Early life acute infections and risk for cow's milk protein allergy or atopic dermatitis at 6 months of age in high risk for allergy infants

Rouzha Pancheva^{1

2}, Zoi Illiodromiti³, George Moschonis⁴, Eva Kontopodi⁵, Eleni Karapati³, Nicolaos Nicolaou^{6

7}, Eva Karaglani⁸, Mikaela Sekkidou^{6

7}, Simoneta Popova¹, Nataliya Usheva^{2

9}, Miglena Marinova¹, Paraskevi Xepapadaki¹⁰, Olympia Sardeli¹¹, Anastasia Kapetanaki¹², Nicoletta Iacovidou¹³, Theodora Boutsikou¹³, Evangelia Papathoma¹⁴, Yannis Manios^{8

15}

Affiliations

¹ Department of Hygiene and Epidemiology, Faculty of Public Health, "Prof. Dr. Paraskev Stoyanov" Medical University-Varna, Varna, Bulgaria.
² Research Group NutriLect, Department of Neuroscience, Research Institute, Medical University "Prof. Dr. Paraskev Stoyanov"-Varna, Varna, Bulgaria.
³ Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Discipline of Food, Nutrition and Dietetics, Department of Sport, Exercise and Nutrition Sciences, School Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
⁵ FrieslandCampina, Amersfoort, Netherlands.
⁶ University of Nicosia Medical School, Nicosia, Cyprus.
⁷ Asthma and Allergy Center, Limassol, Cyprus.
⁸ Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
⁹ Department of Social Medicine and Healthcare Organization, Faculty of Public Health, "Prof. Dr. Paraskev Stoyanov" Medical University-Varna, Varna, Bulgaria.
¹⁰ Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
¹¹ Third Department of Pediatrics, National and Kapodistrian University of Athens, Attikon General University Hospital, Athens, Greece.
¹² Neonatology Department, Helena Venizelou Hospital, Athens, Greece.
¹³ Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
¹⁴ Neonatal Intensive Care Unit, Alexandra University and State Maternity Hospital, Athens, Greece.
¹⁵ Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece.

PMID: 39759882
PMCID: PMC11697985
DOI: 10.3389/fped.2024.1424331

Early life acute infections and risk for cow's milk protein allergy or atopic dermatitis at 6 months of age in high risk for allergy infants

Rouzha Pancheva et al. Front Pediatr. 2024.

. 2024 Dec 16:12:1424331.

doi: 10.3389/fped.2024.1424331. eCollection 2024.

Authors

Affiliations

¹ Department of Hygiene and Epidemiology, Faculty of Public Health, "Prof. Dr. Paraskev Stoyanov" Medical University-Varna, Varna, Bulgaria.
² Research Group NutriLect, Department of Neuroscience, Research Institute, Medical University "Prof. Dr. Paraskev Stoyanov"-Varna, Varna, Bulgaria.
³ Neonatal Department, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Discipline of Food, Nutrition and Dietetics, Department of Sport, Exercise and Nutrition Sciences, School Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
⁵ FrieslandCampina, Amersfoort, Netherlands.
⁶ University of Nicosia Medical School, Nicosia, Cyprus.
⁷ Asthma and Allergy Center, Limassol, Cyprus.
⁸ Department of Nutrition & Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
⁹ Department of Social Medicine and Healthcare Organization, Faculty of Public Health, "Prof. Dr. Paraskev Stoyanov" Medical University-Varna, Varna, Bulgaria.
¹⁰ Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
¹¹ Third Department of Pediatrics, National and Kapodistrian University of Athens, Attikon General University Hospital, Athens, Greece.
¹² Neonatology Department, Helena Venizelou Hospital, Athens, Greece.
¹³ Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
¹⁴ Neonatal Intensive Care Unit, Alexandra University and State Maternity Hospital, Athens, Greece.
¹⁵ Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece.

PMID: 39759882
PMCID: PMC11697985
DOI: 10.3389/fped.2024.1424331

Abstract

Background: Early life infections (ELIs), encompassing both viral and bacterial types, occur within the first six months of life. Influenced by genetic host factors and environmental conditions, the relationship between ELIs and subsequent allergic manifestations, particularly cow's milk protein allergy (CMPA) and atopic dermatitis (AD), is complex and not fully understood.

Objective: The aim of the current study was to examine the potential interplay between nutrition, infections, and allergic manifestations in the first six months of life in infants with a family history of allergies, who were either exclusively breastfed (EBF) or fed a combination of breast milk and standard (SF) or partially hydrolyzed infant formula (pHF).

Methods: The Allergy Reduction Trial (ART) is a multicenter, randomized controlled trial involving 551 participants. From birth, these participants were divided into three groups: Exclusive Breastfeeding (EBF), Partially Hydrolyzed Formula (pHF), and Standard Formula (SF). ELIs, defined as viral and bacterial infections occurring during the first 6 months, and outcomes (AD, CMPA) were recorded through questionnaires (i.e., SCORAD and CоMiSS) and clinical assessments.

Results: The relative risk (RR) for CMPA in infants with ELIs was 0.20 (95% CI: 0.07-0.58), highlighting a protective effect of ELIs against CMPA development. Notably, the incidence of CMPA was significantly lower in infants who experienced ELIs compared to those without (3% vs. 13.4%, p = 0.001), with no cases of CMPA observed at 6 months in exclusively breastfed (EBF) infants with ELIs. For AD, a trend was observed where the incidence was lower in infants with ELIs who were fed with pHF at 6.5%, compared to those fed with SF at 18.2% (p = 0.092), suggesting a potential protective effect of ELIs in the pHF group against AD development.

Conclusion: The study highlights a potential protective role of ELIs in reducing the risk of CMPA, particularly in EBF infants. Furthermore, it suggests a trend towards lower AD incidence in infants fed with pHF, highlighting the complex interplay between early microbial exposures, feeding practices, and immune development. Further research is warranted to unravel this challenging relationship and appropriately inform early life allergy prevention strategies.

Keywords: allergy prevention; allergy reduction trial; atopic dermatitis; cow's milk protein allergy; early life infections; infant feeding.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

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Early life acute infections and risk for cow's milk protein allergy or atopic dermatitis at 6 months of age in high risk for allergy infants

Affiliations

Early life acute infections and risk for cow's milk protein allergy or atopic dermatitis at 6 months of age in high risk for allergy infants

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources