The impact of breastfeeding on the development of allergic disease
- David M Fleischer, MD
David M Fleischer, MD
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- University of Colorado Denver School of Medicine
Human milk is the optimal source of nutrition for term infants during the first six months of life . 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 . The presence of transforming growth factor (TGF)-beta was critical for this interaction.
- Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
- Department of Health and Human Services, Office on Women's Health. Breastfeeding: HHS Blueprint for Action on Breastfeeding. US Department of Health and Human Services, Washington, DC 2000.
- American College of Obstetricians and Gynecologists. Breastfeeding: maternal and infant aspects. ACOG Educational Bulletin 258, American College of Obstetricians and Gynecologists, Washington, DC, 2000.
- Duchén K, Casas R, Fagerås-Böttcher M, et al. Human milk polyunsaturated long-chain fatty acids and secretory immunoglobulin A antibodies and early childhood allergy. Pediatr Allergy Immunol 2000; 11:29.
- Firth MA, Shewen PE, Hodgins DC. Passive and active components of neonatal innate immune defenses. Anim Health Res Rev 2005; 6:143.
- Labbok MH, Clark D, Goldman AS. Breastfeeding: maintaining an irreplaceable immunological resource. Nat Rev Immunol 2004; 4:565.
- Armogida SA, Yannaras NM, Melton AL, Srivastava MD. Identification and quantification of innate immune system mediators in human breast milk. Allergy Asthma Proc 2004; 25:297.
- LeBouder E, Rey-Nores JE, Rushmere NK, et al. Soluble forms of Toll-like receptor (TLR)2 capable of modulating TLR2 signaling are present in human plasma and breast milk. J Immunol 2003; 171:6680.
- LeBouder E, Rey-Nores JE, Raby AC, et al. Modulation of neonatal microbial recognition: TLR-mediated innate immune responses are specifically and differentially modulated by human milk. J Immunol 2006; 176:3742.
- Rigotti E, Piacentini GL, Ress M, et al. Transforming growth factor-beta and interleukin-10 in breast milk and development of atopic diseases in infants. Clin Exp Allergy 2006; 36:614.
- Snijders BE, Damoiseaux JG, Penders J, et al. Cytokines and soluble CD14 in breast milk in relation with atopic manifestations in mother and infant (KOALA Study). Clin Exp Allergy 2006; 36:1609.
- Verhasselt V, Milcent V, Cazareth J, et al. Breast milk-mediated transfer of an antigen induces tolerance and protection from allergic asthma. Nat Med 2008; 14:170.
- Newburg DS, Walker WA. Protection of the neonate by the innate immune system of developing gut and of human milk. Pediatr Res 2007; 61:2.
- Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nat Rev Immunol 2007; 7:379.
- Udall JN, Colony P, Fritze L, et al. Development of gastrointestinal mucosal barrier. II. The effect of natural versus artificial feeding on intestinal permeability to macromolecules. Pediatr Res 1981; 15:245.
- Greer FR, Sicherer SH, Burks AW, et al. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121:183.
- Høst A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999; 81:80.
- Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics 2003; 111:1662.
- Kramer MS, Matush L, Vanilovich I, et al. Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial. BMJ 2007; 335:815.
- Silvers KM, Epton MJ, Frampton CM. Allergy after breast feeding: Study was not designed to test the hypothesis. BMJ 2007; 335:899.
- Kull I, Böhme M, Wahlgren CF, et al. Breast-feeding reduces the risk for childhood eczema. J Allergy Clin Immunol 2005; 116:657.
- Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001; 285:413.
- Schoetzau A, Filipiak-Pittroff B, Franke K, et al. 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. Pediatr Allergy Immunol 2002; 13:234.
- Laubereau B, Brockow I, Zirngibl A, et al. Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life--results from the GINI-birth cohort study. J Pediatr 2004; 144:602.
- Lodge CJ, Tan DJ, Lau MX, et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr 2015; 104:38.
- Ludvigsson JF, Mostrom M, Ludvigsson J, Duchen K. Exclusive breastfeeding and risk of atopic dermatitis in some 8300 infants. Pediatr Allergy Immunol 2005; 16:201.
- Snijders BE, Thijs C, Kummeling I, et al. Breastfeeding and infant eczema in the first year of life in the KOALA birth cohort study: a risk period-specific analysis. Pediatrics 2007; 119:e137.
- Jelding-Dannemand E, Malby Schoos AM, Bisgaard H. Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years. J Allergy Clin Immunol 2015; 136:1302.
- Bergmann RL, Diepgen TL, Kuss O, et al. Breastfeeding duration is a risk factor for atopic eczema. Clin Exp Allergy 2002; 32:205.
- Pesonen M, Kallio MJ, Ranki A, Siimes MA. Prolonged exclusive breastfeeding is associated with increased atopic dermatitis: a prospective follow-up study of unselected healthy newborns from birth to age 20 years. Clin Exp Allergy 2006; 36:1011.
- Giwercman C, Halkjaer LB, Jensen SM, et al. Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants. J Allergy Clin Immunol 2010; 125:866.
- Gdalevich M, Mimouni D, David M, Mimouni M. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 2001; 45:520.
- Snijders BE, Thijs C, Dagnelie PC, et al. Breast-feeding duration and infant atopic manifestations, by maternal allergic status, in the first 2 years of life (KOALA study). J Pediatr 2007; 151:347.
- Yang YW, Tsai CL, Lu CY. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Br J Dermatol 2009; 161:373.
- Flohr C, Nagel G, Weinmayr G, et al. Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. Br J Dermatol 2011; 165:1280.
- Elliott L, Henderson J, Northstone K, et al. Prospective study of breast-feeding in relation to wheeze, atopy, and bronchial hyperresponsiveness in the Avon Longitudinal Study of Parents and Children (ALSPAC). J Allergy Clin Immunol 2008; 122:49.
- Wright AL, Holberg CJ, Martinez FD, et al. Breast feeding and lower respiratory tract illness in the first year of life. Group Health Medical Associates. BMJ 1989; 299:946.
- Holberg CJ, Wright AL, Martinez FD, et al. Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life. Am J Epidemiol 1991; 133:1135.
- Howie PW, Forsyth JS, Ogston SA, et al. Protective effect of breast feeding against infection. BMJ 1990; 300:11.
- Dogaru CM, Nyffenegger D, Pescatore AM, et al. Breastfeeding and childhood asthma: systematic review and meta-analysis. Am J Epidemiol 2014; 179:1153.
- Wright AL, Holberg CJ, Taussig LM, Martinez FD. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax 2001; 56:192.
- Sears MR, Greene JM, Willan AR, et al. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 2002; 360:901.
- den Dekker HT, Sonnenschein-van der Voort AM, Jaddoe VW, et al. Breastfeeding and asthma outcomes at the age of 6 years: The Generation R Study. Pediatr Allergy Immunol 2016; 27:486.
- Nagel G, Büchele G, Weinmayr G, et al. Effect of breastfeeding on asthma, lung function and bronchial hyperreactivity in ISAAC Phase II. Eur Respir J 2009; 33:993.
- Mimouni Bloch A, Mimouni D, Mimouni M, Gdalevich M. Does breastfeeding protect against allergic rhinitis during childhood? A meta-analysis of prospective studies. Acta Paediatr 2002; 91:275.
- Høst A, Halken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol 2008; 19:1.
- Han Y, Chung SJ, Kim J, et al. High sensitization rate to food allergens in breastfed infants with atopic dermatitis. Ann Allergy Asthma Immunol 2009; 103:332.
- Muraro A, Dreborg S, Halken S, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol 2004; 15:291.
- Liao SL, Lai SH, Yeh KW, et al. Exclusive breastfeeding is associated with reduced cow's milk sensitization in early childhood. Pediatr Allergy Immunol 2014; 25:456.
- Hong X, Wang G, Liu X, et al. Gene polymorphisms, breast-feeding, and development of food sensitization in early childhood. J Allergy Clin Immunol 2011; 128:374.
- IMMUNOLOGIC PROPERTIES OF BREAST MILK
- EPIDEMIOLOGIC ISSUES IN BREASTFEEDING STUDIES
- Infants at high risk for developing allergy
- Sources of bias and confounding
- BREASTFEEDING AND ATOPIC DERMATITIS (ECZEMA)
- BREASTFEEDING AND ASTHMA
- BREASTFEEDING AND ALLERGIC RHINITIS
- BREASTFEEDING AND FOOD ALLERGY
- INFORMATION FOR PATIENTS