Szoptatás és allergia

Valóban meg kell-e kezdeni a hozzátáplálást 6 hónapos kor előtt?

A La Leche Liga angliai szervezetének válasza a British Medical Journal című orvosi szaklapban 2011 januárjában megjelent cikkre, amely megkérdőjelezi a hozzátáplálás nem korábban, mint 6 hónapos korban való elkezdésére vonatkozó eddigi ajánlásokat

A La Leche Liga már több mint 50 éve nyújt információt és támogatást azoknak a szülőknek, akik szoptatni szeretnék gyermeküket. Munkája során osztja a WHO, az Egészségügyi Minisztérium és más mértékadó szervezetek azon nézeteit, miszerint a csecsemők optimális növekedését, fejlődését és egészségét az szolgálja legjobban, ha életük első 6 hónapjában kizárólag szopnak. Ezután pedig a szoptatást kiegészítve kapjanak a kisbabák megfelelő minőségű ételeket, hogy növekvő, változó táplálékigényüket kielégíthessék.

Clinical practice: Breastfeeding and the prevention of allergy

Kneepkens CM, Brand PL.
Eur J Pediatr. 2010 Aug;169(8):911-7.

Abstract

The increase in allergic disease prevalence has led to heightened interest in the factors determining allergy risk, fueled by the hope that by influencing these factors one could reduce the prevalence of allergic conditions. The most important modifiable risk factors for allergy are maternal smoking behaviour and the type of feeding.

Chronic disease and infant nutrition: is it significant to public health?

Smith JP, Harvey PJ.
Public Health Nutr. 2010 Jul 13:1-11.

Abstract

OBJECTIVE: To assess the public health significance of premature weaning of infants from breast milk on later-life risk of chronic illness.

Breast-feeding in relation to asthma, lung function, and sensitization in young schoolchildren

Kull I, Melen E, Alm J, Hallberg J, Svartengren M, van Hage M, Pershagen G, Wickman M, Bergström A.
J Allergy Clin Immunol. 2010 May;125(5):1013-9.

Abstract

Background The evidence from previous studies on beneficial effects of breast-feeding in relation to development of asthma is conflicting.

ObjectiveTo investigate the relation between breast-feeding and asthma and/or sensitization during the first 8 years of life.

Breastfeeding and atopic dermatitis: protective or harmful? facts and controversies

Alan M. Dattner MD
Clinics in Dermatology Volume 28, Issue 1, January 2010, Pages 34-37

Abstract

Conventional wisdom posits that breastfeeding during the first 4 months of life generally reduces the incidence of atopic dermatitis in the child. Recent studies question this truism, especially in cases when the mother herself is allergic.

Breastfeeding and the prevalence of allergic diseases in schoolchildren: Does reverse causation matter?

Kusunoki T, Morimoto T, Nishikomori R, Yasumi T, Heike T, Mukaida K, Fujii T, Nakahata T.
Pediatr Allergy Immunol. 2010 Jan 14.

Abstract

Infants at higher risk of allergic diseases might be breastfed for longer periods compared with infants at lower risk in the hope that breastfeeding might reduce the risk of atopic disorders. Therefore, this intention could manifest as an apparent allergy-promoting effect of breastfeeding or reverse causation.

Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper

Grimshaw KE et al.
Allergy. 2009 Oct;64(10):1407-16.

Abstract

The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

A korai táplálkozás hatása a csecsemő-és gyermekkori atópiás megbetegedések kialakulására

Az anyai diéta, a szoptatás, a hidrolizált tápszerek, és a kiegészítő táplálékok bevezetése időpontjának szerepe

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

Frank R. Greer, MD, Scott H. Sicherer, MD, A. Wesley Burks, MD and the Committee on Nutrition and Section on Allergy and Immunology

http://pediatrics.aappublications.org/cgi/content/full/121/1/183

Bevezetés

Az elmúlt néhány évtizedben drasztikusan megnőtt az atópiás betegségek előfordulása. A 4 év alatti gyermekek körében az aszthma előfordulása 160%-kal nőtt, az atópiás dermatitisz pedig 2-3-szorosára.1 Az elmúlt évtizedben a földimogyoró allergiások száma megduplázódott. (USA)2 Emiatt az allergia egyre növekvő problémaként jelentkezik.

Felismerték, hogy a korai gyermekkori történések, mint például a táplálkozás, valószínűleg fontossággal bírnak a későbbi gyermekkori illetve felnőttkori betegségek kialakulása szempontjából. Ez a klinikai beszámoló áttekinti a várandósság és szoptatás alatti illetve az első életév során kínálkozó táplálkozási lehetőségeket, amelyek hatással lehetnek az atópiás betegségek kialakulására. Bár az atópiás betegségeknek nyilvánvaló genetikai alapjuk van, a környezeti tényezők, mint például a korai csecsemőtáplálás jelentős hatással lehetnek a kialakulásukra, és ilyen módon lehetőséget kínálnak a betegség fellépésének elkerülésére vagy késleltetésére.

Ez a jelentés az Amerika Gyermekgyógyászati Akadémia (AAP) korábbi, a hypoallergén tápszerek használatáról szóló állásfoglalásának3 helyébe lép, amely ideiglenes javaslatokat tartalmazott arra vonatkozóan is, hogy milyen táplálkozási irányelveket érdemes követni az atópiás betegségek megelőzésére.

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children

Frank R. Greer, MD, Scott H. Sicherer, MD, A. Wesley Burks, MD and the Committee on Nutrition and Section on Allergy and Immunology

PEDIATRICS Vol. 121 No. 1 January 2008, pp. 183-191

Abstract

This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use of hypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease.

Immunomodulatory constituents of human milk change in response to infant bronchiolitis

Dani-Louise Bryan, Prue H. Hart, Kevin D. Forsyth, Robert A. Gibson (2007)
Pediatric Allergy and Immunology 18 (6), 495–502

Abstract

Although epidemiological evidence is generally supportive of a causal association between respiratory syncytial virus (RSV) bronchiolitis during infancy and the development of persistent wheeze/asthma, if not allergy, the mechanism by which this occurs and an explanation for why all children do not succumb remains to be elucidated. Breast feeding has been found to confer a protective effect against respiratory infections such as RSV bronchiolitis and allergy; however, again there is little direct evidence and no clear mechanism. In this study, we examined whether human milk immunomodulatory factors (cells, cytokines) change in response to clinically diagnosed, severe bronchiolitis in the recipient breast-fed infant.

Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries

Stanley Ip, M.D., Mei Chung, M.P.H., Gowri Raman, M.D., Priscilla Chew, M.P.H., Nombulelo Magula, M.D., Deirdre DeVine, M.Litt., Thomas Trikalinos, M.D., Ph.D., Joseph Lau, M.D.

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, April 2007

Structured Abstract

Objectives: We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries.

Data Sources: We searched MEDLINE®, CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were searched through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts.

Food allergy and the introduction of solid foods to infants: a consensus document

Alessandro Fiocchi MD; Amal Assa'ad MD; Sami Bahna MD

Annals of Allergy, Asthma and Immunology 2006, vol. 97, no. 1, pp. 10 - 21

Abstract

Objective: To make recommendations based on a critical review of the evidence for the timing of the introduction of solid foods and its possible role in the development of food allergy.

Data Sources: MEDLINE searches using the following search algorithm: [weaning AND infant AND allergy]/[food allergy AND sensitization]/[dietary prevention AND food allergy OR allergens]/[Jan 1980-Feb 2006].

Study Selection: Using the authors' clinical experience and research expertise, 52 studies were retrieved that satisfied the following conditions: English language, journal impact factor above 1 or scientific society, expert, or institutional publication, and appraisable using the World Health Organization categories of evidence.

Vitamin C in breast milk may reduce the risk of atopy in the infant

U Hoppu, M Rinne, P Salo-Väänänen, A-M Lampi, V Piironen and E Isolauri

European Journal of Clinical Nutrition (2005) 59, 123−128

Abstract

Objective: To assess the effects of maternal dietary and supplement intake of vitamins C and E on breast milk antioxidant composition (vitamin C, alpha-tocopherol and beta-carotene) and their protective potential against the development of atopy in the infant.

The association of prolonged breastfeeding and allergic disease in poor urban children

C. C. Obihara, B. J. Marais, R. P. Gie1, P. Potter, E. D. Bateman, C. J. Lombard, N. Beyers and J. L. L. Kimpen

Eur Respir J 2005; 25:970-977

The fact that breastfeeding may protect against allergic disease remains controversial, with hardly any reports from developing countries. This study investigated the association between allergic disease in children and prolonged breastfeeding.

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