Article | Published:

Maternal and pediatric nutrition

Retrospective observational cohort study regarding the effect of breastfeeding on challenge-proven food allergy

Abstract

Background/objectives

Human breast milk is generally regarded as the best nutrition for infants in their first months of life. Whether breastfeeding has a protective effect on food allergy is a point of debate and the subject of this study.

Subjects/methods

This retrospective study was conducted in 649 children who underwent a double-blind placebo-controlled food challenge (DBPCFC) as part of routine care in a tertiary care clinic. Food allergy was defined as having at least one positive DBPCFC to any food. The association between both “any” breastfeeding (yes/no) and its duration in months with food allergy was studied by logistic regression analysis with correction for confounding variables.

Results

The prevalence of food allergy was 58.9% (n = 382). Of all subjects, 75.8% (n = 492) was breastfed and 24.2% (n = 157) bottle-fed. There was no significant association between food allergy and breastfeeding versus bottle-feeding after correction for the confounding effect of increased breastfeeding by atopic parents and a history of asthma in the child (OR = 1.24, 95% CI = 0.85–1.79, p = 0.27). However, in breastfed children, every additional month of breastfeeding lowered the risk for food allergy by ~4% (OR = 0.96, 95% CI = 0.93–0.99, p = 0.02). No confounders were identified in this association.

Conclusion

These results show for the first time that in children investigated for possible food allergy, every additional month of breastfeeding is associated with a lower risk of developing clinical food allergy as diagnosed by DBPCFC. However, overall, there was no association between the prevalence of food allergy and breastfeeding versus bottle-feeding in this tertiary care population.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Victora CG, Bahl R, Barros AJD, Franca GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–90.

  2. 2.

    Heinrich J. Modulation of allergy risk by breast feeding. Curr Opin Clin Nutr Metab Care. 2017;20:217–21.

  3. 3.

    Lodge CJ, Tan DJ, Lau M, Dai X, Tham R, Lowe AJ, et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr Suppl. 2015;104:38–53.

  4. 4.

    Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183–91.

  5. 5.

    Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, Aalberse R. Dietary prevention of allergic diseases in infants and small children Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations *. Pediatr Allergy Immunol. 2004;15:291–307.

  6. 6.

    van Odijk J, Kull I, Borres MP, Brandtzaeg P, Edberg U, Hanson LA, et al. Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966–2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy. 2003;58:833–43.

  7. 7.

    Høst A, Halken S, Muraro A, Dreborg S, Niggemann B, Aalberse R, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol. 2008;19:1–4.

  8. 8.

    Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–55.

  9. 9.

    Flokstra-de Blok BMJ, Dubois AEJ, Vlieg-Boerstra BJ, Oude Elberink JNG, Raat H, DunnGalvin A, et al. Health-related quality of life of food allergic patients: comparison with the general population and other diseases. Allergy. 2010;65:238–44.

  10. 10.

    Sicherer SH, Furlong TJ, Maes HH, Desnick RJ, Sampson HA, Gelb BD. Genetics of peanut allergy: a twin study. J Allergy Clin Immunol. 2000;106:53–6. 1 Pt 1

  11. 11.

    Muraro A, Halken S, Arshad SH, Beyer K, AEJ Dubois, du Toit G, et al. EAACI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy. Allergy. 2014;69:590–601.

  12. 12.

    de Silva D, Geromi M, Halken S, Host A, Panesar SS, Muraro A, et al. Primary prevention of food allergy in children and adults: systematic review. Allergy. 2014;69:581–9.

  13. 13.

    McGowan EC, Bloomberg GR, Gergen PJ, Visness CM, Jaffee KF, Sandel M, et al. Influence of early-life exposures on food sensitization and food allergy in an inner-city birth cohort. J Allergy Clin Immunol. 2014;135:178.

  14. 14.

    Luccioli S, Zhang Y, Verrill L, Ramos-Valle M, Kwegyir-Afful E. Infant feeding practices and reported food allergies at 6 years of age. Pediatrics. 2014;134:S21–8.

  15. 15.

    Elbert N, van Meel E, den Dekker H, de Jong N, Nijsten T, Jaddoe V. et al. Duration and exclusiveness of breastfeeding and risk of childhood atopic disorders. Allergy Eur J Allergy Clin Immunol. 2017;72:1936–43.

  16. 16.

    Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, et al. Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant. Pediatr Allergy Immunol. 2009;20:320–7.

  17. 17.

    Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010;126:807–13.

  18. 18.

    Kusunoki T, Morimoto T, Nishikomori R, Yasumi T, Heike T, Mukaida K, et al. Breastfeeding and the prevalence of allergic diseases in schoolchildren: does reverse causation matter? Pediatr Allergy Immunol. 2010;21:60–6.

  19. 19.

    Ito J, Fujiwara T. Breastfeeding and risk of atopic dermatitis up to the age 42 months: a birth cohort study in Japan. Ann Epidemiol. 2014;24:267–72.

  20. 20.

    Vlieg-boerstra BJ, Bijleveld CM, Van Der Heide S, Beusekamp BJ, Wolt-plompen SAA, Kukler J, et al. Development and validation of challenge materials for double-blind, placebo- controlled food challenges in children. J Allergy Clin Immunol. 2004;113:341–6.

  21. 21.

    Sampson Ha, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW. et al. Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012;130:1260–74.

  22. 22.

    van den Berg ME, Flokstra-de Blok BMJ, Vlieg-Boerstra BJ, Kerkhof M, van der Heide S, Koppelman GH, et al. Parental eczema increases the risk of double-blind, placebo-controlled reactions to milk but not to egg, peanut or hazelnut. Int Arch Allergy Immunol. 2012;158:77–83.

  23. 23.

    Twisk JWR. Applied multilevel analysis: a practical guide. Cambridge: Cambridge university Press; 2006.

  24. 24.

    Wang D, Bakhai A. Clinical Trials. A practical guide to design, analysis, and reporting. London: Remedica; 2006. p. 480.

  25. 25.

    Kull I, Melen E, Alm J, Hallberg J, Svartengren M, van Hage M, et al. Breast-feeding in relation to asthma, lung function, and sensitization in young school children. J Allergy Clin Immunol. 2010;125:1013–9.

  26. 26.

    Brew BK, Kull I, Garden F, Almqvist C, Bergström A, Lind T, et al. Breastfeeding, asthma, and allergy: a tale of two cities. Pediatr Allergy Immunol. 2012;23:75–82.

  27. 27.

    Hong X, Wang G, Liu X, Kumar R, Tsai H-J, Arguelles L, et al. Gene polymorphisms, breast-feeding, and development of food sensitization in early childhood. J Allergy Clin Immunol. 2011;128:374–81.e2.

  28. 28.

    Kummeling I, Thijs C, Penders J, Snijders BEP, Stelma F, Reimerink J, et al. Etiology of atopy in infancy: the KOALA Birth Cohort Study. Pediatr Allergy Immunol. 2005;16:679–84.

  29. 29.

    Sears MR, Greene JM, Willan AR, Taylor DR, Flannery EM, Cowan JO, et al. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet. 2002;360:901–7.

  30. 30.

    Saarinen KM, Juntunen-Backman K, Järvenpää AL, Kuitunen P, Lope L, Renlund M, et al. Supplementary feeding in maternity hospitals and the risk of cow’s milk allergy: a prospective study of 6209 infants. J Allergy Clin Immunol. 1999;104:457–61.

  31. 31.

    Venter C, Pereira B, Grundy J, Clayton CB, Roberts G, Higgins B, et al. Incidence of parentally reported and clinically diagnosed food hypersensitivity in the first year of life. J Allergy Clin Immunol. 2006;117:1118–24.

  32. 32.

    Brouwer ML, Wolt-Plompen SA, Dubois AE, Van Der Heide S, Jansen DF, Hoijer MA, et al. No effects of probiotics on atopic dermatitis in infancy: a randomized clinical and experimental allergy. Clin Exp Allergy. 2006;36:899–906.

  33. 33.

    Van ZZ, Maslin K, Dean T, Blaauw R, Venter C. The accuracy of dietary recall of infant feeding and food allergen data. J Hum Nutr Diet. 2016;29:777–85.

  34. 34.

    Kramer MS, Matush L, Vanilovich I, Platt R, Bogdanovich N, Sevkovskaya Z, et al. Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial. Br Med J. 2007;335:815.

  35. 35.

    Kramer MS. Breastfeeding and allergy: the evidence. Ann Nutr Metab. 2011;59:20–6.

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Author contributions

CDvG performed the data preparation, data analysis, interpretation, and wrote the manuscript. GNvdM contributed to the hypothesis, interpretation of the data, and writing of the manuscript. EB contributed to the data preparation. BMJFdB contributed to the data preparation and writing of the manuscript. BJK checked and supervised the statistical analyses and contributed to the writing of the manuscript. GHK contributed to the interpretation of the data and writing of the manuscript. AEJD was the senior author who proposed the study design and supervised the study.

Author information

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to C. D. van Ginkel.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark
Fig. 1