1. Breastfeeding and the Prevention of Allergic Disease Samina Waggoner MD Advisor: Raoul Wolf MD University of Chicago Comer Children’s Hospital AbstractMethodsResultsLimitations BACKGROUND: There is controversy surrounding breast milk’s protective effect against the development of allergic disease. OBJECTIVE: To examine the frequency of formula feeding vs. breastfeeding in allergic patients. METHODS: Data was obtained on patients seen in pulmonary or allergy clinic over a two week period. Patients were then separated into categories of breast-fed vs. formula-fed and their allergy history was obtained, including allergy skin-prick testing. RESULTS: Of 50 patients seen, data on breastfeeding vs. formula feeding was collected on 29 patients. Ten of 29 (34%) patients were breast-fed vs. 19 of 29 (66%) were formula-fed. Of the formula-fed patients, 7 out of 8 (88%) were IgE positive (through skin-prick testing) vs. 4 of 5 tested (80%) in the breast-fed patients. Eight of the 10 (80%) breast-fed patients had a positive maternal allergy history vs. 11 out of 19 (58%) formula-fed patients. CONCLUSION: There was a higher frequency of formula- fed children within the pediatric patients seen in the allergy or pulmonary clinic setting. There was a higher percentage of maternal allergy history among the breast-fed infants vs. the formula-fed patients. There were limitations to the data collected. Background References The nutritional benefits of breastfeeding over formula-feeding have long been known. In addition to these benefits, breast milk’s composition of antibodies, lymphocytes, anti-cytokines and other factors provide passive immunity to a newborn’s immature immune system. Yet there is much controversy that surrounds the role that breast feeding may play in the prevention of allergies. There have been many studies over the years showing that breastfeeding is protective against development of allergies, has no effect or, in some cases, can increase one’s risk of developing allergic disease, specifically asthma. Many of these studies use the presence of IgE, measured by skin-prick or RAST testing, as an objective marker of allergic disease. Our hypothesis is that there is a higher frequency of formula feeding in the allergic patient population. This hypothesis was tested by comparing the incidence of breastfeeding vs. formula feeding in a select pediatric population seen in a pediatric allergy or pulmonary clinic setting. Patient data was collected on patients seen during a two week period at the University of Chicago Pediatric Allergy Clinic, LaRabida Children’s Hospital Allergy Clinic as well as LaRabida’s Pulmonary Clinic. Data on breastfeeding and maternal allergy history was collected through chart review on the patients seen during this time as well as through a brief survey asked of parents by the intake nurse during clinic. Data on allergy skin testing was collected through chart review exclusively. Positive skin tests were defined as wheals of >2mm for at least one allergen tested. Skin-prick testing reflected IgE production to specific allergy antigens and was used as an objective marker of allergy to discern truly allergic/atopic patients from those patients with questionable or mild ‘allergy-like’ symptoms only, i.e. non-allergic wheezing or rhinorrhea. Patients who met strict clinical criteria were also given a diagnosis of allergic disease. Kull I, Almqvist C, Lilja G, Pershagen G, Wickman M Breast-Feeding Reduces the Risk of Asthma During the First 4 Years of Life. The Journal of Allergy and Clinical Immunology. 2004;114(4):755-760. Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G. Breast feeding and allergic diseases in infants—a prospective birth cohort study. Archives of Disease in Childhood 2002;87:478-481. Oddy WH, Peat JK, de Klerk NH. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol. 2002 Jul;110(1):65-7. van Odijk J, Kull I, Borres, Brandtzaeg P, Edberg U, Hanson L, Høst L, Kuitunen L, Olsen LS, Skerfving S, Sundell J, Wille S. 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: 833–843. Peat J, Allen J, Oddy W, Beyond breast-feeding, The Journal of Allergy and Clinical Immunology.1999 Sep 104(3):526-509. Sears MR, Greene JM, Willan AR, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Poulton R. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet. 2002 Sep 21;360(9337):901-7. Wright AL, Sherrill D, Holberg CJ, Halonen M, Martinez FD. Breast-feeding, maternal IgE, and total serum IgE in childhood. J Allergy Clin Immunol. 1999 Sep;104(3 Pt 1):589-94. Wright AL, Holberga CJ, Taussigb LM, Martineza, FD. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood Thorax 2001;56 (March):192-197 Results TABLE I.Breast-Fed Infants vs. (n= 10) Formula-Fed Infants (n = 19) Avg. Age (yrs) Race African-American Caucasian Hispanic Unknown New Patient Follow-Up 11.6 50% (5) 40% (4) 0% 10% (1) 40% (4) 60% (6) 8.8 68% (13) 5% (1) 16% (3) 11% (2) 21% (4) 79% (15) Maternal dietary restrictions* Maternal allergy history Skin-Prick Testing Positive Negative Food Allergies *Gestational diabetes 20% (2) 80% (8) n=5 80% (4) 20% (1) 20% (2) 0% 58% (11) n=8 88% (7) 12% (1) 11% (2) The number of patients was insufficient to result in any statistically significant conclusions but was still suggestive to examine proportions. There is obvious recall bias in questioning parents with regard to infant feeding history. In addition, maternal history of allergies was subjective, based often on parents’ self-diagnosis rather than any objective laboratory or clinical data obtained from their own primary PMD. Referral population to allergic clinic may reflect those patients with the most severe disease. Discussion Several recent studies have examined the link between breast- feeding and the development of allergies. While the majority have shown that breastfeeding decreases the risk of developing atopic disease, other studies show an increased risk of developing allergies with breastfeeding, specifically in those children with atopic mothers. Our results suggest that there is a higher frequency of formula-fed children vs. breast-fed children seen in the atopic pediatric population. There does not seem to be significant difference in percent of positive skin-prick tests between the formula-fed vs. breast-fed patients. Interestingly, our results also suggest that there is a strong correlation between allergies in breast-fed children and atopic mothers. Food allergies were present in allergic children of atopic mothers and not present in allergic children of non-atopic mothers within the breast-fed population. There may be factors in the breast milk of atopic mothers that increase the allergic response in their children. TABLE II.Breast-Fed Infants of Atopic Mothers vs. (n = 8) Breast-Fed Infants of Non-Atopic Mothers (n = 2) Positive Skin-Prick Testing # positive spec. Ags (avg.) Food Allergies Duration of BF <1 month 1-4 months >4 months 3 5.3 2 3 140101140101