Orivuori L, Loss G, Roduit C, Dalphin J-C, Depner M, Genuneit J, Lauener R, Pekkanen J, Pfefferle P, Riedler J, Roponen M, Weber J, von Mutius E, Braun-Fahrländer C, Vaarala O
Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
Clin Exp Allergy. 2014 Jan;44(1):102-12. doi: 10.1111/cea.12199.
The role of breastfeeding for the development of atopic diseases in childhood is contradictory. This might be due to differences in the composition of breast milk and levels of antimicrobial and anti-inflammatory components.
The objective of this study was to examine whether levels of total immunoglobulin A (IgA) or transforming growth factor-β1 (TGF-β1) in breast milk were associated with the risk of developing atopic dermatitis (AD), atopic sensitization or asthma at early age taking breastfeeding duration into account.
The birth cohort study PASTURE conducted in Finland, France, Germany and Switzerland provided 610 breast milk samples collected 2 months after delivery in which soluble IgA (sIgA) and TGF-β1 levels were measured by ELISA. Duration of breastfeeding was assessed using weekly food frequency diaries from month 3 to month 12. Data on environmental factors, AD and asthma were collected by questionnaires from pregnancy up to age 6. Atopic status was defined by specific IgE levels in blood collected at the ages of 4 and 6 years. Multivariate logistic regression models were used for statistical analysis.
Soluble IgA and TGF-β1 levels in breast milk differed between countries, and sIgA levels were associated with environmental factors related to microbial load, for example, contact to farm animals or cats during pregnancy, but not with raw milk consumption. sIgA levels were inversely associated with AD up to the of age 2 years (P-value for adjusted linear trend: 0.005), independent of breastfeeding duration. The dose of sIgA ingested in the first year of life was associated with reduced risk of AD up to the age of 2 (aOR, 95% CI: 0.74; 0.55-0.99) and 4 years (0.73; 0.55-0.96). No clear associations between sIgA and atopy or asthma up to age 6 were observed. TGF-β1 showed no consistent association with any investigated health outcome.
IgA in breast milk might protect against the development of AD.
母乳喂养在儿童特应性疾病发展中的作用存在矛盾。这可能是由于母乳成分以及抗菌和抗炎成分水平的差异所致。
本研究的目的是在考虑母乳喂养持续时间的情况下，探讨母乳中总免疫球蛋白A（IgA）或转化生长因子-β1（TGF-β1）水平是否与儿童早期发生特应性皮炎（AD）、特应性致敏或哮喘的风险相关。
在芬兰、法国、德国和瑞士进行的出生队列研究PASTURE提供了610份产后2个月采集的母乳样本，通过酶联免疫吸附测定法（ELISA）测量其中可溶性IgA（sIgA）和TGF-β1水平。使用从第3个月到第12个月的每周食物频率日记评估母乳喂养持续时间。通过问卷调查收集从孕期到6岁的环境因素、AD和哮喘数据。特应性状态由4岁和6岁时采集的血液中特异性IgE水平定义。采用多变量逻辑回归模型进行统计分析。
各国母乳中可溶性IgA和TGF-β1水平存在差异，sIgA水平与微生物负荷相关的环境因素有关，例如孕期接触农场动物或猫，但与饮用生奶无关。sIgA水平与2岁前的AD呈负相关（调整线性趋势的P值：0.005），与母乳喂养持续时间无关。生命第一年摄入的sIgA剂量与2岁（调整后比值比，95%置信区间：0.74；0.55 - 0.99）和4岁（0.73；0.55 - 0.96）前AD风险降低相关。未观察到sIgA与6岁前的特应性或哮喘之间存在明确关联。TGF-β1与任何研究的健康结局均无一致关联。
母乳中的IgA可能预防AD的发生。
