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The impact of breastfeeding on the development of allergic disease

Author
David M Fleischer, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

Human milk is the optimal source of nutrition for term infants during the first six months of life [1]. Breastfeeding for all infants is strongly supported by both governmental and medical professional organizations because of its acknowledged benefits with respect to nutrition, gastrointestinal function, immediate protection from infectious disease, and psychological well-being [1-3]. In addition, epidemiologic studies suggest that breastfeeding contributes to protection against childhood inflammatory, autoimmune, and malignant diseases, suggesting an impact on longer-term immune function. (See "Infant benefits of breastfeeding".)

This topic reviews the literature examining the effects of breastfeeding on the prevention of allergic diseases, including atopic dermatitis (AD), asthma, allergic rhinitis (AR), and food allergy. Other aspects of the primary prevention of allergic disease are reviewed separately. (See "Primary prevention of allergic disease: Maternal diet in pregnancy and lactation".)

IMMUNOLOGIC PROPERTIES OF BREAST MILK

Human breast milk contains a variety of immunologically active substances, including immunoglobulins, antimicrobial enzymes, and various leukocytes. It also contains anti-inflammatory and tolerance-promoting compounds, such as polyunsaturated long-chain fatty acids, platelet-activating factor (PAF)-acetylhydrolase, and interleukin-10 (IL-10). Additionally, a variety of agonists and antagonists of the innate immune responses, including CD-14 and factors that modulate toll-like receptor (TLR) signaling, have been identified [4-9]. However, a simple relationship between these components and the atopic state of the mother or infant has not been apparent in most studies [10,11]. (See "Infant benefits of breastfeeding".)

Theories about how these immunologically active components of breast milk may interact with the neonatal immune system include the following:

A study in mice demonstrated that airborne allergens inhaled by lactating females and ingested with breast milk by nursing offspring stimulated the induction of regulatory T cells and allergen-specific tolerance [12]. The presence of transforming growth factor (TGF)-beta was critical for this interaction.

         

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 15 00:00:00 GMT+00:00 2016.
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