirds of the children developed symptoms of atopic disease with no significant difference between the groups. No difference was found in the serum immunoglobulins (IgE antibodies, IgA, IgG and IgM) during the observation period. The soy fed children showed transiently lower levels of IgG antibodies to cow's milk but higher levels of IgG antibodies to soy protein. Six children showed cow's milk intolerance and a further five had symptoms possibly related to the use of cow's milk. Withholding cow's milk during the first 9 months did not reduce the incidence of symptoms of cow's milk intolerance from birth to 4 years of age. Thus, no benefit was found from replacing cows' milk with soy. A prolonged breast feeding seems most rational for infants at risk of developing atopic disease, even if the present study did not show evidence of a prophylactic effect of breast milk against the development of atopic disease.

The nutritional and physiological impact of milk in human nutrition

The nutritional value of milk as an important source of energy, high-quality protein, calcium, and riboflavin has been recognized for many years. Currently, the widespread use and promotion of milk in the U.S. as well as developing countries has been questioned. This review examines the nutrient composition of dairy products, factors that account for variability in composition of milk, milk processing, preservation, quality control, and contaminants (such as minerals, radionuclides antibiotics, microorganisms and their metabolites, herbicides, and insecticides) in milk. Consumption patterns for milk and evidence for its nutritional value, especially in children, are presented. Milk consumption has been related to disease or conditions such as atherosclerosis, milk allergy, lactose intolerance, anemia, dental problems, and others. Recent recommendations for dietary changes for individuals in the U.S. and other developed countries could affect the use of milk. In addition, the use of feeding programs in the U.S. and developing countries which are based primarily on milk has been criticized. The preparation of new types of milk designed to offset certain difficulties encountered with cow's milk are now being evaluated in humans.

Atopic disease in seven-year-old children. Incidence in relation to family history

The incidence of atopic disease and its relation to the family history was studied by questionnaire in 1325 children, 7 years of age. A higher incidence of bronchial asthma (2.7%) was found than in a previous Swedish study. The total incidence of atopic disease in the children was 15.1% with a higher level when there was a double parental history of such disease (42.6%) as compared with a single such history (19.8%). When both parents had an identical type of atopic disease, i.e. respiratory or skin, the incidence of atopic disease was higher (72.2%) than when non-identical types occurred in the parents (20.8%). The findings support theories of a polygenic transmission of atopic disease as well as a genetic influence on symptom specificity in such disease and may be of value in genetic counselling.

Atopic allergy and serum IgE in randomly selected eight-year-old children

The incidence of atopic allergy and serum IgE levels as well as specific IgE antibodies was studied in a randomly selected sample of 164 8-year-old children who were followed-up for 2 years. The total incidence of atopic disease was 18.9 per cent. Serum IgE levels were above + 2 s.d. for the age before the onset of atopic disease in seven of 11 children who developed an atopic disease during the observation period. The direct paper disc sandwich radioimmunoassay, PRIST, equalled the Phadebas IgE test for discriminating between atopy and non-atopy, but PRIST is preferred because of its simplicity. Actual or future atopic disease disease is most probable when the serum IgE is above the + 2 s.d. limit for age. Serum IgE levels below the geometrical mean for age are rarely found in atopic disease. An IgE determination with PRIST will give more discriminative information than the family history and is recommended for routine purposes when there is a history of possible atopic allergy in a child.

Prevention of eczema

In a prospective study of the development of reaginic allergy, infants of allergic parents were either subjected to an allergen-avoidance regimen from birth for six months or managed conventionally. The group on the allergen-avoidance regimen had less eczema at six months and one year than did the control group at six months. They also had a lower mean serum-total-IgE level at six weeks.

IgE and atopic allergy in newborns and infants with a family history of atopic disease

Serum IgE levels were studied in 2 groups of children with a family history of atopic disease, 30 in whom the mother only and 38 in whom both parents had atopic disease. IgE antibodies were determined with Phadebas RAST Test and serum IgE with Phadebas IgE Test and Phadebas PRIST at 0, 3, 9, 12 and 18 months of age. There was no correlation between the serum IgE levels in mothers and their newborns. RAST tests were frequently positive in maternal sera but no positive RAST test was found in the newborns. Obvious and probable atopic disease developed during the observation period in 42.1% of the children with a double family history of atopic disease. In 75% of these the serum IgE level was above the upper limit of normal on an average 6 months before the onset of atopic symptoms. An elevated IgE level without atopic symptoms during the observation period occurred in only one child. It is concluded that the serum IgE in newborns seems to be of foetal origin and that the determination of serum IgE in infants is of value in predicting atopic allergy.

Predictive value of high IgE levels in children

A group of 207 healthy non-atopic children 0-14 years of age without any known family history of atopic disease was selected for a study of the relation between serum IgE levels and the occurrence of atopic manifestations during an observation period of 18 months; 206 fullfilled the study. Serum IgE was measured by a direct radioimmunological sandwich technique (PRIST). At the follow-up 28 of 32 with an initial IgE level greater than one standard deviation above the mean for the age continued to show a high level (87.5%). The total concordance was 81.1%. Atopic or probable atopic diseases had developed in 75.0% of children 0-1 year of age with an initial IgE above +1 S.D., but in only 6.4% of those from the same age group with a lower initial IgE. Even among children 2-14 years old, it was noticement of atopic disease. Otitis media was more frequent among children with an initially elevated IgE level than among the rest of the children. Determination of serum IgE with the PRIST-technique has been shown to provide a valuable means for predicting future atopic manifestations and may be used as a screening procedure especially in children of atopic parents.

Serum IgE levels in healthy children quantified by a sandwich technique (PRIST)

Serum IgE was estimated in 226 healthy children aged 0-14 years without obvious atropic disease in their first degree relatives. A paper disc radioimmunoassay technique (PRIST) was used. A number of criteria for selection of cases were established. This led to the exclusion of forty-two potentially atopic children. The remaining group of 184 children is considered representative of normal children and may therefore be used for reference purposes. The IgE levels were found to be lower than in previous investigations, and this is attributed to the refined technique and the method of selection.

Biological and physiological factors in soybeans

There are limitations to which one is justified in drawing broad generalizations concerning the diverse biological and physiological effects of soy protein products. Nevertheless, there appear to be two distinct situations: (A.) Proper heat treatment exerts a beneficial effect upon the nutritive value of whole soybeans, full‐fat and defatted meal. Associated with proper heating is inactivation of trypsin inhibitor and other heat‐labile factors and conversion of raw refractory proteins to forms that are more readily digested. (B.) Moist heat also has a beneficial effect upon the nutritive value of soy protein isolates. However, a deficiency of certain essential nutrients and the interaction of phytic acid with protein, vitamins, and minerals during processing are the primary factors responsible for the poor nutritive value of soy isolates. Occasionally mineral deficiency symptoms do occur in animals fed soybean meal. It is a misnomer to refer to the growth‐inhibiting and pancreatic hypertrophic properties as a “toxic” effect since both properties are reversible. Modern analytical techniques should be used to reinvestigate the relationship between phytic acid and availability of minerals and vitamins in soy protein isolate diets. Research also is needed to determine more accurately vitamin and mineral contents of soy protein isolates and the availability of vitamins and minerals in soy protein concentrates. Breeding soybean varieties genetically deficient in antinutritional and nonflatulent factors does not appear promising. More research is needed to determine whether fermentation and enzyme processes can be used to prepare flatulent‐free soy products. Minor factors to be considered in assessing the nutritive value of soy products include a weak goitrogen present in soybeans, and a very low estrogenic activity.