Pancheva Rouzha, Illiodromiti Zoi, Moschonis George, Kontopodi Eva, Karapati Eleni, Nicolaou Nicolaos, Karaglani Eva, Sekkidou Mikaela, Popova Simoneta, Usheva Nataliya, Marinova Miglena, Xepapadaki Paraskevi, Sardeli Olympia, Kapetanaki Anastasia, Iacovidou Nicoletta, Boutsikou Theodora, Papathoma Evangelia, Manios Yannis
Department of Hygiene and Epidemiology, Faculty of Public Health, "Prof. Dr. Paraskev Stoyanov" Medical University-Varna, Varna, Bulgaria.
Research Group NutriLect, Department of Neuroscience, Research Institute, Medical University "Prof. Dr. Paraskev Stoyanov"-Varna, Varna, Bulgaria.
Front Pediatr. 2024 Dec 16;12:1424331. doi: 10.3389/fped.2024.1424331. eCollection 2024.
Early life infections (ELIs), encompassing both viral and bacterial types, occur within the first six months of life. Influenced by genetic host factors and environmental conditions, the relationship between ELIs and subsequent allergic manifestations, particularly cow's milk protein allergy (CMPA) and atopic dermatitis (AD), is complex and not fully understood.
The aim of the current study was to examine the potential interplay between nutrition, infections, and allergic manifestations in the first six months of life in infants with a family history of allergies, who were either exclusively breastfed (EBF) or fed a combination of breast milk and standard (SF) or partially hydrolyzed infant formula (pHF).
The Allergy Reduction Trial (ART) is a multicenter, randomized controlled trial involving 551 participants. From birth, these participants were divided into three groups: Exclusive Breastfeeding (EBF), Partially Hydrolyzed Formula (pHF), and Standard Formula (SF). ELIs, defined as viral and bacterial infections occurring during the first 6 months, and outcomes (AD, CMPA) were recorded through questionnaires (i.e., SCORAD and CоMiSS) and clinical assessments.
The relative risk (RR) for CMPA in infants with ELIs was 0.20 (95% CI: 0.07-0.58), highlighting a protective effect of ELIs against CMPA development. Notably, the incidence of CMPA was significantly lower in infants who experienced ELIs compared to those without (3% vs. 13.4%, = 0.001), with no cases of CMPA observed at 6 months in exclusively breastfed (EBF) infants with ELIs. For AD, a trend was observed where the incidence was lower in infants with ELIs who were fed with pHF at 6.5%, compared to those fed with SF at 18.2% ( = 0.092), suggesting a potential protective effect of ELIs in the pHF group against AD development.
The study highlights a potential protective role of ELIs in reducing the risk of CMPA, particularly in EBF infants. Furthermore, it suggests a trend towards lower AD incidence in infants fed with pHF, highlighting the complex interplay between early microbial exposures, feeding practices, and immune development. Further research is warranted to unravel this challenging relationship and appropriately inform early life allergy prevention strategies.
早期生活感染（ELIs）包括病毒和细菌感染类型，发生在生命的前六个月内。受宿主遗传因素和环境条件的影响，ELIs与随后的过敏表现之间的关系，尤其是牛奶蛋白过敏（CMPA）和特应性皮炎（AD），是复杂的且尚未完全理解。
本研究的目的是探讨在有过敏家族史的婴儿生命的前六个月中，营养、感染和过敏表现之间的潜在相互作用，这些婴儿要么纯母乳喂养（EBF），要么喂以母乳与标准（SF）或部分水解婴儿配方奶粉（pHF）的组合。
过敏减少试验（ART）是一项多中心随机对照试验，涉及551名参与者。从出生起，这些参与者被分为三组：纯母乳喂养（EBF）、部分水解配方奶粉（pHF）和标准配方奶粉（SF）。ELIs定义为前6个月内发生的病毒和细菌感染，通过问卷（即SCORAD和CоMiSS）和临床评估记录结果（AD、CMPA）。
ELIs婴儿发生CMPA的相对风险（RR）为0.20（95%CI：0.07 - 0.58），突出了ELIs对CMPA发生的保护作用。值得注意的是，经历过ELIs的婴儿中CMPA的发生率明显低于未经历过的婴儿（3%对13.4%，P = 0.001），在有ELIs的纯母乳喂养（EBF）婴儿中，6个月时未观察到CMPA病例。对于AD，观察到一种趋势，即6.5%接受pHF喂养的有ELIs的婴儿的发病率低于接受SF喂养的婴儿（18.2%）（P = 0.092），这表明在pHF组中ELIs对AD发生有潜在的保护作用。
该研究突出了ELIs在降低CMPA风险方面的潜在保护作用，特别是在纯母乳喂养的婴儿中。此外，它表明接受pHF喂养的婴儿中AD发病率有降低的趋势，突出了早期微生物暴露、喂养方式和免疫发育之间复杂的相互作用。有必要进行进一步的研究来揭示这种具有挑战性的关系，并为早期生活过敏预防策略提供适当的信息。
