Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

Dong Chan Kim; An Deok Seo; Song I Yang; Hae Ran Lee; So-Yeon Lee

doi:10.4168/aard.2016.4.3.188

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Kim, Seo, Yang, Lee, and Lee: Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(3): 188-194.

Published online: 31 May 2016

DOI: https://doi.org/10.4168/aard.2016.4.3.188

Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

Dong Chan Kim, An Deok Seo, Song I Yang, Hae Ran Lee, So-Yeon Lee

Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Correspondence to: So-Yeon Lee. Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. Tel: +82-31-380-1685, Fax: +82-31-380-1900, imipenem@hanmail.net

Received 31 August 2015 Revised 12 October 2015 Accepted 19 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

Breast-feeding is recommended to prevent allergies, particularly in high-risk infants, but the evidence of protective effects that breast-feeding has on food allergy (FA) remains elusive. The aim of this study was to investigate risk factors of FA and the association between breast-feeding and FA symptoms/food sensitization (FS) in children with atopic dermatitis under 2 years of age.

Methods

We reviewed the medical records of 384 children with atopic dermatitis under 2 years of age who visited our pediatric allergy clinic from March 1, 2009 through December 31, 2014. Symptoms of FA, feeding type, and family history of allergic disease were assessed. Laboratory tests were conducted, including serum total IgE, eosinophil (%), serum 25-hydroxyvitamin D, and specific IgE to egg white, milk, soy, peanut, and wheat.

Results

Subjects were divided into 3 groups based on FA symptoms and evidence of sensitization: The FA symptom group (n=240), no symptom group (n=53) and no FS group (n=91). The FA symptom group had a higher log total IgE level (2.0 vs. 1.3, P<0.001) and eosinophil (%) (7.0% vs. 4.7%, P=0.001) than the no FA symptom group. In multivariate analysis, breast-feeding was associated with FS (adjusted odds ratio [aOR], 2.43; 95% confidence intervals [CI], 1.03–5.74) but was not associated with FA symptoms (aOR, 0.65; 95% CI, 0.23–1.83).

Conclusion

Breast-feeding may increase the risk of FS, but not immediate-type FA symptoms in children with atopic dermatitis.

Keywords: Breastfeeding, Food hypersensitivity, Atopic dermatitis

Figures and Tables

Table 1

Comparison of study subject characteristics

Characteristic	FA symptom (+) FS (+)	FA symptom (–)		P-value^*
Characteristic	FA symptom (+) FS (+)	FS (+)	FS (–)	P-value^*
No. of subjects	240	53	91
Age (mo)	8.9±4.2	8.6±4.3	7.4±4.0	0.004
Sex, male:female	150:90	36:17	56:35	0.785
Anaphylaxis history	53 (22.1)^†,‡	0 (0)	0 (0)	<0.001
Family history of allergic disease	170 (70.8)^‡	34 (64.2)	52 (57.1)	0.025
Delivery type (vaginal)	176 (73.3)	42 (79.2)	64 (70.3)	0.952
Breastfeeding	188 (78.3)^‡	41 (77.4)^‡	48 (52.7)	<0.001
Log total IgE	2.0±0.6^†,‡	1.7±0.5^‡	1.0±0.5	<0.001
25(OH)D (ng/mL)	18.9±11.8^‡	22.9±12.6^‡	28.3±14.3	<0.001
Eosinophil (%)	7.0±5.1^†,‡	5.2±4.1	4.5±3.0	<0.001
Egg white sensitization	204 (85.0)^‡	40 (75.5)^‡	0 (0)	<0.001
Milk sensitization	171 (71.3)^†,‡	21 (39.6)^‡	0 (0)	<0.001

Values are presented as mean±standard deviation or number (%).

FA, food allergy; FS, food sensitization; 25(OH)D, 25-hydroxyvitamin D.

^*FA symptom group compared with no FA symptom group. ^†P<0.05 compared to FA symptom (–) and FS (+). ^‡P<0.05 compared to FA symptom (–) and FS (–).

Table 2

Comparison of characteristics between study subgroups

Characteristic	FA symptom (–) FS (+)	FA symptom (–) FS (–)	P-value	FA symptom (+) FS (+)	FA symptom (–) FS (–)	P-value	FA Symptom (+) FS (+)	FA symptom (–) FS (+)	P-value
No. of subjects	53	91		240	91		240	53
Age (mo)	8.6 ± 4.3	7.4 ± 4.0	0.057	8.9 ± 4.2	7.4 ± 4.0	< 0.001	8.9 ± 4.2	8.6 ± 4.3	0.525
Sex, male:female	36:17	56:35	0.442	150:90	56:35	0.872	150:90	36:17	0.458
Family history of allergic disease	34 (64.2)	52 (57.1)	0.408	170 (70.8)	52 (57.1)	0.018	170 (70.8)	34 (64.2)	0.338
Delivery type (vaginal)	42 (79.2)	64 (70.3)	0.242	176 (73.3)	64 (70.3)	0.585	176 (73.3)	42 (79.2)	0.372
Breastfeeding	41 (77.4)	48 (52.7)	0.003	188 (78.3)	48 (52.7)	< 0.001	188 (78.3)	41 (77.4)	0.876
Log total IgE	1.7 ± 0.5	1.0 ± 0.5	< 0.001	2.0 ± 0.6	1.0 ± 0.5	< 0.001	2.0 ± 0.6	1.7 ± 0.5	< 0.001
25(OH)D (ng/mL)	22.9 ± 12.6	28.3 ± 14.3	0.043	18.9 ± 11.8	28.3 ± 14.3	< 0.001	18.9 ± 11.8	22.9 ± 12.6	0.071
Eosinophil (%)	5.2 ± 4.1	4.5 ± 3.0	0.831	7.0 ± 5.1	4.5 ± 3.0	< 0.001	7.0 ± 5.1	5.2 ± 4.1	0.004

Values are presented as mean±standard deviation or number (%).

FA, food allergy; FS, food sensitization; 25(OH)D, 25-hydroxyvitamin D.

Table 3

Risk factors for food sensitization among infants with atopic dermatitis

Variable	Crude OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
Breastfeeding	3.21 (1.95–5.27)	< 0.001	2.43 (1.03–5.74)	0.043
Family history of allergic disease	1.72 (1.06–2.79)	0.028	0.65 (0.26–1.62)	0.359
Vitamin D deficiency ( < 20 ng/mL)	2.35 (1.36–4.08)	0.002	1.16 (0.41–3.33)	0.773
Total IgE ( ≥ 100 IU/mL)	24.38 (7.54–78.84)	< 0.001	5.24 (1.27–21.68)	0.022
Eosinophil ( ≥ 4%)	2.36 (1.46–3.86)	< 0.001	1.03 (0.37–2.81)	0.772

Data were calculated by logistic regression multivariate analysis.

Adjusted for food allergy symptom, age, sex, delivery mode and season of sampling time.

OR, odds ratio; CI, confidence interval.

Table 4

Risk factors for food allergy symptoms among infants with atopic dermatitis

Variable	Crude OR (95% CI)	P-value	Adjusted OR (95% CI)	P-value
Breastfeeding	2.23 (1.42–3.52)	0.001	0.65 (0.23–1.83)	0.415
Family history of allergic disease	1.64 (1.06–2.53)	0.026	2.58 (1.16–5.75)	0.020
Vitamin D deficiency ( < 20 ng/mL)	2.30 (1.41–3.76)	0.001	1.99 (0.79–5.06)	0.146
Total IgE ( ≥ 100 IU/mL)	7.35 (4.17–12.94)	< 0.001	3.06 (1.26–7.40)	0.013
Eosinophil ( ≥ 4%)	2.35 (1.85–4.38)	< 0.001	4.03 (1.83–8.89)	0.001

Data were calculated by logistic regression multivariate analysis.

Adjusted for food sensitization, age, sex, delivery mode and season of sampling time.

OR, odds ratio; CI, confidence interval.

Table 5

Risk of breast feeding for food allergy symptom and food sensitization in subgroup analysis

Breastfeeding	FA symptom				FS
Breastfeeding	Crude OR (95% CI)	P-value	Adjusted OR (95% CI)^*	P-value	Crude OR (95% CI)	P-value	Adjusted OR (95% CI)^†	P-value
With family history of AD (n = 256)	2.34 (1.31–4.19)	0.004	1.07 (0.42–2.72)	0.885	3.51 (1.84–6.70)	0.000	3.34 (1.22–9.20)	0.019
Without family history of AD (n = 128)	1.90 (0.90–3.98)	0.091	0.86 (0.26–2.79)	0.796	2.57 (1.18–5.63)	0.018	2.66 (0.80–8.82)	0.110

Data were calculated by logistic regression multivariate analysis.

FA, food allergy; FS, food sensitization; OR, odds ratio; CI, confidence interval; AD, allergic disease.

^*Adjusted for food sensitization, age and sex. ^†Adjusted for food allergy symptom, age and sex.

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ORCID iDs: So-Yeon Lee
https://orcid.org/http://orcid.org/0000-0002-2499-0702
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