Effect of exclusive breast‐feeding and early solid food avoidance on the incidence of atopic dermatitis in high‐risk infants at 1 year of age

The aim of this study was to assess the preventive effect of exclusive breast‐feeding and early solid food avoidance on atopic dermatitis (AD) in infancy. This study is part of a dietary clinical trial in a prospective cohort of healthy term newborns at risk of atopy. It was recommended to breast‐feed for at least 4 months and to avoid solid food in the same time‐period. Eight hundred and sixty‐five infants exclusively breast‐fed, and 256 infants partially or exclusively formula‐fed, were followed‐up until the end of the first year following birth. AD and sensitization to milk and egg were considered as study end‐points. The 1‐year incidence of AD was compared between the two study groups. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. The incidence of AD was calculated in relation to age at introduction of solid food and amount of food given. In the breast‐fed group, the adjusted OR for AD was 0.47 (95% CI 0.30–0.74). The strongest risk factor was the occurrence of AD in the subject's core family. The risk of infants with AD to be sensitized to milk was four times higher, and to egg eight times higher, than in infants without AD. Age at first introduction of solid food and diversity of solid food showed no effect on AD incidence. We conclude that in infants at atopic risk, exclusive breast‐feeding for at least 4 months is effective in preventing AD in the first year of life.     

Prospective study on the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation

Abstract The preventive effect of maternal avoidance of cow's milk and eggs on the development of atopic dermatitis and sensitization to food allergens was studied in a prospective trial with families at high risk for atopy. intervention included encouraging exclusive breast feeding for at least 3 months and delaying the controlled introduction of solid foods. In addition, one group received a maternal diet with the complete avoidance of milk and eggs in the last trimester of pregnancy and during the period of exclusive breast feeding, another group had the same diet starting after delivery, and mothers of the third group had no dietary restrictions. The period prevalences of atopic dermatitis as well as the rates of specific sensitization to eggs and milk at 6 and 12 months were not significantly different between groups. We were unable to demonstrate a significant preventive effect of maternal diet.Conclusion While breast feeding should be promoted for children at risk for atopy, mothers can be encouraged to stay on normal diet during pregnancy and the breast feeding period.     

Compliance with a Dietary Manipulation Programme in Families with Infants Prone to Atopy

ABSTRACT. The success of familial compliance with a dietary manipulation programme was studied prospectively in 91 newborn babies from atopic families for up to 12 months. The control group consisted of 72 infants from non-atopic families. The percentages of infants breast-fed at the age of six months were 58% and 38% in the study group and control group, respectively. The introduction of cow's milk based formulas was postponed until the age of three months in 63% of the infants in the study group and 47% of the infants in the control group. Solid food was avoided during the first three months in 76% and 45% of the infants in the study group and control group, respectively. Maternal age, smoking and low social class were associated with poor compliance. The existence of atopic dermatitis in any member of the family was associated with good compliance. The main advantages of our programme were the increased number of children breast-fed until the age of six months, and the reduced number of infants introduced to cow's milk based formulas or solid food before three months of age.     

Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention:A prospective, randomized study

The aim of this study was to compare the allergy‐preventive effect of a partially hydrolyzed formula with two extensively hydrolyzed formulas, in infants with a high risk for development of allergic disease. High‐risk infants from four Danish centres were included in the period from June 1994 to July 1995. Five‐hundred and ninety‐five high‐risk infants were identified. High‐risk infants were defined as having bi‐parental atopy, or a single atopic first‐degree relative combined with cord blood immunoglobulin E (IgE) ≥ 0.3 kU/l. At birth all infants were randomized to one of three different blinded formulas. All mothers had unrestricted diets during pregnancy and lactation and were encouraged to breast‐feed exclusively. If breast‐feeding was insufficient, one of the three formulas, according to randomization, was given during the first 4 months. It was recommended not to introduce cow's milk, cow's milk products, and solid foods until the age of 4 months. After the age of 4 months a normal unrestricted diet and conventional cow's milk‐based formula were given when needed. All infants were followed‐up prospectively with interview and physical examination at the age of 6, 12, and 18 months, and if any possible atopic symptoms were reported. If food allergy was suspected, controlled elimination/challenge procedures were performed in a hospital setting. Of 550 infants included in the study, 514 were seen at all visits and 36 were excluded owing to non‐compliance. Of 478 infants who completed the study, 232 were exclusively breast‐fed, 79 received an extensively hydrolyzed casein formula (Nutramigen), 82 an extensively hydrolyzed whey formula (Profylac), and 85 a partially hydrolyzed whey formula (Nan HA), during the first 4 months of life. These four groups were identical in regard to atopic predisposition, cord blood IgE, birthplace, and gender. Exclusively breast‐fed children were exposed less to tobacco smoke and pets at home and belonged to higher social classes, whereas the three formula groups were identical concerning environmental factors. The frequency of breast‐feeding was high; only eight (2%) children were not breast‐fed at all. The three formula groups were identical in regard to duration of breast‐feeding and age at introduction of formula and solid foods. No significant differences were found in the three groups of infants receiving formula milk regarding the cumulative incidence of atopic dermatitis or respiratory symptoms. The cumulative incidence of parental‐reported cow's milk allergy was significantly higher in children fed partially hydrolyzed formula (Nan HA) compared with extensively hydrolyzed formula (Nutramigen or Profylac) at 12 and 18 months (NanHA, 7.1%; Nutramigen, 2.5%; Profylac, 0%; p = 0.033). The cumulative incidence of confirmed cow's milk allergy was 1.3% (three of 232) in exclusively breast‐fed infants, 0.6% (one of 161) in infants fed extensively hydrolyzed formula (Nutramigen or Profylac), and 4.7% (four of 85) in infants fed partially hydrolyzed formula (Nan HA). Partially hydrolyzed formula was found to be less effective than extensively hydrolyzed formula in preventing cow's milk allergy, 0.6% vs. 4.7% (p = 0.05), but because of the small number of cases the results should be interpreted with caution. Compared with other similar studies the frequency of atopic symptoms was low, even though the dietetic intervention did not include either maternal diet during lactation or dietary restrictions to the children after the age of 4 months.     

Compliance with a dietary manipulation programme in families with infants prone to atopy

The success of familial compliance with a dietary manipulation programme was studied prospectively in 91 newborn babies from atopic families for up to 12 months. The control group consisted of 72 infants from non-atopic families. The percentages of infants breast-fed at the age of six months were 58% and 38% in the study group and control group, respectively. The introduction of cow's milk based formulas was postponed until the age of three months in 63% of the infants in the study group and 47% of the infants in the control group. Solid food was avoided during the first three months in 76% and 45% of the infants in the study group and control group, respectively. Maternal age, smoking and low social class were associated with poor compliance. The existence of atopic dermatitis in any member of the family was associated with good compliance. The main advantages of our programme were the increased number of children breast-fed until the age of six months, and the reduced number of infants introduced to cow's milk based formulas or solid food before three months of age.     

Does breast feeding protect from atopic diseases?

It is well established that food antigens can pass from mothers to infants via the breast milk. Bovine-beta-lactoglobulin has been detected in several breast milk samples from mothers with regular intake of cow's milk. Healthy breastfed infants can produce IgG antibodies against cow's milk protein and in infants at risk for atopic disease specific IgE antibodies were found before cow's milk based infant formula was introduced into the diet. However, several clinical studies in infants at risk for atopic disease indicate that exclusive breastfeeding decreases the incidence of atopic disease. The protective effect of breastfeeding is only relative and it is uncertain, how long protection lasts. Sensitization to food antigens may occur already in utero, because infants whose mothers avoid common allergenic foods during the whole pregnancy and then during the lactation period have a lower incidence of atopic eczema than infants whose mothers are on an unrestricted diet. Avoidance of common allergenic foods only during the last trimester of pregnancy had no effect, because the fetus is capable of forming IgE immune response.     

Dietary insulin as an immunogen and tolerogen

We have shown that exposure to bovine insulin (BI) in cow's milk (CM) formula induces an insulin-specific immune response in infants. Here we studied the role of human insulin (HI) in breast milk as a modulator of the immune response to insulin. In a group of 128 children participating in the TRIGR pilot study, maternal breast milk samples were collected 3-7 days and/or 3 months after delivery. After exclusive breast-feeding, the children received either CM formula or casein hydrolysate during the first 6-8 months of life. Insulin concentration in breast milk and immunoglobulin G (IgG) antibodies to BI in plasma samples were measured by EIA. The levels of insulin in breast milk samples were higher in mothers affected by type 1 diabetes than in non-diabetic mothers (p = 0.007 and p < 0.001). The concentration of insulin in breast milk correlated inversely with the plasma levels of IgG antibodies to BI at 6 months of age in children who received CM formula (r = -0.39, p = 0.013), and at 12 months of age in all children (r = -0.25, p = 0.029). The levels of breast milk insulin were higher in the mothers of nine children who developed beta-cell autoimmunity when compared with autoantibody-negative children (p = 0.030); this holds true also when only children of diabetic mothers were included (p = 0.045). BI in CM induces higher levels of IgG to insulin in infants than does HI in breast-fed children. Instead, HI in breast milk seems to be tolerogenic and may downregulate the IgG response to dietary BI. However, our results in infants who developed beta-cell autoimmunity suggest that in this subgroup of children breast milk insulin does not promote tolerance.     

喂养干预对特应性高风险婴儿湿疹、食物过敏影响的跟踪研究

目的对具有特应性遗传背景的高风险婴儿随机进行不同方式的喂养干预,观察湿疹和食物过敏的发生情况,探讨喂养干预对婴儿湿疹和食物过敏发生的影响。方法从特应性夫妇中筛选出46例脐血IgE〉0．35kU／L的婴儿,随机分为干预组和非干预组。干预组23例,母乳喂养〉4个月,4个月龄内不添加任何固体辅食,随后低抗原性配方奶粉喂养,6个月内不添加鱼类、虾类食物,12个月内不添加蛋类、花生和坚果类食物;非干预组23例,母乳喂养〈4个月,或普通配方奶粉混合喂养或人工喂养,4个月添加蛋类辅食,其他辅食添加内容和顺序无任何建议或暗示,随访至18个月。临床观察婴儿湿疹的发生情况,食物点刺试验或Fx5E或sIgE检测食物过敏的发生情况。结果6个月时,喂养干预组婴儿湿疹累计发生率4．3％（1／23）,非干预组婴儿湿疹累计发生率26．1％（6／23）;12个月时．喂养干预组婴儿湿疹累计发生率8．7％（2／23）,非干预组婴儿湿疹累计发生率34．8％（8／23）;18个月时,喂养干预组时婴儿湿疹累计发生率17．4％（4／23）,非干预组婴儿湿疹累计发生率39．1％（9／23）,两组湿疹的发生率在各个阶段差异均有统计学意义。干预组食物过敏发生率为13．0％（3／23）;非干预组食物过敏发生率为34．8％（9／23）,差异有统计学意义,过敏食物以鸡蛋最为常见。结论母乳喂养、低抗原性配方奶、延迟添加辅食、高风险食物回避等综合喂养干预方式可以降低高风险婴儿特应性湿疹和食物过敏的发生率,是对具有特应性遗传背景的婴儿有效的初级干预措施。     

Weaning to hypoallergenic formula improves gut barrier function in breast-fed infants with atopic eczema

OBJECTIVES: Infants may be sensitized to dietary antigens even during exclusive breast-feeding. Because food antigen traces in breast milk may have harmful effects on gut barrier function in infants with atopy, the authors sought to evaluate whether or not it is beneficial to shift such infants from breast milk to a hypoallergenic formula. METHODS: Fifty-six infants (mean age, 5.0 months) manifesting atopic eczema during exclusive breast-feeding were studied at weaning to a tolerated hypoallergenic formula. The urinary recovery ratios of orally administered lactulose and mannitol, fecal alpha-1 antitrypsin and urinary methylhistamine, and eosinophil protein X concentrations were assessed during breast-feeding and after weaning. RESULTS: The median (interquartile range, IQR) concentration of fecal alpha-1 antitrypsin was 2.3 mg/g (range, 1.2-3.3 mg/g) during breast-feeding and 0 (0.0-1.9 mg/g) after weaning to a tolerated hypoallergenic formula, z = -4.23, P < 0.0001. The urinary recovery ratio of lactulose and mannitol decreased from 0.029 (range, 0.021-0.042) to 0.023 (range, 0.016-0.031), respectively, z = -3.45, P = 0.0006. Concomitantly, the atopic eczema improved, and the concentration of urinary eosinophil protein X decreased significantly. CONCLUSIONS: In breast-fed infants with atopy, gut barrier function is improved after cessation of breast-feeding and starting of hypoallergenic formula feeding.     

Breast milk fatty acid composition is associated with development of atopic dermatitis in the infant

OBJECTIVE: Breast milk fatty acids may have immunomodulatory properties related to the development of atopic disease. The aim of this study was to assess the impact of the breast milk fatty acid composition on the development of atopic dermatitis (AD) in high-risk infants. METHODS: Mothers with atopic disease were recruited at the end of gestation. Maternal food records and breast milk samples were collected at the infants' age of one month. Infants were clinically examined and AD diagnosed at one, three, six, and 12 months. RESULTS: Altogether 13 of 34 (38%) infants were diagnosed with AD during the first year of life. Infants developing AD had consumed breast milk with a higher ratio of saturated to polyunsaturated fatty acids and less n-3 fatty acids compared to infants not developing AD. Specifically, breast milk consumed by infants with AD contained more stearic acid, 8.9% of total fatty acids (95% confidence interval 7.9-10.0) in comparison to those without AD, 7.1% (95% CI 6.6-7.7). CONCLUSION: Breast milk rich in saturated and low in n-3 fatty acids may be a risk factor for atopic dermatitis in the infant.     

Dietary prevention of allergic diseases in infants and small children

The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer-reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used.     

Carnitine during prolonged breast feeding

To assess carnitine levels during prolonged sole breast feeding we measured serum and breast milk carnitine concentrations in 37 lactating mothers and their healthy term infants from birth to the age of 1 yr. The number of solely breast-fed infants decreased to 31 at 2 months of age, to 28 at 6 months, and to seven at 9 months, because formula and/or solid food was added when there was not enough breast milk. In mothers the mean serum carnitine increased from 35 to 50 mumol/liter during the first 2 months after delivery and remained unchanged thereafter. Irrespective of the type of feeding, the mean serum carnitine in infants increased from 29 to 59 mumol/liter during the first 2 months, remained unchanged during 2-9 months, and decreased to the mean level of mothers thereafter. The mean carnitine concentration of breast milk was high (106 mumol/liter) immediately after delivery. During the first 2 months the mean carnitine concentration of milk decreased to the mean serum level of mothers and remained unchanged thereafter. The carnitine concentrations of serum and breast milk did not correlate, however. The mean daily carnitine intake of the breast-fed infants was 5.7 mumol/kg at 4 months of age, 4.7 mumol/kg at 6 months, and 6.0 mumol/kg at 9 months whereas the mean daily carnitine intake of the infants receiving formula was 28.9 mumol/kg at 1 month of age and 30.7 mumol/kg at 2 months. The serum concentration of carnitine in our infants did not correlate with carnitine intake. Our results indicate that serum carnitine concentrations are maintained during prolonged sole breast feeding.     

Early solid food diet and eczema in childhood: a 10-year longitudinal study

The relationship between early solid feeding in the first four months and risks of eczema in childhood was examined in a birth cohort of 1265 children studied to the age of 10 years. The major findings of this analysis were: 1) children exposed to a diverse solid food diet during their first four months had risks of eczema in early childhood which were about 1.6 times those of children who were not introduced to solid food by age four months. These associations persisted when a range of confounding factors (including family history of atopic disease, infant milk diet (breast/bottle) and family social background factors) were taken into account. 2) Similar associations between early infant diet and risks of chronic and recurrent eczema up to the age of ten years were also found. It was estimated that after adjustment for confounding factors, children exposed to an early diverse solid food diet had risks of eczema which were over 2.5 times those of children not introduced to solid feeding. These results are generally consistent with the hypothesis that early exposure to a diverse solid food diet may increase risks of eczema in children who are susceptible to this condition.     

Intake and growth of breast-fed and formula-fed infants in relation to the timing of introduction of complementary foods: the DARLING study

We examined if the timing of introduction of solid foods was related to growth, intake, morbidity, activity or motor development among infants either breast fed or formula fed until 12 months of age. Breast-fed infants given solids before 6 months of age (earlysol) consumed less breast milk at 6 and 9 months of age than those given solids 6 months (latesol); thus total energy intake did not differ between groups. Z scores for weight, length and weight-for-length at 1–18 months did not differ between groups. Latesol infants gained less weight from 6 to 9 months but not during any other interval. Neither activity level nor morbidity differed between groups, but several developmental milestones occurred earlier in the earlysol versus the latesol group, probably due to reverse causation. Among formula-fed infants, timing of introduction of solid foods was not related to intake, growth, activity or morbidity. We conclude that solid foods given before 6 months of age generally replace the milk source among breast-fed but not formula-fed infants.     

Atopy, eczema and breast milk fatty acids in a high-risk cohort of children followed from birth to 5 yr

BACKGROUND: The incidence of atopic diseases such as eczema is increasing in westernized societies. The suggestion that there is a "protective" association between the unique fatty acid composition of breast milk, particularly the omega-3 (n-3) and omega-6 (n-6) essential polyunsaturated fatty acid content, and the development of atopic disease in children was investigated in a cohort study of 263 infants born into families with a history of allergy (one or both parents had asthma, hayfever, eczema). The objectives of this study were to determine the lipid profile [specifically in relation to long-chain polyunsaturated fatty acid (LC-PUFA) composition] in maternal breast milk samples collected at 6 wk and at 6 months following birth, and to investigate the potential role of these fatty acids in modulating the phenotype of children at high genetic risk of developing atopic disease. METHOD: Breast milk samples were available from 91 atopic mothers at their child's ages of 6 wk and 6 months. These samples were analysed for the fatty acid spectrum. Analysis of variance was used to detect differences between groups of outcomes (no atopy or eczema, non-atopic eczema, atopy, atopic eczema) at ages 6 months and 5 yr, and a multiple comparisons procedure was conducted to isolate the parameters producing the different results (F-test, LSD test). For the exposure variables, n-3 and n-6 fatty acids are expressed as weight percentage and as a ratio (at both time-points). RESULTS: The fatty acid profiles of maternal breast milk at 6 wk and 6 months were similar. An increased ratio of n-6: n-3 fatty acids in both 6 wk and 6 month milk samples was associated with non-atopic eczema (p < 0.005) but not atopy alone or atopic eczema. CONCLUSION: We found milk fatty acids were a significant modulator of non-atopic eczema but not atopy or atopic eczema in infants at 6 months. In mothers with a history of asthma, hayfever or eczema, their 6-month-old infants were more likely to develop non-atopic eczema if their milk had a higher ratio of n-6: n-3 LC-PUFA.     

The development of atopic sensitization in Estonian infants

In a prospective study, 251 infants were followed from birth up to 12 months of age, recording manifestations of allergy by questionnaires at 3, 6, 9 and 12 months and by clinical examinations at 6 and/or 12 months. Blood samples were obtained at birth and at 6 and 12 months and analysed for serum lgE levels. The children were skin-prick tested with foods at 6 and 12 months of age and with inhalant allergens at 12 months. Blood samples from SPT-positive individuals and controls were analysed for the presence of IgE antibodies to common inhalant allergens and their cord sera for the presence of IgE antibodies to cow's milk and egg. Twelve infants (7%) were sensitized against foods [3 to cow's milk (CM) and 9 to egg white (EW)] at 6 months and 11 (5%) (2 to CM and 9 to EW) at 12 months. Seventeen infants (7%) had IgE antibodies against inhalant allergens at 6 and/or 12 months, as determined by either SPT and/or the demonstration of circulating IgE antibodies. Out of 30 children with positive SPT and/or circulating IgE antibodies against foods and inhalant allergens at any age, 6 had atopic dermatitis, 4 gastrointestinal food allergy, 1 urticaria and 4 probable allergy, while 15 had no clinical manifestation of allergy. Immunoglobulin E antibodies against Ascaris were detected in 17% of the infants with S-IgE levels >20kU/l. The study indicates that the incidence of sensitization and manifestations of allergic disease is similar among Estonian and Scandinavian infants during the first year of life. Given earlier findings indicating a significantly higher prevalence of atopic disease in Scandinavian school-children relative to their counterparts in Eastern Europe, the present study suggests that the key events which determine disease expression do not occur exclusively during the first year of life.     

Breast feeding and allergic diseases in infants-a prospective birth cohort study.

AIMS: To investigate the effect of breast feeding on allergic disease in infants up to 2 years of age. METHODS: A birth cohort of 4089 infants was followed prospectively in Stockholm, Sweden. Information about various exposures was obtained by parental questionnaires when the infants were 2 months old, and about allergic symptoms and feeding at 1 and 2 years of age. Duration of exclusive and partial breast feeding was assessed separately. Symptom related definitions of various allergic diseases were used. Odds ratios (OR) and 95% confidence intervals (CI) were estimated in a multiple logistic regression model. Adjustments were made for potential confounders. RESULTS: Children exclusively breast fed during four months or more exhibited less asthma (7.7% v 12%, OR(adj) = 0.7, 95% CI 0.5 to 0.8), less atopic dermatitis (24% v 27%, OR(adj) = 0.8, 95% CI 0.7 to 1.0), and less suspected allergic rhinitis (6.5% v 9%, OR(adj) = 0.7, 95% CI 0.5 to 1.0) by 2 years of age. There was a significant risk reduction for asthma related to partial breast feeding during six months or more (OR(adj) = 0.7, 95% CI 0.5 to 0.9). Three or more of five possible allergic disorders-asthma, suspected allergic rhinitis, atopic dermatitis, food allergy related symptoms, and suspected allergic respiratory symptoms after exposure to pets or pollen-were found in 6.5% of the children. Exclusive breast feeding prevented children from having multiple allergic disease (OR(adj) = 0.7, 95% CI 0.5 to 0.9) during the first two years of life. CONCLUSION: Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease-that is, asthma, atopic dermatitis, and suspected allergic rhinitis, up to 2 years of age. This protective effect was also evident for multiple allergic disease.     

The association of atopic dermatitis in infancy with immunoglobulin E food sensitization

OBJECTIVE: To prospectively investigate the association of high levels of immunoglobulin E (IgE) sensitization to foods and the presence of atopic dermatitis (judged by reported topical steroid use during the first 16 months of life) in a birth cohort of 620 Australian children "at risk" of allergic disease because of family history. RESULTS: A total of 559 of the children in the cohort were fully evaluated, and the cumulative prevalence of atopic dermatitis was 24%. More children in the cohort who had atopic dermatitis had strongly positive skin test results (> or = 4+, histamine equivalent units, > or = approximately 6-mm wheal), consistent with IgE food sensitization to either cow's milk, egg, or peanut at 6 months (22% vs 5%, chi(2) = 35; P < 10(-6)) and at 12 months (36% vs 11%, chi(2) = 41; P < 10(-6)) than those without atopic dermatitis. The calculated attributable risk percent for IgE food sensitization as a cause of atopic dermatitis was 65% and 64% at these times. In a separate group of infants with severe atopic dermatitis, the equivalent rates of IgE food sensitization at 6 months was 83% and at 12 months, 65%. CONCLUSION: IgE food sensitization is a major risk factor for the presence of atopic dermatitis in infancy.     

Lactose malabsorption in young Lithuanian children with atopic dermatitis

AIM: To determine the prevalence of lactose malabsorption in young Lithuanian atopic dermatitis children; to evaluate the relationship between lactose malabsorption and the duration of exclusive breastfeeding, and the relationship between lactose malabsorption and cow's milk intolerance in parents and grandparents. METHODS: 144 children with atopic dermatitis aged 1.5-24 mo (study group) and 32 children without symptoms of allergic diseases aged 1.5-23 mo (control group) were investigated. Lactose and glucose-galactose absorption tests based on serial blood glucose determination, culture of stool, latex agglutination test for rotavirus and microscopic examination of stool for parasites were performed. RESULTS: Lactose malabsorption was determined in 59 (40.9%) and glucose-galactose malabsorption in 17 (11.8%) children with atopic dermatitis. The risk of developing lactose malabsorption was higher in children fed exclusively on breast milk up to 1 mo of age than in children fed exclusively on breast milk for 4 to 6 mo (OR: 2.62; 95% CI: 1.02-6.75). Lactose malabsorption was significantly more frequent in patients whose mothers did not tolerate cow's milk (20/30; 66.7%) than in patients whose mothers were tolerant to it (39/95; 41.1%) (p = 0.02). CONCLUSION: Lactose malabsorption was determined in 40.9% of Lithuanian atopic dermatitis children aged under 2 y. Lactose malabsorption appeared to be associated with the duration of exclusive breastfeeding up to only 1 mo and mothers' milk intolerance.     

Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy

Polyunsaturated fatty acids (PUFAs) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis (AD). The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants. Based on the parents' decision on their babies' primary feeding, mothers and newborns were randomized to the supplementation with gamma-linolenic acid (GLA) or placebo for up to 6 months. Breastfed infants received GLA by supplementing their mothers. Formula diet was commercial whey hydrolysate unsupplemented with PUFAs. Of 131 eligible infants, 24 developed AD within the first year of life. Of these, nine belonged to the exclusively breastfed group (n = 58), 14 to the combined-fed group (n = 53), and one to the never breastfed group (n = 20). We could not find an influence of GLA on the development of AD. In subjects with AD, at 1 yr of age the serum-immunoglobulin E (IgE) was the lowest in the GLA-supplemented group A-subjects. In the GLA-supplemented group, GLA-levels in breast milk were similar in atopic and non-atopic infants. In the non-supplemented group the GLA-content of breast milk was 0.07% of total fatty acids in atopic infants vs. 0.17% in non-atopic infants (p < 0.01). Dietary GLA-supplementation could not prevent AD. Interestingly, the number of infants developing AD was the lowest in never breastfed children. In infants suffering from AD, GLA-supplementation seemed to reduce total IgE in the first year of life.