title: Immune Components in Human Milk Are Associated with Early Infant Immunological Health Outcomes: A Prospective Three-Country Analysis Early regular egg exposure in infants with eczema: A randomized controlled trial. Peanut, milk, and wheat intake during pregnancy is associated with reduced allergy and asthma in children. Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age. A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy Maternal dietary folate, folic acid and vitamin D intakes during pregnancy and lactation and the risk of cows' milk allergy in the offspring. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. Randomized placebo‐controlled trial of hen's egg consumption for primary prevention in infants Comparison of food allergy prevalence among Chinese infants in Chongqing, 2009 versus 1999. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study. Randomized controlled trial of early regular egg intake to prevent egg allergy Early introduction of food reduces food allergy – Pro and Con Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial Increased food allergy and vitamin D: randomized, double-blind, placebo-controlled trial. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics Introduction of Complementary Foods and the Relationship to Food Allergy VITALITY trial: protocol for a randomised controlled trial to establish the role of postnatal vitamin D supplementation in infant immune health
abstract: The role of breastfeeding in improving allergy outcomes in early childhood is still unclear . Evidence suggests that immune mediators in human milk ( HM ) play a critical role in infant immune maturation as well as protection against atopy/allergy development . We investigated relationships between levels of immune mediators in colostrum and mature milk and infant outcomes in the first year of life . In a large prospect i ve study of 398 pregnant/lactating women in the United Kingdom , Russia and Italy , colostrum and mature human milk ( HM ) sample s  were analysed for immune active molecules . Statistical analyses used models adjusting for the site of collection , colostrum collection time , parity and maternal atopic status . Preliminary univariate analysis showed detectable interleukin ( IL ) 2 and IL13 in HM to be associated with less eczema . This finding was further confirmed in multivariate analysis , with detectable HM IL13 showing protective effect OR 0.18 ( 95 % CI 0.04–0.92 ) . In contrast , a higher risk of eczema was associated with higher HM concentrations of transforming growth factor β ( TGFβ ) 2 OR 1.04 ( 95 % CI 1.01–1.06 ) per ng/mL. Parental-reported food allergy was reported less often when IL13 was detectable in colostrum OR 0.10 ( 95 % CI 0.01–0.83 ) . HM hepatocyte growth factor ( HGF ) was protective for common cold incidence at 12 months OR 0.19 ( 95 % CI 0.04–0.92 ) per ng/mL. Data from this study suggests that differences in the individual immune composition of HM may have an influence on early life infant health outcomes . Increased TGFβ2 levels in HM are associated with a higher incidence of reported eczema , with detectable IL13 in colostrum showing protective effects for food allergy and sensitization . HGF shows some protective effect on common cold incidence at one year of age . Future studies should be focused on maternal genotype , human milk microbiome and diet influence on human milk immune composition and both short- and long-term health outcomes in the infant BACKGROUND Observational studies suggest that early regular ingestion of allergenic foods might reduce the risk of food allergy . OBJECTIVE We sought to determine whether early regular oral egg exposure will reduce subsequent IgE-mediated egg allergy in infants with moderate-to-severe eczema . METHODS In a double-blind , r and omized controlled trial infants were allocated to 1 teaspoon of pasteurized raw whole egg powder ( n = 49 ) or rice powder ( n = 37 ) daily from 4 to 8 months of age . Cooked egg was introduced to both groups after an observed feed at 8 months . The primary outcome was IgE-mediated egg allergy at 12 months , as defined based on the results of an observed pasteurized raw egg challenge and skin prick tests . RESULTS A high proportion ( 31 % [ 15/49 ] ) of infants r and omized to receive egg had an allergic reaction to the egg powder and did not continue powder ingestion . At 4 months of age , before any known egg ingestion , 36 % ( 24/67 ) of infants already had egg-specific IgE levels of greater than 0.35 kilounits of antibody (kUA)/L. At 12 months , a lower ( but not significant ) proportion of infants in the egg group ( 33 % ) were given a diagnosis of IgE-mediated egg allergy compared with the control group ( 51 % ; relative risk , 0.65 ; 95 % CI , 0.38 - 1.11 ; P = .11 ) . Egg-specific IgG4 levels were significantly ( P < .001 ) greater in the egg group at both 8 and 12 months . CONCLUSION Induction of immune tolerance pathways and reduction in egg allergy incidence can be achieved by early regular oral egg exposure in infants with eczema . Caution needs to be taken when these high-risk infants are first exposed to egg because many have sensitization already by 4 months of age BACKGROUND  Maternal diet during pregnancy may affect childhood allergy and asthma . OBJECTIVE We sought to examine the associations between maternal intake of common childhood food allergens during early pregnancy and childhood allergy and asthma . METHODS We studied 1277 mother-child pairs from a US prebirth cohort unselected for any disease . Using food frequency question naires administered during the first and second trimesters , we assessed maternal intake of common childhood food allergens during pregnancy . In mid-childhood ( mean age , 7.9 years ) , we assessed food allergy , asthma , allergic rhinitis , and atopic dermatitis by question naire and serum-specific IgE levels . We examined the associations between maternal diet during pregnancy and childhood allergy and asthma . We also examined the cross-sectional associations between specific food allergies , asthma , and atopic conditions in mid-childhood . RESULTS Food allergy was common ( 5.6 % ) in mid-childhood , as was sensitization to at least 1 food allergen ( 28.0 % ) . Higher maternal peanut intake ( each additional z score ) during the first trimester was associated with 47 % reduced odds of peanut allergic reaction ( odds ratio [ OR ] , 0.53 ; 95 % CI , 0.30 - 0.94 ) . Higher milk intake during the first trimester was associated with reduced asthma ( OR , 0.83 ; 95 % CI , 0.69 - 0.99 ) and allergic rhinitis ( OR , 0.85 ; 95 % CI , 0.74 - 0.97 ) . Higher maternal wheat intake during the second trimester was associated with reduced atopic dermatitis ( OR , 0.64 ; 95 % CI , 0.46 - 0.90 ) . Peanut , wheat , and soy allergy were each cross-sectionally associated with increased childhood asthma , atopic dermatitis , and allergic rhinitis ( ORs , 3.6 to 8.1 ) . CONCLUSION Higher maternal intake of peanut , milk , and wheat during early pregnancy was associated with reduced odds of mid-childhood allergy and asthma BACKGROUND Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy . OBJECTIVE We analyzed the association between maternal diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age . DESIGN Data from 2641 children at 2 y of age were analyzed within a German prospect i ve birth cohort study ( LISA ) . Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency question naire , which was administered shortly after childbirth . RESULTS High maternal intake of margarine [ adjusted odds ratio ( aOR ) : 1 . 49 ; 95 % CI : 1.08 , 2.04 ] and vegetable oils ( aOR : 1.48 ; 95 % CI : 1.14 , 1.91 ) during the last 4 wk of pregnancy was positively associated and high maternal fish intake ( aOR : 0.75 ; 95 % CI : 0.57 , 0.98 ) was inversely associated with eczema during the first 2 y in the offspring . High celery ( aOR : 1.85 ; 95 % CI : 1.18 , 2.89 ) and citrus fruit ( aOR : 1.73 ; 95 % CI : 1.18 , 2.53 ) intakes increased the risk of sensitization against food allergens . In turn , sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat ( aOR : 1.61 ; 95 % CI : 1.02 , 2.54 ) , raw sweet pepper ( aOR : 2.16 ; 95 % CI : 1.20 , 3.90 ) , and citrus fruit ( aOR : 1.72 ; 95 % CI : 1.02 , 2.92 ) . CONCLUSIONS We suggest that the intake of allergenic foods and foods rich in n-6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n-3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring Background : Epidemiologic evidence suggests delayed introduction of egg might not protect against egg allergy in infants at risk of allergic disease . Objective : We sought to assess whether dietary introduction of egg between 4 and 6 months in infants at risk of allergy would reduce sensitization to egg . Methods : We conducted a r and omized controlled trial in infants with at least 1 first‐degree relative with allergic disease . Infants with a skin prick test ( SPT ) response to egg white ( EW ) of less than 2 mm were r and omized at age 4 months to receive whole‐egg powder or placebo ( rice powder ) until 8 months of age , with all other dietary egg excluded . Diets were liberalized at 8 months in both groups . The primary outcome was an EW SPT response of 3 mm or greater at age 12 months . Results : Three hundred nineteen infants were r and omized : 165 to egg and 154 to placebo . Fourteen infants reacted to egg within 1 week of introduction ( despite an EW SPT response < 2 mm at entry ) and were unsuitable for intervention . Two hundred fifty‐four ( 83 % ) infants were assessed at 12 months of age . Loss to follow‐up was similar between groups . Sensitization to EW at 12 months was 20 % and 11 % in infants r and omized to placebo and egg , respectively ( odds ratio , 0.46 ; 95 % CI , 0.22–0.95 ; P = .03 , χ2 test ) . The absolute risk reduction was 9.8 % ( 95 % CI , 8.2 % to 18.9 % ) , with a number needed to treat of 11 ( 95 % CI , 6–122 ) . Levels of IgG4 to egg proteins and IgG4/IgE ratios were higher in those r and omized to egg ( P < .0001 for each ) at 12 months . There was no effect on the proportion of children with probable egg allergy ( placebo , 13 ; egg , 8) . Conclusions : Introduction of whole‐egg powder into the diets of high‐risk infants reduced sensitization to EW and induced egg‐specific IgG4 levels . However , 8.5 % of infants r and omized to egg were not amenable to this primary prevention Maternal nutrient intake during pregnancy and lactation potentially influences the development of allergic diseases . Cows ' milk allergy ( CMA ) is often the first manifestation of atopic diseases , but the impact of early nutritional influences on CMA has not been explored . The associations between maternal intakes of folate , folic acid and vitamin D during pregnancy and lactation were addressed in a prospect i ve , population -based birth cohort within the Finnish Type 1 Diabetes Prediction and Prevention Study . Mothers of 4921 children during pregnancy and 2940 children during lactation provided information on maternal dietary intake during the 8th month of pregnancy and the 3rd month of lactation using a detailed , vali date d FFQ . Information on diagnosed CMA in the offspring was obtained from a medical registry as well as queried from the parents . The Finnish food composition data base was used to calculate nutrient intake . Logistic regression was applied for statistical analyses .  Folate intake and folic acid and vitamin D supplement  use were associated with an increased risk of CMA in the offspring , whereas vitamin D intake from foods during pregnancy was associated with a decreased risk of CMA . Thus , maternal nutrient intake during pregnancy and lactation may affect the development of CMA in offspring . Supplementation with folic acid may not be beneficial in terms of CMA development , especially in children of allergic mothers . The association between dietary supplement use and CMA risk can at least partly be explained by increased health-seeking behaviour among more educated mothers who also use more dietary supplements Background The influence of early exposure to allergenic foods on the subsequent development of food allergy remains uncertain . Objective We sought to determine the feasibility of the early introduction of multiple allergenic foods to exclusively breast-fed infants from 3 months of age and the effect on breastfeeding performance . Methods We performed a r and omized controlled trial . The early introduction group ( EIG ) continued breastfeeding with sequential introduction of 6 allergenic foods : cow 's milk , peanut , hard-boiled hen 's egg , sesame , whitefish ( cod ) , and wheat ; the st and ard introduction group followed the UK infant feeding recommendations of exclusive breastfeeding for around 6 months with no introduction of allergenic foods before 6 months of age . Results One thous and three hundred three infants were enrolled . By 5 months of age , the median frequency of consumption of all 6 foods was 2 to 3 times per week for every food in the EIG and no consumption for every food in the st and ard introduction group ( P < .001 for every comparison ) . By 6 months of age , non introduction of the allergenic foods in the EIG was less than 5 % for each of the 6 foods . Achievement of the stringent per- protocol consumption target for the EIG proved more difficult ( 42 % of evaluable EIG participants ) . Breastfeeding rates in both groups significantly exceeded UK government data for equivalent mothers ( P < .001 at 6 and at 9 months of age ) . Conclusion Early introduction , before 6 months of age , of at least some amount of multiple allergenic foods appears achievable and did not affect breastfeeding . This has important implication s for the evaluation of food allergy prevention strategies BACKGROUND The diversity in the perceived prevalence , recovery , and risk factors for cow 's milk allergy ( CMA ) necessitated a large-scale , population -based prospect i ve study . OBJECTIVE We sought to determine the prevalence , cross-reactivity with soy allergy , and risk factors for the development of CMA . METHODS In a prospect i ve study the feeding history of 13,019 infants was obtained by means of telephone interview ( 95.8 % ) or question naire ( 4.2 % ) . Infants with probable adverse reactions to milk were examined , skin prick tested , and challenged orally . RESULTS Ninety-eight percent of the cohort participated in the study . The cumulative incidence for IgE-mediated CMA was 0.5 % ( 66/13,019 patients ) . The mean age of cow 's milk protein ( CMP ) introduction was significantly different ( P < .001 ) between the healthy infants ( 61.6 + /- 92.5 days ) and those with IgE-mediated CMA ( 116.1 + /- 64.9 days ) . Only 0.05 % of the infants who were started on regular CMP formula within the first 14 days versus 1.75 % who were started on formula between the ages of 105 and 194 days had IgE-mediated CMA ( P < .001 ) . The odds ratio was 19.3 ( 95 % CI , 6.0 - 62.1 ) for development of IgE-mediated CMA among infants with exposure to CMP at the age of 15 days or more ( P < .001 ) . Sixty-four patients with IgE-mediated CMA tolerated soy , and none had a proved allergy to soy . CONCLUSIONS IgE-mediated CMA is much less common than generally reported . Early exposure to CMP as a supplement to breast-feeding might promote tolerance . Finally , soy is a reasonable feeding alternative in patients with IgE-mediated CMA Background : Hen 's egg is the most common cause of food allergy in early childhood . Objective : We investigated the efficacy and safety of early hen 's egg introduction at age 4 to 6 months to prevent hen 's egg allergy in the general population . Methods : This r and omized , placebo‐controlled trial included 4‐ to 6‐month‐old infants who were not sensitized against hen 's egg , as determined based on specific serum antibodies ( IgE ) . These infants were r and omized to receive either verum ( egg white powder ) or placebo ( rice powder ) added to the first weaning food 3 times a week under a concurrent egg‐free diet from age 4 to 6 until 12 months . The primary outcome was sensitization to hen 's egg ( increased specific serum IgE levels ) by age 12 months . Hen 's egg allergy ( secondary outcome ) was confirmed by double‐blind , placebo‐controlled food challenges . Results : Among 406 screened infants , 23 ( 5.7 % ) had hen 's egg – specific IgE before r and omization . Seventeen of 23 underwent subsequent double‐blind , placebo‐controlled food challenges , and 16 were confirmed as allergic , including 11 with anaphylactic reactions . Of the 383 nonsensitized infants ( 56.7 % male ) , 184 were r and omized to verum and 199 to placebo . At 12 months of age , 5.6 % of the children in the verum group were hen 's egg sensitized versus 2.6 % in the placebo group ( primary outcome ; relative risk , 2.20 ; 95 % CI , 0.68–7.14 ; P = .24 ) , and 2.1 % were confirmed to have hen 's egg allergy versus 0.6 % in the placebo group ( relative risk , 3.30 ; 95 % CI , 0.35–31.32 ; P = .35 ) . Conclusion : We found no evidence that consumption of hen 's egg starting at 4 to 6 months of age prevents hen 's egg sensitization or allergy . In contrast , it might result in frequent allergic reactions in the community considering that many 4‐ to 6‐month‐old infants were already allergic to hen 's egg BACKGROUND Food allergy prevalence is increasing in developed countries , but these results have not yet been verified in developing countries , especially in China . Our aim was to determine whether the prevalence and characteristics of food allergy have changed over the last 10 years in Chongqing , China . METHODS Two cross-sectional studies were performed , 10 years apart ( 1999 and 2009 ) using the same diagnostic methods in the same age group ( 0 - 24 months ) of the same clinic in Chongqing , China . A total of 401 infants were r and omly selected for the present study . Food allergy was confirmed by food challenge .  spss 15.0 was used to analyze the difference in prevalence . RESULTS Food allergy prevalence increased significantly from 3.5 % in 1999 to 7.7 % in 2009 ( P= 0.017 ) . The prevalence of a positive skin-prick-test response was also increased ( from 9.9 % to 18 % ; P= 0.002 ) . Egg and cow 's milk were still the most common food allergens , which cause skin and gastrointestinal symptoms in most infants . CONCLUSION This is the first study in China to indicate time trends in food allergy prevalence and characteristics . Our data show that in the 10-year period from 1999 to 2009 , the prevalence of food allergy seems to have increased in China IMPORTANCE The etiology of the increasing childhood prevalence of peanut or tree nut ( P/TN ) allergy is unknown . OBJECTIVE To examine the association between peripregnancy consumption of P/TN  by mothers and the risk of P/TN allergy in their offspring . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study . The 10,907 participants in the Growing Up Today Study 2 , born between January 1 , 1990 , and December 31 , 1994 , are the offspring of women who previously reported their diet during , or shortly before or after , their pregnancy with this child as part of the ongoing Nurses ' Health Study II . In 2006 , the offspring reported physician-diagnosed food allergy . Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results . Two board-certified pediatricians , including a board-certified allergist/immunologist , independently review ed each potential case and assigned a confirmation code ( eg , likely food allergy ) to each case . Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring . EXPOSURE Peripregnancy consumption of P/TN . MAIN OUTCOMES AND MEASURES Physician-diagnosed P/TN allergy in offspring . RESULTS Among 8205 children , we identified 308 cases of food allergy ( any food ) , including 140 cases of P/TN allergy . The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more  P/TN  in their peripregnancy diet ( ≥ 5 times vs < 1 time per month : odds ratio = 0.31 ; 95 % CI , 0.13 - 0.75 ; P(trend ) = .004 ) . By contrast , a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers ( P(trend ) = .12 ) . The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant ( P(interaction ) = .004 ) . CONCLUSIONS AND RELEVANCE Among mothers without P/TN allergy , higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring . Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy BACKGROUND Early life allergen exposure may increase the risk of childhood allergy , but the protective effect of reduction in allergen exposure remains uncertain . OBJECTIVE To evaluate the effect of reduction in food and house dust mite ( HDM ) allergen exposure in infancy in preventing asthma and allergy . METHODS Infants , at higher risk because of family predisposition , were recruited prenatally and r and omized to prophylactic ( n = 58 ) and control ( n = 62 ) groups . Prophylactic group infants were either breast-fed with mother on a low allergen diet or given an extensively hydrolyzed formula . Exposure to HDM was reduced by the use of an acaricide and mattress covers . The control group followed st and ard advice .  Development of allergic diseases and sensitization to common allergens ( atopy ) was assessed blindly at ages 1 , 2 , 4 , and 8 years in all 120 children . RESULTS Repeated measurement analysis , adjusted for all relevant confounding variables , confirmed a preventive effect on asthma : adjusted odds ratio ( OR ) , 0.24 ; 95 % CI , 0.09 - 0.66 ; P = .005 ; atopic dermatitis , OR , 0.23 ; CI , 0.08 - 0.64 ; P = .005 ; rhinitis , OR , 0.42 ; CI , 0.19 - 0.92 ; P = .03 ; and atopy , OR , 0.13 ; CI , 0.05 - 0.32 ; P < .001 . The protective effect was primarily observed in the subgroup of children with persistent disease ( symptoms at all visits ) and in those with evidence of allergic sensitization . CONCLUSION Allergic diseases can be reduced , for at least the first 8 years of life , by combined food and HDM allergen avoidance in infancy . CLINICAL IMPLICATION S Strict food and HDM allergen avoidance should be considered for prevention of allergy in high-risk infants Background : The ideal age to introduce egg into the infant diet has been debated for the past 2 decades in the context of rising rates of egg allergy . Objective : We sought to determine whether regular consumption of egg protein from age 4 to 6 months reduces the risk of IgE‐mediated egg allergy in infants with hereditary risk , but without eczema . Methods : Infants aged 4 to 6 months were r and omly allocated to receive daily pasteurized raw whole egg powder ( n = 407 ) or a color‐matched rice powder ( n = 413 ) to age 10 months . All infants followed an egg‐free diet and cooked egg was introduced to both groups at age 10 months . The primary outcome was IgE‐mediated egg allergy defined by a positive pasteurized raw egg challenge and egg sensitization at age 12 months . Results : There was no difference between groups in the percentage of infants with IgE‐mediated egg allergy ( egg 7.0 % vs control 10.3 % ; adjusted relative risk , 0.75 ; 95 % CI , 0.48–1.17 ; P = .20 ) . A higher proportion of participants in the egg group stopped taking the study powder because of a confirmed allergic reaction ( 25 of 407 [ 6.1 % ] compared with 6 of 413 [ 1.5 % ] ) . Egg‐specific IgG4 levels were substantially higher in the egg group at 12 months ( median , 1.22 mgA/L vs control 0.07 mgA/L ; P < .0001 ) . Conclusions : We found no evidence that regular egg intake from age 4 to 6 months substantially alters the risk of egg allergy by age 1 year in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry Over the past two decades we have been debating the question of whether the age of commencement of complementary feeding affects the risk of developing food allergy . We ate up the notion that delayed introduction of more allergenic foods in early childhood , would help overcome the increasing rates of food allergy , then we promptly spat it out again despite limited evidence . Recently high- quality r and omised controlled trial evidence has given us the confidence to swallow the concept that allergenic foods , like egg and peanut , should be given to infants . We now need to recommend that when an infant is developmentally ready , a variety of nutritious foods should be introduced to ensure high diet diversity , including the ‘ more allergenic ’ foods during infancy . This article is protected by copyright . All rights reserved BACKGROUND Extended breast-feeding is recommended for newborn children at risk of allergy-associated diseases , but the evidence of a protective effect on sensitization and these diseases remains elusive . OBJECTIVE The aim of this study was to investigate the effects of the duration of exclusive breast-feeding on the development of sensitization in preschool children . METHODS Information on breast-feeding was gathered by interviews involving 335 children aged 1 , 6 , and 12 months from the Copenhagen Prospect i ve Study on Asthma in Childhood2000 birth cohort born to mothers with a history of asthma . Skin prick test responses and specific IgE levels against 12 common inhalant and 10 food allergens were assessed longitudinally at ages ½ year , 1½ years , 4 years , and 6 years . Eczema , wheeze/asthma , and allergic rhinitis were diagnosed at the Copenhagen Prospect i ve Studies on Asthma in Childhood clinic at 7 years of age , strictly adhering to predefined algorithms . Associations between duration of exclusive breast-feeding and outcomes were analyzed by logistic regression . RESULTS We found no significant association between duration of  exclusive breast-feeding and development of sensitization in the first 6 years of life ( odds ratio [ OR ] : ½ year , 1.10 [ 95 % CI , 0.90 - 1.36 ] ; 1½ years , 1.15 [ 95 % CI , 0.97 - 1.36 ] ; 4 years , 1.08 [ 95 % CI , 0.93 - 1.25 ] ; and 6 years , 0.96 [ 95 % CI , 0.84 - 1.10 ] ) or with current eczema , wheeze/asthma , and allergic rhinitis at age 7 years ( OR , 1.07 [ 95 % CI , 0.92 - 1.24 ] ; OR , 0.97 [ 95 % CI , 0.82 - 1.14 ] ; and OR , 1.02 [ 95 % CI , 0.84 - 1.23 ] , respectively ) . Adjusting for reverse causation by excluding children with eczema , wheeze , or a positive skin prick test response before ending exclusive breast-feeding did not alter the results . CONCLUSION Exclusive breast-feeding does not affect sensitization in early childhood or associated diseases at 7 years of age in at-risk children BACKGROUND Evidence is accumulating that early consumption is more beneficial than is delayed introduction as a strategy for primary prevention of food allergy . However , allergic reactions caused by early introduction of such solid foods have been a problematic issue . We investigated whether or not early stepwise introduction of eggs to infants with eczema combined with optimal eczema treatment would prevent egg allergy at 1 year of age . METHODS In this r and omised , double-blind , placebo-controlled trial , we enrolled infants 4 - 5 months of age with eczema from two centres in Japan . Exclusion criteria were being born before 37 weeks of gestational age , experience of ingestion of hen 's eggs or egg products , history of immediate allergic reaction to hen 's eggs , history of non-immediate allergic reaction to a particular type of food , and complications of any severe disease . Infants were r and omly assigned ( block size of four ; stratified by institution and sex ) to early introduction of egg or placebo ( 1:1 ) . Participants in the egg group consumed orally 50 mg of heated egg powder per day from 6 months to 9 months of age and 250 mg per day thereafter until 12 months of age . We aggressively treated participants ' eczema at entry and maintained control without exacerbations throughout the intervention period . Participants and physicians were masked to assignment , and allocation was concealed . The primary outcome was the proportion of participants with hen 's egg allergy confirmed by open oral food challenges at 12 months of age , assessed blindly by st and ardised methods , in all r and omly allocated participants who received the intervention . This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry , number UMIN000008673 . FINDINGS Between Sept 18 , 2012 , and Feb 13 , 2015 , we r and omly allocated 147 participants ( 73 [ 50 % ] to the egg group and 74 [ 50 % ] to the placebo group ) . This trial was terminated on the basis of the results of the scheduled interim analysis of 100 participants , which showed a significant difference between the two groups ( four [ 9 % ] of 47 participants had an egg allergy in the egg group vs 18 [ 38 % ] of 47 in the placebo group ; risk ratio 0·222 [ 95 % CI 0·081 - 0·607 ] ; p=0·0012 ) . In the primary analysis population , five ( 8 % ) of 60 participants had an egg allergy in the egg group compared with 23 ( 38 % ) of 61 in the placebo group ( risk ratio 0·221 [ 0·090 - 0·543 ] ; p=0·0001 ) . The only difference in adverse events between groups was admissions to hospital ( six [ 10 % ] of 60 in the egg group vs none in the placebo group ; p=0·022 ) . 19 acute events occurred in nine ( 15 % ) participants in the egg group versus 14 events in 11 ( 18 % ) participants in the placebo group after intake of the trial powder . INTERPRETATION Introduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen 's egg allergy in high-risk infants . In this study , we developed a practical approach to overcome the second wave of the allergic epidemic caused by food allergy . FUNDING Ministry of Health , Labour and Welfare , and National Centre for Child Health and Development , Japan BACKGROUND To eluci date whether maternal vitamin D supplementation during lactation improves infantile eczema and other subsequent allergic disorders , a r and omized , double-blind , placebo-controlled trial was performed . METHODS Mothers ( n = 164 ) of infants with facial eczema at 1 month check-up were r and omly assigned to receive vitamin D3 supplements ( n = 82 ; 800 IU/day ) or placebo ( n = 82 ) for 6 weeks from May 2009 to January 2011 . The primary outcome was infantile eczema quantified on Scoring Atopic Dermatitis ( SCORAD ) index at 3 month check-up , and the secondary outcomes were atopic dermatitis , food allergy , and wheeze diagnosed by doctors up to 2 years of age . RESULTS There was no significant difference in SCORAD at 3 month check-up between the two groups . Doctor-diagnosed food allergy was significantly more common up to age 2 years in the vitamin D group ( 10/39 , 25.7 % ) than in the placebo group ( 3/40 , 7.5 % ; risk ratio ( RR ) , 3.42 ; 95 % confidence interval [ CI ] : 1.02 - 11.77 ; P = 0.030 ) . Moreover , at least one secondary outcome was also significantly more common in the vitamin D group ( 17/39 , 43.6 % ) than in the placebo group ( 7/40 , 17.5 % ; RR , 2.49 ; 95%CI : 1.16 - 5.34 ; P = 0.012 ) . CONCLUSIONS Vitamin D supplementation may not decrease the severity of infantile eczema at 3 months of age , but may rather increase the risk of later food allergy up to 2 years of age . Because a large number of subjects was lost to follow up , further study is needed to confirm the findings Background The prevalence of allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Prebiotics – non-digestible oligosaccharides that stimulate growth of probiotic bacteria – have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of prebiotics in the prevention of allergy . Methods The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy . We performed a systematic review of r and omized controlled trials of prebiotics , and review ed the evidence about patient values and preferences , and re source requirements ( up to January 2015 , with an up date on July 29 , 2015 ) . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . Results Based on GRADE evidence to decision frameworks , the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants . Both recommendations are conditional and based on very low certainty of the evidence . We found no experimental or observational study of prebiotic supplementation  in pregnant women or in breastfeeding mothers . Thus , the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding , at this time . Conclusions WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy , term infants KE Grimshaw , J Maskell , EM Oliver . Pediatrics . 2013;132(6 ) . Available at : www.pediatrics.org/cgi/content/full/132/6/e1529 The study analyzed the significance of complementary feeding and breastfeeding in association with allergy development . This study was a nested case-control trial of 41 infants with food allergy diagnosed by age 2 years and 82 matched controls within a cohort study involving 1140 infants . The infants ’ food allergies were confirmed by using double-blind , placebo-controlled food challenges , the gold st and ard for diagnosing food allergies . Infants with food allergies were recruited from the PIFA ( Prevalence of Infant Food Allergy ) study in the United Kingdom . Parents kept prospect i ve daily food diaries and Introduction Postnatal vitamin D supplementation may be associated with a reduction in IgE-mediated food allergy , lower respiratory tract infections and improved bone health . Countries in the Northern hemisphere recommend universal infant vitamin D supplementation to optimise early vitamin D levels , despite the absence of large trials proving safety or efficacy for any disease outcome . With the aim of determining the clinical and cost-effectiveness of daily vitamin D supplementation in breastfed infants from age 6–8 weeks to 12 months of age , we have started a double-blind , r and omised , placebo-controlled trial of daily 400 IU vitamin D supplementation during the first year of life , VITALITY . Methods nd analysis Infants ( n=3012 ) who are fully breastfed and not receiving vitamin D supplementation will be recruited at the time of their first immunisation , from council-led immunisation clinics throughout metropolitan Melbourne , Australia . The primary outcome is challenge-proven food allergy at 12 months of age . Secondary outcomes are food sensitisation ( positive skin prick test ) , number of lower respiratory infections ( through hospital linkage ) , moderately-severe and persistent eczema ( by history and examination ) and vitamin D deficiency ( serum vitamin D < 50 nmol/L ) at age 12 months . The trial is underway and the first 130 participants have been recruited . Ethics and dissemination The VITALITY study is approved by the Royal Children 's Hospital ( RCH ) Human Research Ethics Committee ( # 34168 ) . Outcomes will be disseminated through publication and will be presented at scientific conferences . Trial registration numbers ANZCTR12614000334606 and NCT02112734 ; pre- results
target: Despite several intervention trials involving modifications to the maternal diet , the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear .
  Summary Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants .
background: Purpose of review In the past decade , food allergy has been increasingly recognized as an important public health issue .
  The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period .
  Recently , research in this area has moved from observational studies to intervention trials , and the findings from these trials have started to influence infant feeding guidelines .
  In this article , we review recent studies of dietary interventions for preventing food allergy , summarize current knowledge and discuss future research directions .