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Moumin NA, D'Vaz N, Kidd C, MacRae A, Zhou SJ, Richards T, Palmer DJ, Grzeskowiak LE, Sullivan TR, Green TJ. Urinary ferritin as a non-invasive means of assessing iron status in young children. J Nutr 2024:S0022-3166(24)00272-4. [PMID: 38729575 DOI: 10.1016/j.tjnut.2024.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Iron deficiency (ID) is the most common nutritional deficiency affecting young children. Serum ferritin is the preferred biomarker for measuring iron status as it reflects iron stores; however, blood collection can be distressing for young children and can be logistically difficult. A Non-invasive means to measure iron status would be attractive to either diagnose or screen for ID in young children. OBJECTIVE 1) To determine the correlation between urinary and serum ferritin in young children; 2) To determine if correcting urinary ferritin for creatinine and specific gravity improves the correlation; and 3) To determine a urine ferritin cut point to predict ID. METHODS Validation study using paired serum and urine collected from 3-year-old children (n=142) participating in a longitudinal birth cohort study; the ORIGINS project in Perth, Western Australia. We calculated the sensitivity, specificity, positive, and negative predictive value of urinary ferritin in identifying those with ID at the clinical cut point used by the World Health Organization (serum ferritin <12 ng/mL). RESULTS Urine ferritin, corrected for creatinine, correlated moderately with serum ferritin r=0.53 (0.40-0.64) and performed well in predicting those with ID (area under the curve 0.85, 95% CI 0.75-0.94). Urine ferritin < 2.28 ng/mg creatinine was sensitive (86%) and specific (77%) in predicting ID and had a high negative predictive value of 97%; however, the positive predictive value was low (40%) due to the low prevalence of ID in the sample (16%). CONCLUSIONS Urine ferritin showed good diagnostic performance for ID. The non-invasive biomarker maybe a useful screening tool to exclude ID in healthy young children; however, further research is needed in other populations.
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Affiliation(s)
- Najma A Moumin
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide SA 5000, Australia; Discipline of Pediatrics, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide SA 5000, Australia.
| | - Nina D'Vaz
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
| | - Courtney Kidd
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
| | - Andrea MacRae
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia
| | - Shao J Zhou
- School of Agriculture, Food & Wine, The University of Adelaide, Urrbrae SA 5064, Australia; Robinson Research Institute, The University of Adelaide, Adelaide SA 5000, Australia
| | - Toby Richards
- School of Medicine, Division of Surgery, University of Western Australia, Perth WA 6009, Australia
| | - Debra J Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA 6009, Australia; School of Medicine, University of Western Australia, Crawley WA 6009, Australia
| | - Luke E Grzeskowiak
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide SA 5000, Australia; College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia
| | - Thomas R Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide SA 5000, Australia; Discipline of Public Health, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide SA 5000, Australia
| | - Tim J Green
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide SA 5000, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park SA 5042, Australia
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Mancini VO, Brook J, Hernandez C, Strickland D, Christophersen CT, D'Vaz N, Silva D, Prescott S, Callaghan B, Downs J, Finlay-Jones A. Associations between the human immune system and gut microbiome with neurodevelopment in the first 5 years of life: A systematic scoping review. Dev Psychobiol 2023; 65:e22360. [PMID: 36811373 PMCID: PMC10107682 DOI: 10.1002/dev.22360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 01/13/2023]
Abstract
The aim of this review was to map the literature assessing associations between maternal or infant immune or gut microbiome biomarkers and child neurodevelopmental outcomes within the first 5 years of life. We conducted a PRISMA-ScR compliant review of peer-reviewed, English-language journal articles. Studies reporting gut microbiome or immune system biomarkers and child neurodevelopmental outcomes prior to 5 years were eligible. Sixty-nine of 23,495 retrieved studies were included. Of these, 18 reported on the maternal immune system, 40 on the infant immune system, and 13 on the infant gut microbiome. No studies examined the maternal microbiome, and only one study examined biomarkers from both the immune system and the gut microbiome. Additionally, only one study included both maternal and infant biomarkers. Neurodevelopmental outcomes were assessed from 6 days to 5 years. Associations between biomarkers and neurodevelopmental outcomes were largely nonsignificant and small in effect size. While the immune system and gut microbiome are thought to have interactive impacts on the developing brain, there remains a paucity of published studies that report biomarkers from both systems and associations with child development outcomes. Heterogeneity of research designs and methodologies may also contribute to inconsistent findings. Future studies should integrate data across biological systems to generate novel insights into the biological underpinnings of early development.
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Affiliation(s)
- Vincent O Mancini
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Juliet Brook
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christian Hernandez
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Deborah Strickland
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Claus T Christophersen
- WA Human Microbiome Collaboration Centre, School of Molecular and Life Sciences, Curtin University, Bentley, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nina D'Vaz
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Desiree Silva
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan Prescott
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Bridget Callaghan
- Brain and Body Lab, University of California, Los Angeles, Los Angeles, California, USA
| | - Jenny Downs
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Amy Finlay-Jones
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
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D'Vaz N, Okitika TA, Shackleton C, Devadason SG, Hall GL. Bronchodilator responsiveness in children with asthma is not influenced by spacer device selection. Pediatr Pulmonol 2019; 54:531-536. [PMID: 30719873 DOI: 10.1002/ppul.24263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/19/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Spacer devices optimize delivery of aerosol therapies and maximize therapeutic efficacy. We assessed the impact of spacer device on the prevalence and magnitude of bronchodilator response (BDR) in children with asthma. METHODS Children with physician confirmed asthma and parentally reported symptoms in the last 12 months were recruited for this study. Each participant completed two separate visits (5-10 days apart) with spirometry performed at baseline and following cumulative doses of salbutamol (200, 400, 800, and 200 μg) delivered by either a small volume disposable spacer or a large volume multi-use spacer. Spacer type was alternated for each participant during each visit. The primary outcome was the effect of spacer type on bronchodilator responsiveness. The secondary outcome was to assess the relationships between spacer device, salbutamol dose and the proportion of children with a clinically relevant BDR. RESULTS Thirty-two children (mean age 11.8 years) completed both visits. Change in lung function following bronchodilators was increased using the large volume spacer, for relative but not absolute increase in FEV1 [mean difference (95% confidence intervals): 1.28% (0.02, 2.54; P = 0.047) and 0.013 L (-0.01, 0.04; P = 0.288)], respectively. There was no observed difference in FVC by spacer type. Overall, 59% (n = 19) of children exhibited a clinically relevant BDR at 400 µg of salbutamol for any spacer and was independent of spacer type. CONCLUSION Spacer device was not associated with clinically important differences in lung function following bronchodilator inhalation in children with asthma. At a recommended dose of 400 μg, some children with asthma may have their bronchodilator responsiveness misclassified.
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Affiliation(s)
- Nina D'Vaz
- Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia.,Telethon Kids Institute, Perth, Western Australia
| | | | - Claire Shackleton
- Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia.,Telethon Kids Institute, Perth, Western Australia.,Child Health Research Centre, University of Queensland, South Brisbane, Queensland
| | - Sunalene G Devadason
- Division of Paediatrics, Medical School, University of Western Australia, Perth, Western Australia
| | - Graham L Hall
- Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia.,Telethon Kids Institute, Perth, Western Australia.,School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia
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Metcalfe JR, Marsh JA, D'Vaz N, Geddes DT, Lai CT, Prescott SL, Palmer DJ. Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial. Clin Exp Allergy 2016; 46:1605-1613. [PMID: 27562481 DOI: 10.1111/cea.12806] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is limited understanding of how maternal diet affects breastmilk food allergen concentrations, and whether exposure to allergens through this route influences the development of infant oral tolerance or sensitization. OBJECTIVE To investigate how maternal dietary egg ingestion during early lactation influences egg protein (ovalbumin) levels detected in human breastmilk. METHODS In a randomized controlled trial, women were allocated to a dietary group for the first six weeks of lactation: high-egg diet (> 4 eggs per week), low-egg diet (one-three eggs per week) or an egg-free diet. Breastmilk samples were collected at 2, 4 and 6 weeks of lactation for the measurement of ovalbumin. The permeability of the mammary epithelium was assessed by measuring the breastmilk sodium : potassium ratio. Egg-specific IgE and IgG4 were measured in infant plasma at 6 weeks, and prior to the introduction of egg in solids at 16 weeks. RESULTS Average maternal egg ingestion was associated with breastmilk ovalbumin concentration. Specifically, for each additional egg ingested per week, there was an average 25% increase in ovalbumin concentration (95% CI: 5-48%, P = 0.01). Breastmilk ovalbumin concentrations were significantly higher in the 'high-egg' group (> 4 eggs per week) compared with the 'egg-free' group (P = 0.04). However, one-third of women had no breastmilk ovalbumin detected. No detectable associations were found between mammary epithelium permeability and breastmilk ovalbumin concentrations. Infant plasma egg-specific IgG4 levels were also positively associated with maternal egg ingestion, with an average 22% (95% CI: 3-45%) increase in infant egg-specific IgG4 levels per additional egg consumed per week (P = 0.02). CONCLUSIONS AND CLINICAL RELEVANCE Increased maternal egg ingestion is associated with increased breastmilk ovalbumin, and markers of immune tolerance in infants. These results highlight the potential for maternal diet to benefit infant oral tolerance development during lactation.
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Affiliation(s)
- J R Metcalfe
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - J A Marsh
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Mathematics & Statistics, The University of Western Australia, Perth, WA, Australia
| | - N D'Vaz
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - D T Geddes
- School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA, Australia
| | - C T Lai
- School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA, Australia
| | - S L Prescott
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - D J Palmer
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
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Metcalfe JR, D'Vaz N, Makrides M, Gold MS, Quinn P, West CE, Loh R, Prescott SL, Palmer DJ. Elevated IL-5 and IL-13 responses to egg proteins predate the introduction of egg in solid foods in infants with eczema. Clin Exp Allergy 2016; 46:308-16. [DOI: 10.1111/cea.12608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. R. Metcalfe
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
| | - N. D'Vaz
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
| | - M. Makrides
- Women's & Children's Health Research Institute; Adelaide SA Australia
- Healthy Mothers, Babies and Children; South Australian Health and Medical Research Institute; Adelaide SA Australia
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - M. S. Gold
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - P. Quinn
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - C. E. West
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Department of Clinical Sciences; Pediatrics; Umeå University; Umea Sweden
| | - R. Loh
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - S. L. Prescott
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - D. J. Palmer
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Women's & Children's Health Research Institute; Adelaide SA Australia
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Jones A, D'Vaz N, Meldrum S, Palmer D, Zhang G, Prescott S. 25-hydroxyvitamin D3 status is associated with developing adaptive and innate immune responses in the first 6 months of life. Clin Exp Allergy 2014; 45:220-31. [DOI: 10.1111/cea.12449] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 12/23/2022]
Affiliation(s)
- A.P. Jones
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- Telethon Kids Institute; University of Western Australia; Perth WA Australia
| | - N. D'Vaz
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- Telethon Kids Institute; University of Western Australia; Perth WA Australia
| | - S. Meldrum
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- Telethon Kids Institute; University of Western Australia; Perth WA Australia
| | - D.J. Palmer
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- Telethon Kids Institute; University of Western Australia; Perth WA Australia
- ‘In-FLAME’ the International Inflammation Network; Worldwide Universities Network (WUN); Perth WA Australia
| | - G. Zhang
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- School of Public Health; Curtin University of Technology; Perth WA Australia
| | - S.L. Prescott
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
- Telethon Kids Institute; University of Western Australia; Perth WA Australia
- ‘In-FLAME’ the International Inflammation Network; Worldwide Universities Network (WUN); Perth WA Australia
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Keelan JA, Mas E, D'Vaz N, Dunstan JA, Li S, Barden AE, Mark PJ, Waddell BJ, Prescott SL, Mori TA. Effects of maternal n-3 fatty acid supplementation on placental cytokines, pro-resolving lipid mediators and their precursors. Reproduction 2014; 149:171-8. [PMID: 25504868 DOI: 10.1530/rep-14-0549] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The aim of this study was to determine whether supplementation with fish oil-derived n-3 polyunsaturated fatty acids (n-3 PUFA) during pregnancy modifies placental PUFA composition, the accumulation of specialised pro-resolving lipid mediators (SPMs, specifically resolvins (Rv), protectins (PD) and upstream precursors) and inflammatory gene expression. Placentas were collected from women (n=51) enrolled in a randomised, placebo controlled trial of n-3 PUFA supplementation from 20-week gestation. Lipids were extracted for fatty acid analysis and SPMs were quantitated by mass spectrometry. Gene expression was determined by qRT-PCR. Using multiple regression analysis, data were correlated for placental n-3 PUFA and SPM levels with PUFA levels in maternal and cord blood erythrocytes. Supplementation with n-3 PUFAs increased placental docosahexaenoic acid (DHA) levels, but not eicosapentaenoic acid (EPA) levels (P<0.05), and increased the levels of the SPM precursors 18-hydroxyeicosapentaenoic acid and 17-hydroxydocosahexaenoic acid (17-HDHA) by two- to threefold (P<0.0005). RvD1, 17R-RvD1, RvD2 and PD1 were detectable in all placentas, but concentrations were not significantly increased by n-3 PUFA supplementation. Placental DHA levels were positively associated with maternal and cord DHA levels (P<0.005), and with placental 17-HDHA concentrations (P<0.0001). Placental mRNA expression of PTGS2, IL1β, IL6 and IL10 was unaffected by n-3 PUFA supplementation, but TNFα expression was increased by 14-fold (P<0.05). We conclude that n-3 PUFA supplementation in pregnancy i) enhances placental accumulation of DHA and SPM precursors, ii) does not alter placental EPA levels, and iii) has no stimulatory effects on inflammatory gene expression. Further studies are required to ascertain the biological significance of SPMs in the placenta and the potential immunomodulatory effects of elevating placental SPM levels.
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Affiliation(s)
- Jeffrey A Keelan
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Emilie Mas
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Nina D'Vaz
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Janet A Dunstan
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Shaofu Li
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Anne E Barden
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Peter J Mark
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Brendan J Waddell
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Susan L Prescott
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Trevor A Mori
- School of Women's and Infants' HealthKing Edward Memorial Hospital, University of Western Australia, 374 Bagot Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of Medicine and PharmacologyRoyal Perth Hospital, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, AustraliaSchool of Paediatrics and Child HealthTelethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, AustraliaSchool of AnatomyPhysiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
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8
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D'Vaz N, Meldrum SJ, Dunstan JA, Lee-Pullen TF, Metcalfe J, Holt BJ, Serralha M, Tulic MK, Mori TA, Prescott SL. Fish oil supplementation in early infancy modulates developing infant immune responses. Clin Exp Allergy 2012; 42:1206-16. [PMID: 22805468 DOI: 10.1111/j.1365-2222.2012.04031.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Maternal fish oil supplementation during pregnancy has been associated with altered infant immune responses and a reduced risk of infant sensitization and eczema. OBJECTIVE To examine the effect of early postnatal fish oil supplementation on infant cellular immune function at 6 months of age in the context of allergic disease. METHODS In a double-blind randomized controlled trial (ACTRN12606000281594), 420 infants of high atopic risk received fish oil [containing 280 mg docosahexaenoic acid (DHA) and 110 mg eicosapentanoic acid (EPA)] or control oil daily from birth to 6 months. One hundred and twenty infants had blood collected at 6 months of age. Fatty acid levels, induced cytokine responses, T cell subsets and monocyte HLA-DR expression were assessed at 6 months of age. Infant allergies were assessed at 6 and 12 months of age. RESULTS DHA and EPA levels were significantly higher in the fish oil group and erythrocyte arachidonic acid (AA) levels were lower (all P < 0.05). Infants in the fish oil group had significantly lower IL-13 responses (P = 0.036) to house dust mite (HDM) and higher IFNγ (P = 0.035) and TNF (P = 0.017) responses to phytohaemaglutinin (PHA). Infants with relatively high DHA levels had lower Th2 responses to allergens including lower IL-13 to β-lactoglobulin (BLG) (P = 0.020), and lower IL-5 to BLG (P = 0.045). CONCLUSIONS AND CLINICAL RELEVANCE Postnatal fish oil supplementation increased infant n-3 polyunsaturated fatty acid (PUFA) levels and associated with lowered allergen-specific Th2 responses and elevated polyclonal Th1 responses. Our results add to existing evidence of n-3 PUFA having immunomodulatory properties that are potentially allergy-protective.
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Affiliation(s)
- N D'Vaz
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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9
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D'Vaz N, Ma Y, Dunstan JA, Lee-Pullen TF, Hii C, Meldrum S, Zhang G, Metcalfe J, Ferrante A, Prescott SL. Neonatal protein kinase C zeta expression determines the neonatal T-Cell cytokine phenotype and predicts the development and severity of infant allergic disease. Allergy 2012; 67:1511-8. [PMID: 23004934 DOI: 10.1111/all.12027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have demonstrated that reduced T-cell protein kinase C zeta (PKCζ) expression is associated with allergy development in infants born to atopic mothers. This study examined whether this relationship extends to a general population and addressed the basis for the association. METHODS A flow cytometry assay was developed for the measurement of T-cell PKCζ levels in PBMC, cord blood mononuclear cell and whole blood. Cord blood T-cell PKCζ levels were measured in 135 neonates, and allergic disease was evaluated by skin prick test and clinical examination at 12 months of age. RESULTS Allergic children (particularly those with eczema) had significantly lower neonatal T-cell PKCζ expression than nonallergic children (P < 0.001). PKCζ levels predicted allergic disease with optimal specificity of 86% and sensitivity of 54%. The sensitivity was increased in the children of allergic mothers, who had significantly lower PKC levels than the children of nonallergic mothers. Cord blood PKCζ levels did not affect T-cell maturation in culture as assessed by CD45RA/RO expression, but low PKCζ expression was associated with reduced capacity for IFNγ production by matured T cells. Low cord blood PKC expression was further associated with increased IL-13 responses at 6 months. CONCLUSIONS The findings suggest a potential role for the use of PKCζ levels in cord blood T cells as a presymptomatic test to predict allergy risk in children, particularly offspring of allergic mothers, and that the basis of this relationship is related to cytokine patterns in mature T cells.
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Affiliation(s)
- N. D'Vaz
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | - Y. Ma
- Department of Immunopathology, SA Pathology; Women and Children's Hospital Campus; Adelaide and Discipline of Paediatrics; University of Adelaide; Adelaide; SA; Australia
| | - J. A. Dunstan
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | - T. F. Lee-Pullen
- Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth; WA; Australia
| | - C. Hii
- Department of Immunopathology, SA Pathology; Women and Children's Hospital Campus; Adelaide and Discipline of Paediatrics; University of Adelaide; Adelaide; SA; Australia
| | - S. Meldrum
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | - G. Zhang
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | - J. Metcalfe
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | | | - S. L. Prescott
- School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
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D'Vaz N, Meldrum SJ, Dunstan JA, Martino D, McCarthy S, Metcalfe J, Tulic MK, Mori TA, Prescott SL. Postnatal fish oil supplementation in high-risk infants to prevent allergy: randomized controlled trial. Pediatrics 2012; 130:674-82. [PMID: 22945403 DOI: 10.1542/peds.2011-3104] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS Postnatal fish oil supplementation improved infant n-3 status but did not prevent childhood allergic disease.
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Affiliation(s)
- N D'Vaz
- School of Paediatrics and Child Health Research (SPACH), Princess Margaret Hospital, University of Western Australia, PO Box D184, Perth, Western Australia, 6001 Australia
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Meldrum SJ, D'Vaz N, Dunstan JA, Mori TA, Hird K, Simmer K, Prescott SL. Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour. Early Hum Dev 2012; 88:567-73. [PMID: 22284984 DOI: 10.1016/j.earlhumdev.2011.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/14/2011] [Accepted: 12/15/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear. AIMS To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months. STUDY DESIGN Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months. SUBJECTS Infants with a maternal history of allergic disease (n=324). OUTCOME MEASURES Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development. RESULTS Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p=.016), and this was most apparent for a diagnosis of eczema (p=.007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p=.010), along with a trend for effects on the Social-Emotional composite score for IgE-Mediated food allergies (p=.052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes. CONCLUSION This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.
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Affiliation(s)
- Suzanne J Meldrum
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
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Meldrum SJ, D'Vaz N, Casadio Y, Dunstan JA, Niels Krogsgaard-Larsen N, Simmer K, Prescott SL. Determinants of DHA levels in early infancy: differential effects of breast milk and direct fish oil supplementation. Prostaglandins Leukot Essent Fatty Acids 2012; 86:233-9. [PMID: 22572105 DOI: 10.1016/j.plefa.2012.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/16/2012] [Accepted: 03/16/2012] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Although omega (n)-3 long-chain polyunsaturated fatty acids (LCPUFA), particularly docosahexaenoic acid (DHA), intakes are important during infancy, the optimal method of increasing infant status remains unclear. We hypothesized that high-dose infant fish oil supplementation would have greater relative effects upon n-3 LCPUFA status at six months of age than breast milk fatty acids. PATIENTS AND METHODS Infants (n=420) were supplemented daily from birth to six months with fish oil or placebo. In a subset of infants, LCPUFA levels were measured in cord blood, breast milk and in infant blood at 6 months. RESULTS DHA levels increased in the fish oil group relative to placebo (p<05). Breast milk DHA was the strongest predictor of infant erythrocyte DHA levels (p=<001). This remained significant after adjustment for cord blood DHA, supplementation group and adherence. CONCLUSION In this cohort, breast milk DHA was a greater determinant of infant erythrocyte n-3 LCPUFA status, than direct supplementation with fish oil.
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Affiliation(s)
- S J Meldrum
- School of Paediatrics and Child Health, University of Western Australia, WA 6008,
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D'Vaz N, Prescott SL. The allergy protective effects of fish oil: a matter of timing? Evid Based Med 2012; 17:22-23. [PMID: 22127339 DOI: 10.1136/ebmed-2011-100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Nina D'Vaz
- School of Paediatrics and Child Health Research (SPACH), University of Western Australia, Perth, Western Australia
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Dunstan JA, West C, McCarthy S, Metcalfe J, Meldrum S, Oddy WH, Tulic MK, D'Vaz N, Prescott SL. The relationship between maternal folate status in pregnancy, cord blood folate levels, and allergic outcomes in early childhood. Allergy 2012; 67:50-7. [PMID: 21923665 DOI: 10.1111/j.1398-9995.2011.02714.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dietary changes may epigenetically modify fetal gene expression during critical periods of development to potentially influence disease susceptibility. This study examined whether maternal and/or fetal folate status in pregnancy is associated with infant allergic outcomes. METHODS Pregnant women (n=628) were recruited in the last trimester of pregnancy. Folate status determined by both food frequency questionnaires and folate levels in maternal and cord blood serum was examined in relation to infant allergic outcomes at 1 year of age (n=484). RESULTS Infants who developed allergic disease (namely eczema) did not show any differences in cord blood or maternal folate levels compared with children without disease. Although maternal folate intake from foods was also not different, folate derived from supplements was higher (P=0.017) in children with subsequent eczema. Furthermore, infants exposed to >500 μg folic acid/day as a supplement in utero were more likely to develop eczema than those taking <200 μg/day (OR [odds ratio] =1.85; 95% CI 1.14-3.02; P=0.013), remaining significant after adjustment for maternal allergy and other confounders. There was a nonlinear relationship between cord blood folate and sensitization, with folate levels <50 nmol/l (OR=3.02; 95% CI 1.16-7.87; P=0.024) and >75 nmol/l (OR=3.59; 95% CI 1.40-9.20; P=0.008) associated with greater sensitization risk than levels between 50 and 75 nmol/l. CONCLUSION Fetal levels between 50 and 75 nmol/l appeared optimal for minimizing sensitization. While folate taken as a supplement in higher doses during the third trimester was associated with eczema, there was no effect on other allergic outcomes including sensitization. Further studies are needed to determine the significance of this.
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Affiliation(s)
- J A Dunstan
- School of Paediatrics and Child Health, Centre for Child Health Research, University of Western Australia, Perth, WA 6001, Australia
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Abstract
Emerging evidence suggests that exposures during pregnancy and the early postnatal period can modify gene expression and disease propensity. Diet is a major environmental exposure, and dietary factors, including polyunsaturated fatty acids, probiotics, oligosaccharides, antioxidants, folate, and other vitamins, have effects on immune function. Some also have been implicated in reduced risk of allergy in observational studies. Intervention trials with polyunsaturated fatty acids, probiotics, and oligosaccharides suggest preliminary but as-of-yet-unconfirmed benefits. Food allergen avoidance during pregnancy, lactation, or infancy has provided no consistent evidence in allergy prevention and is no longer recommended. Rather, there is now a focus on food allergens in tolerance induction. Specific nutrients can induce changes in gene expression during early development and have been implicated in potentially heritable "epigenetic" changes in disease predisposition. Collectively, these observations emphasize that early exposures may modify tolerance development and that further research on these exposures should remain a priority.
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Affiliation(s)
- Christina E West
- Department of Clinical Sciences, Pediatrics, Umeå University, SE-901 87, Umeå, Sweden.
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Meldrum S, D'Vaz N, Dunstan J, Mori T, Prescott S. The Infant Fish Oil Supplementation Study (IFOS): Design and research protocol of a double-blind, randomised controlled n−3 LCPUFA intervention trial in term infants. Contemp Clin Trials 2011; 32:771-8. [DOI: 10.1016/j.cct.2011.05.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/13/2011] [Accepted: 05/25/2011] [Indexed: 01/11/2023]
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Tulic MK, Hodder M, Forsberg A, McCarthy S, Richman T, D'Vaz N, van den Biggelaar AHJ, Thornton CA, Prescott SL. Differences in innate immune function between allergic and nonallergic children: new insights into immune ontogeny. J Allergy Clin Immunol 2010; 127:470-478.e1. [PMID: 21093030 DOI: 10.1016/j.jaci.2010.09.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/01/2010] [Accepted: 09/10/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Microbial products are of central interest in the modulation of allergic propensity. OBJECTIVE We sought to explore whether allergic children show differences in microbial Toll-like receptor (TLR)-mediated responses over their first 5 years of life. METHODS Mononuclear cells isolated from 35 allergic and 35 nonallergic children at birth and 1, 2.5, and 5 years of age were stimulated with TLR2-TLR9 ligands to study innate immune function and with allergens or mitogen to assess adaptive T-cell responses. Cytokine production was measured by using Luminex multiplexing technology. RESULTS Nonallergic children show progressive and significant age-related increases in innate cytokine responses (IL-1β, IL-6, TNF-α, and IL-10) to virtually all TLR ligands. This innate maturation corresponds with a parallel increase in adaptive T(H)1 (IFN-γ) responses to allergens and mitogens. In contrast, allergic children show exaggerated innate responses at birth (P < .01) but a relative decrease with age thereafter, so that by age 5 years, TLR responses are attenuated compared with those seen in nonallergic subjects (P < .05). This early hyperresponsiveness in allergic subjects fails to translate to a corresponding maturation of T(H)1 function, which remains attenuated relative to that seen in nonallergic subjects but is associated with a characteristic age-dependent increase in allergen-specific T(H)2 responses (P < .01). CONCLUSION Our findings suggest significant differences in the developmental trajectory of innate immune function in children with allergic disease that might contribute to the recognized differences in postnatal adaptive T-cell immunity.
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Affiliation(s)
- Meri K Tulic
- Childhood Allergy and Immunology Research, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
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