Breastfeeding and Allergic Diseases: What's New?

Experimental models of antibiotic exposure and atopic disease

In addition to numerous clinical studies, research using experimental models have contributed extensive evidence to the link between antibiotic exposure and atopic disease. A number of mouse models of allergy have been developed and used to uncover the specific effects of various microbiota members and perturbations on allergy development. Studies in mice that lack microbes entirely have also demonstrated the various components of the immune system that require microbial exposure. The importance of the early-life period and the mechanisms by which atopy "protective" species identified in human cohorts promote immune development have been elucidated in mice. Finally, non-animal models involving human-derived cells shed light on specific effects of bacteria on human epithelial and immune responses. When considered alongside clinical cohort studies, experimental model systems have provided crucial evidence for the link between the neonatal gut microbiota and allergic disease, immensely supporting the stewardship of antibiotic administration in infants. The following review aims to describe the range of experimental models used for studying factors that affect the relationship between the gut microbiota and allergic disease and summarize key findings that have come from research in animal and in vitro models.

Secretory IgA in breast milk protects against asthma through modulation of the gut microbiota

Asthma susceptibility is linked to dysbiosis in early-life gut microbiota, and the antibody secretory immunoglobulin (Ig)A (SIgA) is a key determinant of gut microbiota composition. SIgA is obtained through breast milk during the critical early-life window. We use a mouse model of SIgA deficiency and the house dust mite (HDM) model of asthma to elucidate the role of maternal SIgA in modulating the early-life gut microbiota and asthma protection. Mice that do not receive maternal SIgA display a transient bloom of segmented filamentous bacteria (SFB) in the small intestine during the early post-weaning period. Mice that do not receive maternal SIgA also display elevated T helper type 17 (Th17) cell activation in the intestine, which persists into adulthood and is associated with more severe inflammation in response to the HDM model of asthma. This study demonstrates a mechanism by which breast-milk-derived SIgA influences immune development and asthma susceptibility by modulating the early-life gut microbiota.

Breastfeeding: science and knowledge in pediatric obesity prevention

The increasing prevalence of childhood obesity worldwide is a significant concern due to its link to severe health issues in adulthood, such as non-communicable diseases (NCDs). To address this issue, this review evaluates the effectiveness of various preventive measures for childhood obesity, focusing on maternal nutrition and breastfeeding. The study underscores the criticality of the periconceptional period, where the diets of both parents can influence epigenetic modifications that impact the child's metabolic pathways and obesity risks. Breastfeeding is a potent protective mechanism against early-onset obesity, significantly enhancing the infant's metabolic and immune health by modifying DNA methylation and gene expression. Furthermore, the perspective underscores the significance of the Mediterranean diet during the periconceptional period and lactation. This diet can effectively prevent gestational complications and improve breast milk quality, fostering optimal infant development. Recognizing that obesity results from genetic, epigenetic, environmental, and social factors, the paper advocates for a comprehensive, multidisciplinary approach from the earliest stages of life. This approach champions a balanced maternal diet, exclusive breastfeeding, and timely introduction to complementary foods. In conclusion, addressing pediatric obesity requires a multifaceted strategy emphasizing improving prenatal and postnatal nutrition. Further research is necessary to understand the epigenetic mechanisms influenced by nutrition and their long-term effects on children's health. This will help refine interventions that curb the obesity epidemic among future generations.

Transfer of celiac disease-associated immunogenic gluten peptides in breast milk: variability in kinetics of secretion

Background

Exposure to antigens is crucial for child immune system development, aiding disease prevention and promoting infant health. Some common food antigen proteins are found in human breast milk. However, it is unclear whether gluten antigens linked to celiac disease (CD) are transmitted through breast milk, potentially impacting the development of the infant's immune system.

Objective

This study aimed to analyze the passage of gluten immunogenic peptides (GIP) into human breast milk. We evaluated the dynamics of GIP secretion after lactating mothers adopted a controlled gluten-rich diet.

Methods

We prospectively enrolled 96 non-CD and 23 CD lactating mothers, assessing total proteins and casein in breast milk, and GIP levels in breast milk and urine. Subsequently, a longitudinal study was conducted in a subgroup of 12 non-CD lactating mothers who adopted a controlled gluten-rich diet. GIP levels in breast milk and urine samples were assayed by multiple sample collections over 96 hours.

Results

Analysis of a single sample revealed that 24% of non-CD lactating mothers on a regular unrestricted diet tested positive for GIP in breast milk, and 90% tested positive in urine, with significantly lower concentrations in breast milk. Nevertheless, on a controlled gluten-rich diet and the collection of multiple samples, GIP were detected in 75% and 100% of non-CD participants in breast milk and urine, respectively. The transfer dynamics in breast milk samples were long-enduring and GIP secretion persisted from 0 to 72 h. In contrast, GIP secretion in urine samples was limited to the first 24 h, with inter-individual variations. In the cohort of CD mothers, 82.6% and 87% tested negative for GIP in breast milk and urine, respectively.

Conclusions

This study definitively established the presence of GIP in breast milk, with substantial inter-individual variations in secretion dynamics. Our findings provide insights into distinct GIP kinetics observed in sequentially collected breast milk and urine samples, suggesting differential gluten metabolism patterns depending on the organ or system involved. Future research is essential to understand whether GIP functions as sensitizing or tolerogenic agents in the immune system of breastfed infants.

Role of breastfeeding in disease prevention

Human milk provides the infant with many bioactive factors, including immunomodulating components, antimicrobials and prebiotics, which modulate the infant microbiome and immune system maturation. As a result, breastfeeding can impact infant health from infancy, through adolescence, and into adulthood. From protecting the infant from infections, to reducing the risk of obesity, type 1 diabetes and childhood leukaemia, many positive health outcomes are observed in infants receiving breastmilk. For the mother, breastfeeding protects against postpartum bleeding and depression, increases weight loss, and long-term lowers the risk of type 2 diabetes, breast and ovarian cancer, and cardiovascular diseases. Beyond infants and mothers, the wider society is also impacted because of avoidable costs relating to morbidity and mortality derived from a lack of human milk exposure. In this review, Medline was used to search for relevant articles to discuss the health benefits of breastfeeding and its societal impact before exploring future recommendations to enhance our understanding of the mechanisms behind breastfeeding's positive effects and promote breastfeeding on a global scale.

Understanding the burden of food allergy among urban and rural school children from north India

Background

There is paucity of reliable epidemiological data regarding the burden of food allergy in most developing countries, including India.

Objective

To provide current estimates of the prevalence and distribution of food allergy among urban and rural school children aged 6-14 years in Delhi and the National Capital Region (NCR) of Khekra in India.

Methods

A cross-sectional study was conducted from January 2022 to February 2023 to enroll school children, 6-14 years, from select urban and rural schools in Delhi and NCR. A questionnaire consisting of questions focused on household environment, early life factors, and pediatric food allergy characteristics was administered by a trained medical researcher to collect parent-proxy data. Univariate statistics were used to describe frequencies, percentages, and 95% confidence intervals for survey items.

Results

The estimated prevalence of parent-reported food allergy was 0.8% (95% CI: 0.4-1.5; urban: 0.4%, 95% CI: 0.1-1.1; rural: 1.7%, 95% CI: 0.7-3.5). Fruits such as mango (0.3%, 95% CI: 0.1-0.9), strawberry (0.1%, 95% CI: 0.0-0.7), orange (0.1%, 95% CI: 0.0-0.7), and custard apple (0.1%, 95% CI: 0.0-0.7) were reported only by urban children, while rural children reported yogurt (0.6%, 95% CI: 0.1-1.8) and wheat (0.3%, 95% CI: 0.0-1.3). Both groups reported brinjal (also known as eggplant) and banana, 0.1% (95% CI: 0.0-0.7) of urban and 0.3% (95% CI: 0.0-1.3) of rural, respectively. Overall, commonly reported clinical symptoms were diarrhea and/or vomiting (100%, 95% CI: 76.2-100), abdominal pain (88.9%, 95% CI: 58.6-98.8), and rash/itchy skin (66.7%, 95% CI: 34.8-89.6). Among children with parent reported food allergy, 66.7% (95% CI: 34.8-89.6) of food allergies were physician diagnosed, of which 33.3% were diagnosed via history alone (95% CI:7.7-71.4) while 66.7% (95% CI: 28.6-92.3) were confirmed via skin prick test and/or blood test.

Conclusion

The overall prevalence of food allergy is very low in Delhi and Khekra, India. Future work should focus on elucidating the complex interplay of early-life, environmental, genetic, and lifestyle factors to understand the reasons for India's low food allergy burden and improve epidemiological clues to prevention for the nations with higher disease burden.

Science and Faith to Understand Milk Bioactivity for Infants

Milk bioactivity refers to the specific health effects of milk components beyond nutrition. The science of milk bioactivity involves the systematic study of these components and their health effects, as verified by empirical data, controlled experiments, and logical arguments. Conversely, 'faith in milk bioactivity' can be defined as personal opinion, meaning, value, trust, and hope for health effects that are beyond investigation by natural, social, or human sciences. Faith can be strictly secular, but also influenced by spirituality or religion. The aim of this paper is to show that scientific knowledge is frequently supplemented with faith convictions to establish personal and public understanding of milk bioactivity. Mammalian milk is an immensely complex fluid containing myriad proteins, carbohydrates, lipids, and micronutrients with multiple functions across species, genetics, ages, environments, and cultures. Human health includes not only physical health, but also social, mental, and spiritual health, requiring widely different fields of science to prove the relevance, safety, and efficacy of milk interventions. These complex relationships between milk feeding and health outcomes prevent firm conclusions based on science and logic alone. Current beliefs in and understanding of the value of breast milk, colostrum, infant formula, or isolated milk proteins (e.g., immunoglobulins, α-lactalbumin, lactoferrin, and growth factors) show that both science and faith contribute to understand, stimulate, or restrict the use of milk bioactivity. The benefits of breastfeeding for infants are beyond doubt, but the strong beliefs in its health effects rely not only on science, and mechanisms are unclear. Likewise, fear of, or trust in, infant formula may rely on both science and faith. Knowledge from science safeguards individuals and society against 'milk bioactivity superstition'. Conversely, wisdom from faith-based convictions may protect science from unrealistic 'milk bioactivity scientism'. Honesty and transparency about the potentials and limitations of both scientific knowledge and faith convictions are important when informing individuals and society about the nutritious and bioactive qualities of milk.

Effects of Lactobacillus salivarius ssp. salicinius SA-03 Supplementation on Reversing Phthalate-Induced Asthma in Mice

Probiotics may protect against asthma. We want to investigate whether probiotics can reverse the adverse effects of phthalate exposure on asthma. We selected the female offspring of BALB/c mice, born from pregnant female mice fed with diethylhexyl phthalate (DEHP). They were continuously administrated DEHP and Lactobacillus salivarius ssp. salicinius SA-03 when they were 5 weeks old, and ovalbumin (OVA) for asthma induction started at 6 weeks for 32 days. The mice were divided into four groups (n = 6/group): 1. control group (C), 2. OVA/DEHP group (OD), 3. OVA/DEHP/probiotics low-dose group (ODP-1X), and OVA/DEHP/probiotics high-dose group (ODP-5X). We found that the administration of probiotics significantly reduced the asthma severity of the mice, as well as serum IgE and IL-5. In the ODP-5X group, the proportion of CD4+ cells in the lung was reduced, whereas IL-10 in serum and CD8+ cells in BALF were increased. In histopathology, the ODP group showed reduced infiltration of inflammatory cells, bronchial epithelial cell hyperplasia, and tracheal mucus secretion. These results might indicate that high-dose probiotics may affect anti-inflammatory cytokines and reduce asthma-relative indicators. The above results may provide evidence that high-dose probiotics supplementation might play a modulating role in DEHP causes of allergic asthma in the pediatric animal model.

Breast milk preservation: thermal and non-thermal processes and their effect on microorganism inactivation and the content of bioactive and nutritional compounds

Human Breast Milk (HBM) is widely acknowledged as the best nutritional source for neonates. Data indicates that, in 2019, 83.2% of infants in the United States received breast milk at birth, slightly reducing to 78.6% at 1 month. Despite these encouraging early figures, exclusive breastfeeding rates sharply declined, dropping to 24.9% by 6 months. This decline is particularly pronounced when direct breastfeeding is challenging, such as in Neonatal Intensive Care Units (NICU) and for working mothers. Given this, it is vital to explore alternative breast milk preservation methods. Technologies like Holder Pasteurization (HoP), High-Temperature Short-Time Pasteurization (HTST), High-Pressure Processing (HPP), UV radiation (UV), and Electric Pulses (PEF) have been introduced to conserve HBM. This review aims to enhance the understanding of preservation techniques for HBM, supporting the practice of extended exclusive breastfeeding. It explicitly addresses microbial concerns, focusing on critical pathogens like Staphylococcus aureus, Enterococcus, Escherichia coli, Listeria monocytogenes, and Cytomegalovirus, and explores how various preservation methods can mitigate these risks. Additionally, the review highlights the importance of retaining the functional elements of HBM, particularly its immunological components such as antibodies and enzymes like lysozyme and Bile Salt Stimulated Lipase (BSSL). The goal is to provide a comprehensive overview of the current state of HBM treatment, critically assess existing practices, identify areas needing improvement, and advocate for extended exclusive breastfeeding due to its vital role in ensuring optimal nutrition and overall health in infants.

Innovative Food Safety Approaches and Nutraceuticals to Promote Children's Health on Future Outbreaks with the Reflection of COVID-19

After the COVID-19 pandemic, innovative methods have emerged for the management of food safety, child nutrition has become more important than ever, and increasing attention has been paid to the consequences of COVID-19. For instance, since SARS-CoV-2 is an animal-based zoonotic virus, there is a changing trend in consumer preferences from conventional meat products to cultured meat and vegan supplementation. Due to the effects mentioned, this chapter provides strategic guidance on novel foods, food safety innovations, and novel health and safety procedures in public places such as restaurants or bars. There are also long-term health impacts on children in the aftermath of COVID-19. Since the risk of myopia is one of the important long-term effects to be considered, trending nutritional immunology approaches are presented to reduce emerging problems in child eye health. The enhancement of immune system remains problematic for many children considering that they cannot use the COVID-19 vaccine. Therefore, this chapter also emphasizes the importance of breastfeeding on the side effects of viral infections and new supplements, such as probiotic drops, to improve children's and babies' immune health. Additionally, efforts should be undertaken to improve nanoencapsulation techniques to prepare for future epidemics and pandemics. Nanomaterial-supported nutraceuticals, nanoencapsulation of functional ingredients or their nanoparticles, and nano-combination of phytochemicals, fatty acids, or probiotics should be investigated to improve the immunity of children. In this sense, detailed further research in this area needs to be adapted to innovative technologies for the treatment of infants and children against future zoonotic viruses.

Psychometric Properties of the Breastfeeding and Employment Scale

OBJECTIVE

To evaluate the psychometric properties of the Breastfeeding and Employment Scale (BES).

DESIGN

Secondary analysis of data from the Infant Feeding Practices Study II survey, a longitudinal study on infant feeding practices.

SETTING

United States.

PARTICIPANTS

Women who were employed, breastfeeding, and completed the Infant Feeding Practices Study II BES at the 3-month postpartum assessment (N = 508).

METHODS

Participants reported their perceived level of breastfeeding support in the workplace by responding to the nine binary items on the BES. We evaluated the instrument's internal consistency reliability (Kuder-Richardson 20), test-retest reliability (Cohen's kappa), construct validity (principal component analysis), and convergent validity (relationship with a similar item).

RESULTS

The internal consistency of the BES (Kuder-Richardson 20 = 0.72) supported the reliability of scale. The test-retest reliability was moderate (0.41-0.60). The Spearman's rho correlation coefficient was 0.66, indicating adequate test-rest reliability for the total BES score between the 3-month and 6-month assessments (p < .01). The factor analysis demonstrated that the items cluster into one factor (psychosocial and structural barriers to breastfeeding in the workplace). Participants who reported more barriers to breastfeeding in the workplace also reported a less supportive workplace environment, which supported the convergent validity of the scale.

CONCLUSION

The psychometric testing of the BES provided initial support for the reliability and validity of the instrument. It may be a useful tool for measuring workplace lactation support in a concise manner.

Early-life interactions between the microbiota and immune system: impact on immune system development and atopic disease

Prenatal and early postnatal life represent key periods of immune system development. In addition to genetics and host biology, environment has a large and irreversible role in the immune maturation and health of an infant. One key player in this process is the gut microbiota, a diverse community of microorganisms that colonizes the human intestine. The diet, environment and medical interventions experienced by an infant determine the establishment and progression of the intestinal microbiota, which interacts with and trains the developing immune system. Several chronic immune-mediated diseases have been linked to an altered gut microbiota during early infancy. The recent rise in allergic disease incidence has been explained by the 'hygiene hypothesis', which states that societal changes in developed countries have led to reduced early-life microbial exposures, negatively impacting immunity. Although human cohort studies across the globe have established a correlation between early-life microbiota composition and atopy, mechanistic links and specific host-microorganism interactions are still being uncovered. Here, we detail the progression of immune system and microbiota maturation in early life, highlight the mechanistic links between microbes and the immune system, and summarize the role of early-life host-microorganism interactions in allergic disease development.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Potential sex differences in human milk fatty acids and their association with atopic dermatitis: Results of the Ulm SPATZ health study

BACKGROUND

Polyunsaturated fatty acids (PUFAs) in human milk are essential in immune system maturation and might play a role in the development of allergic conditions, such as atopic dermatitis (AD) in infants. Immune system responses are modulated by sex, but data on the sex-specific associations with PUFAs are limited. We therefore explored sex-specific differences in human milk PUFAs and their association with AD up to 2 years.

METHODS

PUFAs were measured in human milk samples from the Ulm SPATZ Health Study at 6 weeks (n = 512) and 6 months (n = 367). Associations with AD up to 2 years were evaluated using crude and multivariable logistic regression. Interactions between infant sex and PUFAs were explored by including the product term.

RESULTS

No significant associations were observed with 6-week data. At 6 months, the median relative proportion of docosahexaenoic acid (DHA) was significantly higher in milk for female than male infants (p = .001). Female infants whose milk was lower in quintile proportions of alpha-linolenic acid (ALA) at 6 months had lower odds of AD compared to males [first vs. fifth quintile OR (95% confidence interval): 0.13 (0.02, 0.66), p = .02]. This interaction was not significant when correcting for multiple testing (α threshold: p = .004). No other statistically significant associations were observed.

CONCLUSION

Individual quintile PUFA proportions in human milk were not associated with AD, overall and in a sex-specific manner. More comprehensive and statistically powered longitudinal studies are needed to determine whether potential sex differences in human milk, if any, could be of clinical relevance for infants including the investigation of mediating factors.

Breastfeeding initiation and duration through the COVID-19 pandemic, a linked population-level routine data study: the Born in Wales Cohort 2018-2021

OBJECTIVES

The WHO recommends exclusive breastfeeding for the first 6 months of life. This study aimed to examine the impact the pandemic had on breastfeeding uptake and duration, and whether intention to breastfeed is associated with longer duration of exclusive breastfeeding.

METHODS

A cohort study using routinely collected, linked healthcare data from the Secure Anonymised Information Linkage databank. All women who gave birth in Wales between 2018 and 2021 recorded in the Maternal Indicators dataset were asked about intention to breastfeed. These data were linked with the National Community Child Health Births and Breastfeeding dataset to examine breastfeeding rates.

RESULTS

Intention to breastfeed was associated with being 27.6 times more likely to continue to exclusively breastfeed for 6 months compared with those who did not intend to breastfeed (OR 27.6, 95% CI 24.9 to 30.7). Breastfeeding rates at 6 months were 16.6% prepandemic and 20.5% in 2020. When compared with a survey population, the initial intention to breastfeed/not breastfeed only changes for about 10% of women.

CONCLUSION

Women were more likely to exclusively breastfeed for 6 months during the pandemic compared with before or after the pandemic. Arguably, interventions which enable families to spend more time with their baby such as maternal and paternal leave may help improve breastfeeding duration. The biggest predictor of breastfeeding at 6 months was intention to breastfeed. Therefore, targeted interventions during pregnancy to encourage motivation to breastfeed could improve duration of breastfeeding.

Microbial Diversity and Correlation between Breast Milk and the Infant Gut

The gut microbiota is significant for infants to grow and develop in the early stages of life. The breast milk microbiota directly or indirectly influences colonizing and the development of early infant intestinal microbiota. Therefore, we wanted to study the microbial diversity and correlation between breast milk and the infant gut. By sequencing the 16S rRNA V3-V4 regions of microbiome in infant feces 1, 14, 20, 30, and 90 days after delivery as well as those in breast milk using Illumina NovaSeq, we studied the component of microbiome in both human milk and infant stools, analyzed the diversity of microbiota, and explored the relationship between them. We found that the richest bacteria in breast milk were Acinetobacter, Stenotrophomonas, Sphingopyxis, Pseudomonas, and Streptococcus, with a small amount of Lactobacillus, Bifidobacterium, and Klebsiella. The infant feces were abundant in Bifidobacterium, Escherichia-Shigella, Klebsiella, Streptococcus, Serratia, Bacteroides, and Lactobacillus, with a small number of Acinetobacter and Pseudomonas. Acinetobacter, Bifidobacterium, Klebsiella, and Lactobacillus appeared in the breast milk and infant feces, suggesting that they were transferred from the breast milk to the infant's gut.

IgE-Dependent Food Sensitisation and Its Role in Clinical and Laboratory Presentation of Paediatric Inflammatory Bowel Disease

The rising prevalence of inflammatory bowel disease (IBD) and food allergies and their partially overlapping mechanisms such as microbiome diversity reduction raise questions about the role of allergies in IBD. While data on their comorbidity are available, analysis of IgE-sensitization's influence on the clinical presentation of IBD is lacking and is the aim of this study. Histories of 292 children with newly diagnosed IBD (173 cases of ulcerative colitis, 119 cases of Crohn's disease) were analyzed. Disease age of onset, activity, location, behaviour, and anthropometric and laboratory parameters were tested for its dependence on the presence of chosen IgE sensitization markers. A.o. Chi2, OR and phi coefficient were assessed. In Crohn's disease (CD), elevated total IgE (tIgE) correlated with weight loss, rectal bleeding, ASCA IgG positivity (φ = 0.19 for all) and negatively correlated with complicated disease behaviour (φ = -0.19). TIgE > 5 × reference range correlated with being underweight (φ = 0.2), ASCA IgG positivity (φ = 0.3), ASCA double (IgA and IgG) positivity (φ = 0.25) and elevated total IgG (φ = 0.18). The presence of specific IgEs (sIgE) correlated with extraintestinal manifestations of IBD (φ = 0.19): Egg white sIgE correlated with upper GI involvement (L4b) (φ = 0.26), severe growth impairment (φ = 0.23) and colonic mucosal eosinophilia (φ = 0.19). In ulcerative colitis, decreased IgA correlated with egg white sIgE (φ = 0.3), as well as the presence of any (φ = 0.25) or multiple sIgEs (φ = 0.2); the latter correlated also with elevated IgG (φ = 0.22), fever (φ = 0.18), abdominal pain (φ = 0.16) and being underweight (φ = 0.15). Cow's milk sIgE correlated positively with growth impairment (φ = 0.15) and elevated IgG (φ = 0.17) and negatively with extensive colitis (φ = -0.15). Pancolitis correlated negatively with sIgE presence (φ = -0.15). In summary, single moderate and numerous weak but interesting relationships were observed.

Microbial transmission, colonisation and succession: from pregnancy to infancy

The microbiome has been proven to be associated with many diseases and has been used as a biomarker and target in disease prevention and intervention. Currently, the vital role of the microbiome in pregnant women and newborns is increasingly emphasised. In this review, we discuss the interplay of the microbiome and the corresponding immune mechanism between mothers and their offspring during the perinatal period. We aim to present a comprehensive picture of microbial transmission and potential immune imprinting before and after delivery. In addition, we discuss the possibility of in utero microbial colonisation during pregnancy, which has been highly debated in recent studies, and highlight the importance of the microbiome in infant development during the first 3 years of life. This holistic view of the role of the microbial interplay between mothers and infants will refine our current understanding of pregnancy complications as well as diseases in early life and will greatly facilitate the microbiome-based prenatal diagnosis and treatment of mother-infant-related diseases.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Health Behavior and Social-Emotional Health Status of School-Aged Children According to their Experience with Atopic Dermatitis Diagnosis: Based on the 12th (2019) Panel Study on Korean Children

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is common in children and is increasing worldwide. This study aimed to identify differences in children's health behavior and social-emotional health status based on AD diagnosis at late school age. For this purpose, we conducted a descriptive survey using the 12th Panel Study on Korean Children data obtained in 2019. The data were analyzed using descriptive statistics, the Rao-Scott χ2 test, and a t-test using a complex sample analysis. A total of 1412 11-year-old Korean children participated in the study, of whom an estimated 8.2% were diagnosed with AD. In the children diagnosed with AD, the transition from exclusive breastfeeding to mixed feeding was later than that in children without AD (F = 5.71, p = 0.024), and the prevalence of AD in their parents was higher (F = 6.97, p = 0.014). Regarding health behaviors, the children diagnosed with AD had a higher intake frequency of protein (F = 5.41, p = 0.028) and vegetables (F = 6.09, p = 0.020). Regarding social-emotional health, subjective health status (F = 3.94, p = 0.026) and friend relationships (F = 2.95, p = 0.007) were lower in the children diagnosed with AD. These results, as preliminary data for interventions for school-aged children with AD, suggest that the difficulties of children's peer relationships should be considered and dealt with in further interventions.

The role of breastfeeding as a protective factor against the development of the immune-mediated diseases: A systematic review

INTRODUCTION

Breast milk is rich in nutrients and immunological factors capable of protecting infants against various immunological diseases and disorders. The current systematic review has been framed with the objective of studying the role of breastfeeding as a protective factor against the development of immune-mediated diseases.

METHODS

The database and website searches were performed using PubMed, PubMed Central, Nature, Springer, Nature, Web of Science, and Elsevier. The studies were scrutinized based on the nature of participants and the nature of disease considered. The search was restricted to infants with immune-mediated diseases such as diabetes mellitus, allergic conditions, diarrhoea, and rheumatoid arthritis.

RESULTS

We have included 28 studies, out of which seven deal with diabetes mellitus, two rheumatoid arthritis, five studies about Celiac Disease, twelve studies about allergic/ asthma/wheezing conditions and one study on each of the following diseases: neonatal lupus erythematosus and colitis.

DISCUSSION

Based on our analysis, breastfeeding in association with the considered diseases was found to be positive. Breastfeeding is involved as protective factor against various diseases. The role of breastfeeding in the prevention of diabetes mellitus has been found to be significantly higher than for other diseases.

Lactobacillus paragasseri BBM171 Ameliorates Allergic Airway Inflammation Induced by Ovalbumin in Mice via Modulating the Th1/Th2 Balance

Supplementation with specific probiotics has been shown to improve allergic airway symptoms. This study aimed to investigate immunomodulatory effects of a potential probiotic strain isolated from breast milk, Lactobacillus paragasseri BBM171 (BBM171), in an ovalbumin (OVA)-induced allergic mouse model. OVA-sensitized and OVA-challenged BALB/c mice were orally administered live or heat-inactivated BBM171 for 48 consecutive days. After the last allergen challenge, serum immunoglobulin (Ig) levels, inflammatory cell levels in the lungs, and cytokine levels in bronchoalveolar lavage fluid (BALF) were assessed. The results showed that oral administration of live or heat-inactivated BBM171 decreased serum levels of total IgE, OVA-specific IgE, and OVA-specific IgG1, while increasing OVA-specific IgG2a and reducing the extent of airway inflammation in OVA-induced allergic mice. In addition, both live and heat-inactivated BBM171 modulated the cytokine profile in BALF to a type 1 T helper (Th1) response. Furthermore, ex vivo experiments using OVA-induced allergic mouse splenocytes showed that both live and heat-inactivated BBM171 could regulate the Th1/Th2 balance, decrease the proinflammatory cytokine interleukin (IL)-17 level, and increase the anti-inflammatory cytokine IL-10 level. Taken together, these results suggest that oral administration of live or heat-inactivated BBM171 improved allergen-induced airway inflammation symptoms by modulating the host immune response toward Th1 dominance.

Feeding Practices of Infants and Toddlers by Their Mothers in Selected Northern Emirates of the United Arab Emirates

Research on the feeding practices of infants and young children in the United Arab Emirates (UAE) is limited, especially in the northern regions of the country. A retrospective web-based survey was conducted to assess child feeding practices among the mothers of young children aged 6 months to 2.5 years in the northern emirates of the UAE. Information from a total of 475 mothers was collected on maternal socio-demographic factors, child feeding practices, and the use of vitamin and mineral supplements. For the first 6 months, 46.7% of the infants were exclusively breastfed, 43.8% were fed on both breastmilk and formula, and 9.5% were given formula only. Significant differences in the types of feeding were found correlating with maternal age (p = 0.02) and employment status (p < 0.001) but not with educational level, with a higher proportion of younger and unemployed women exclusively breastfeeding. However, although a significantly higher proportion of mothers with lower educational levels breastfed their children for ≥6 months (p = 0.026), they introduced “other milk” (non-breastmilk or formula) before the child reached the age of 12 months (p = 0.022). In this study, 22.1% of the infants and 8.1% of the toddlers did not receive an animal source of iron, while 52.6% of the children received vitamin/mineral supplements. The median daily frequency intake of sweets and savory snacks was substantially higher than the respective intake of fruits and vegetables. Intervention programs that focus on healthy infant and toddler feeding, including food sources of iron and nutrient-dense food groups, are needed in the UAE.

The Role of Breastfeeding on Respiratory Outcomes Later in Childhood

BACKGROUND

Breastfeeding is associated with a lower risk of wheezing in early childhood, but its effect later in childhood remains unclear. We investigated the association of breastfeeding and respiratory outcomes in children aged 11 years.

MATERIALS AND METHODS

We performed an observational longitudinal study including 110 prepubertal children. Information about breastfeeding duration, wheezing and asthma was collected by questionnaires. At 11 years of age, we measured spirometry parameters, lung volumes, diffusing lung capacity, and fractional exhaled nitric oxide. We used logistic and linear regression models to examine the associations of breastfeeding duration with the odds of asthma and lung function measures. All multivariable analyses were adjusted for sex, smoking during pregnancy, gestational age at birth, twins, and mode of delivery (confounder model).

RESULTS

Breastfeeding duration was associated with FEV₁ z-score [β = 0.04, CI 95% (0.02-0.09)], FEF75 z-score [β = 0.06, CI 95% (0.03-0.09)] and FEV₁/FVC z-score [β = 0.03, CI 95% (0.00-0.07)], but not with diffusing lung capacity and fractional exhaled nitric oxide. No association of breastfeeding duration with preschool wheezing, ever asthma and current asthma was documented.

CONCLUSION

We showed that children breastfed for longer time presented higher FEV₁, FEV₁/FVC, and FEF75 z-score values at 11 years of age compared to children breastfed for shorter time, suggesting a protective effect of breastfeeding on airways, and not on lung parenchyma (lung volumes and alveolar capillary membrane) or allergic airway inflammation. The positive effect of breastfeeding duration on lung function lays the foundation to promote breastfeeding more and more as effective preventive measure.