title: Postnatal Fish Oil Supplementation in High-Risk Infants to Prevent Allergy: Randomized Controlled Trial Prenatal Vitamin D Supplementation and Child Respiratory Health: A Randomised Controlled Trial Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Associations between Maternal Antioxidant Intakes in Pregnancy and Infant Allergic Outcomes Probiotics in the prevention of eczema: a randomised controlled trial Anti-infective proteins in breast milk and asthma-associated phenotypes during early childhood. Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years. Early exposure to solid foods and the development of eczema in children up to 4 years of age.
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 r and omized 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 Background Observational studies suggest high prenatal vitamin D intake may be associated with reduced childhood wheezing .  We examined the effect of prenatal vitamin D on childhood wheezing  in an interventional study . Methods We r and omised 180 pregnant women at 27 weeks gestation to either  no vitamin D , 800 IU ergocalciferol daily until delivery or single oral bolus of 200,000 IU cholecalciferol  , in an ethnically stratified , r and omised controlled trial . Supplementation improved but did not optimise vitamin D status . Research ers blind to allocation assessed offspring at 3 years . Primary outcome was any history of wheeze assessed by vali date d question naire . Secondary outcomes included atopy , respiratory infection , impulse oscillometry and exhaled nitric oxide . Primary analyses used logistic and linear regression . Results We evaluated 158 of 180 ( 88 % ) offspring at age 3 years for the primary outcome . Atopy was assessed by skin test for 95 children ( 53 % ) , serum IgE for 86 ( 48 % ) , exhaled nitric oxide for 62 ( 34 % ) and impulse oscillometry of acceptable quality for 51 ( 28 % ) . We found no difference between supplemented and control groups in risk of wheeze  [ no vitamin D : 14/50 ( 28 % ) ; any vitamin D : 26/108 ( 24 % ) ( risk ratio 0.86 ; 95 % confidence interval 0.49 , 1.50 ; P = 0.69 ) ] . There was no significant difference in atopy , eczema risk , lung function or exhaled nitric oxide between supplemented groups and controls . Conclusion Prenatal vitamin D supplementation in late pregnancy that had a modest effect on cord blood vitamin D level , was not associated with decreased wheezing in offspring at age three years . Trial Registration Controlled-Trials.com IS RCT BACKGROUND Some breastfed infants with atopic eczema benefit from elimination of cow milk , egg , or other antigens from their mother 's diet . Maternal dietary antigens are also known to cross the placenta . OBJECTIVES To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation , or both , on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child . SEARCH METHODS We search ed the Cochrane Pregnancy and Childbirth Group 's Trials Register ( 6 July 2012 ) . SELECTION CRITERIA All r and omized or quasi-r and omized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women . We excluded trials of multimodal interventions that included manipulation of the infant 's diet other than breast milk or of non-dietary aspects of the infant 's environment . DATA COLLECTION AND ANALYSIS We extracted data from published reports , supplemented by additional information received from the trialists we contacted . MAIN RESULTS The evidence from five trials , involving 952 participants , does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life . Data on allergic rhinitis or conjunctivitis , or both , and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences . Longer-term atopic outcomes have not been reported . The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain , a non-significantly higher risk of preterm birth , and a non-significant reduction in mean birthweight . The evidence from two trials , involving 523 participants , did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk , egg , or peanut antigen at one , two , or seven years . One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity . AUTHORS ' CONCLUSIONS Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child 's risk of atopic diseases , and such a diet may adversely affect maternal or fetal nutrition , or both . Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child 's risk of developing atopic eczema , but better trials are needed . Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema , but larger trials are needed Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease . We investigated associations between maternal intakes of β-carotene , vitamin C , vitamin E , copper and zinc , and infant allergic outcomes .  Antioxidant intakes of pregnant women ( n = 420 ) assessed prospect ively by a food frequency question naire , were examined in relation to allergic outcomes at 1 year of age ( n = 300 ) . The main relationships with allergic outcomes were seen with dietary vitamin C and copper . Specifically , higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze . After adjustment for potential confounders the relationship with wheeze remained statistically significant . There was also an inverse linear relationship between vitamin C and food allergy . Higher dietary copper intake was associated with reduced risk of eczema , wheeze and any allergic disease . The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis , and there was also an inverse linear relationship between copper and food allergy . However , these relationships were only seen for nutrients present in food . There were no relationships between β-carotene , vitamin E or zinc and any allergic outcomes . In summary , this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze , and that copper intake is associated with reduced risk of several allergic outcomes Objective To evaluate a multistrain , high-dose probiotic in the prevention of  eczema .  Design A r and omised , double-blind , placebo-controlled , parallel group trial . Setting s Antenatal clinics , research clinic , children at home . Patients Pregnant women and their infants . Interventions Women from 36 weeks gestation and their infants to age 6 months received daily either the probiotic ( Lactobacillus salivarius CUL61 , Lactobacillus paracasei CUL08 , Bifidobacterium animalis subspecies lactis CUL34 and Bifidobacterium bifidum CUL20 ; total of 1010 organisms/day ) or matching placebo . Main outcome measure Diagnosed eczema at age 2 years . Infants were followed up by question naire . Clinical examination and skin prick tests to common allergens were done at 6 months and 2 years . Results The cumulative frequency of diagnosed eczema at 2 years was similar in the probiotic ( 73/214 , 34.1 % ) and placebo arms ( 72/222 , 32.4 % ; OR 1.07 , 95 % CI 0.72 to 1.6 ) . Among the secondary outcomes , the cumulative frequency of skin prick sensitivity at 2 years was reduced in the probiotic ( 18/171 ; 10.5 % ) compared with the placebo arm ( 32/173 ; 18.5 % ; OR 0.52 , 95 % CI 0.28 to 0.98 ) . The statistically significant differences between the arms were mainly in sensitisation to cow 's milk and hen 's egg proteins at 6 months . Atopic eczema occurred in 9/171 ( 5.3 % ) children in the probiotic arm and 21/173 ( 12.1 % ) in the placebo arm ( OR 0.40 , 95 % CI 0.18 to 0.91 ) . Conclusions The study did not provide evidence that the probiotic either prevented eczema during the study or reduced its severity . However , the probiotic seemed to prevent atopic sensitisation to common food allergens and so reduce the incidence of atopic eczema in early childhood . Trial registration Number IS RCT N26287422 BACKGROUND The impact of breast milk feeding on susceptibility to asthma in childhood is highly controversial , due in part to failure of the majority of studies in the area to adequately account for key confounders exemplified by respiratory infection history , plus the effects of recall bias . METHODS As part of a prospect i ve cohort study on the role of respiratory infections in asthma development in high-risk children , we measured the concentration of a panel of anti-infective proteins in maternal milk sample s  and analyzed associations between these and subsequent atopy- , infection- , and asthma-related outcomes prospect ively to age 10 years . RESULTS We observed significant but transient inverse associations between the concentration of milk proteins and susceptibility to upper respiratory infections in year 1 only , and parallel but positive transient associations with early lower respiratory infections and atopy . No associations were seen with asthma-related outcomes . CONCLUSIONS Breast milk feeding may influence the expression of inflammatory symptoms associated with respiratory infections and atopy in early life , but these effects appear to be inconsistent and transient . The heterogeneous nature of breast-feeding effects suggests it may influence systemic immunoinflammatory function at several different levels 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 Early exposure to solid foods in infancy has been associated with the development of allergic diseases . However , scientific evidence for this is conflicting . The aim of this study was to examine the association between early exposure to solid foods in the infant 's diet and the development of  eczema up to 4 years of age . We conducted an etiologic case-control study nested in the PIPO cohort ( Prospect i ve Cohort on the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies ) . In this cohort data on nutrition , environmental exposures and parent-reported eczema were collected prospect ively starting from 5 months pregnancy by means of question naires administered during two home visits and semi-annual postal question naires . In addition , detailed information on the timing of introduction of solid foods at individual food item level was collected at 1 year of age . Adjusted odds ratios and 95 % confidence intervals were computed using logistic regression analysis as a measure of association between eczema and the timing of exposure to solid foods . Early introduction ( within the first 4 months ) of solid foods was inversely associated with eczema up to 4 years of age ( adj OR : 0.49 ; 95 % CI : 0.32 - 0.74 ) . Moreover , we found that early exposure to solid foods was associated with a reduced risk for eczema only among children with allergic parents ( adj OR : 0.35 ; 95 % CI : 0.20 - 0.63 ) , whereas no significant effect was found among children with non-allergic parents ( adj OR : 0.69 ; 95 % CI : 0.37 - 1.29 ) . The results of this study show that early exposure to solid foods is associated with less parent-reported eczema in children , particularly among children with allergic parents . Therefore , the current study does not support a delayed introduction of solid foods for the prevention of  eczema  in childhood
target: Based on the existing information , it is not possible to establish the role of antioxidants and vitamin D supplementation in atopic disease development .
  There is no evidence of major effects of prenatal use of folic acid on asthma or allergies .
  The association of some nutritional interventions with less atopic sensitization seems rather speculative even if such an effect has not been found for some other foods .
  The findings indicate rather a balanced and diverse diet without restrictions than a special dietary protocol .
  Farming-related exposures may protect against the development of atopic disorders in children .
  Long-chain polyunsaturated fatty acids and probiotics seem to be promising c and i date s for allergy prevention .
background: The paper refers to the recently published empirical data and systematic review s on the impact of diets , foods , nutrients and bioactive substance exposures in pregnancy and in early infancy , on the development of atopic disorders .