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The Editor recommends this issue's articles to the reader

The Editor recommends this issue's articles to the reader Anti‐infective proteins in breast milk and asthma‐associated phenotypes during early childhood Guicheng Zhang Breastfeeding is widely endorsed to have protective effects against allergies. However the impact of breastfeeding on susceptibility to asthma is highly debateable and a growing body of information derived from birth cohort studies has questioned the validity of this concept. The birth cohort study conducted by Zhang et al. had extensive assessments of respiratory infection within the first 5 years of life. Asthma symptoms and allergy status were also thoroughly investigated at 6 months, 1, 2, 5 and 10 years age in the cohort. In the 137 subjects available who were exclusively breastfed for their first 6 months, they found that levels of the anti‐bacterial proteins IgA and Lactoferrin in breast milk correlated inversely with frequency of upper respiratory infections in the first two years of life. This transient protective effect is consistent with the anti‐infective properties of maternal milk mediated via direct effects of anti‐microbial molecules on incoming pathogens. In contrast, transient positive associations were observed between milk levels of these anti‐bacterial proteins and rates of lower respiratory infections, and with early atopic outcomes such as eczema and atopy defined by skin rick test. Significant associations between asthma risk and anti‐bacterial protein levels in breast milk were not observed. The authors concluded that breast milk feeding may influence the expression of inflammatory symptoms associated with respiratory infections and atopy in early life but these effects appear to be inconsistent and transient. This study provided data supporting that the long‐term benefits of breast milk feeding in relation to these atopy‐ and asthma‐associated phenotypes are limited. The impact of exclusively breast feeding on asthma and allergy should further be clarified. However considering the known benefits of breastfeeding on other conditions in children, current recommendations encouraging breast feeding should remain. Reintroduction failure after negative peanut challenges in children Francine C. van Erp To prevent unnecessary (psychosocial) burden on families with food allergic children, it is important to diagnose the culprit foods accurately. The double blind placebo controlled food challenge (DBPCFC) is considered to be the gold standard. If no objective symptoms to one of the active doses occur, a DBPCFC is considered negative and reintroduction of the challenged food is advised. However, in some children reintroduction fails and despite negative DBCPFC those children and parents may still have a decreased quality of life. In the follow‐up study of Van Erp et al. parents of children with negative DBPCFC for peanut were systematically interviewed about the current diet, symptoms and problems during reintroduction and reactions to peanut after the reintroduction period. Their results point out that reintroduction failure is a common problem in children after negative peanut challenge (32%). Parents continued to carefully read labels of products possibly containing peanut and reported refusal, fear and uncertainty about the diagnosis as reasons for failure. An elimination diet for more than three other foods, a long elimination diet for peanut and peanut related symptoms at home were significant risk factors for reintroduction failure. Based on the results of the present study, the authors strongly advise to guide parents and children and monitor the occurrence of (peanut related) symptoms during follow‐up after food challenges. Moreover, when typical food allergic symptoms re‐occur revision of food challenge outcome should be considered. Autoimmune disease comorbidities in patients with atopic dermatitis: a nationwide case–control study in Taiwan Lung‐Chi Wu As we all know, the immunological aberrations play a fundamental role in the pathogenesis of atopic dermatitis (AD) in addition to the intricate interactions among genetic mutation, skin barrier dysfunction and environmental factors. It is been an interesting question that whether the immunological aberrations make AD patients more susceptible to other autoimmune diseases. Unfortunately, only one descriptive cross‐sectional study in previous literature demonstrated the association between AD and autoimmune diseases. In this study, Lung‐chi and Chian‐Yaw et al. adopted the National Health Insurance Research Database (NHIRD) from the National Health Insurance (NHI) program, a public healthcare system enrolled more than 99% population in Taiwan, to examine the association of AD and several autoimmune diseases. In total, 41,950 patients with AD (19,175 males and 22,775 females) were identified. Four age‐ and gender‐matched individuals without AD were randomly selected for each study subject to serve as the control group. The authors found the study subjects had higher prevalence of asthma, allergic rhinitis, lupus erythematosus (LE), rheumatoid arthritis, and diabetes mellitus than control group. They further evaluated the association of AD and autoimmune diseases by multivariate analyses. Patients with AD have significantly higher risk of LE and it is more prominent in females than males. The risk of thyroid disease only significantly increased in male AD subjects. They also performed age‐stratified analysis to elucidate the relationship between the onset age of AD and various autoimmune diseases, The results showed that patients younger than or equal to 18 years had higher risk of LE, particular in female subjects when compared with control group. In conclusion, patients with AD, especially female patients, are at increased risk of LE, and those aged younger than 18 years are at even higher risk. Clinicians should be alert to this condition to avoid misdiagnosing LE in these populations at risk. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Allergy and Immunology Wiley

The Editor recommends this issue's articles to the reader

Pediatric Allergy and Immunology , Volume 25 (6) – Oct 1, 2014
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References (3)

Publisher
Wiley
Copyright
"Copyright © 2014 John Wiley & Sons A/S"
ISSN
0905-6157
eISSN
1399-3038
DOI
10.1111/pai.12293
Publisher site
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Abstract

Anti‐infective proteins in breast milk and asthma‐associated phenotypes during early childhood Guicheng Zhang Breastfeeding is widely endorsed to have protective effects against allergies. However the impact of breastfeeding on susceptibility to asthma is highly debateable and a growing body of information derived from birth cohort studies has questioned the validity of this concept. The birth cohort study conducted by Zhang et al. had extensive assessments of respiratory infection within the first 5 years of life. Asthma symptoms and allergy status were also thoroughly investigated at 6 months, 1, 2, 5 and 10 years age in the cohort. In the 137 subjects available who were exclusively breastfed for their first 6 months, they found that levels of the anti‐bacterial proteins IgA and Lactoferrin in breast milk correlated inversely with frequency of upper respiratory infections in the first two years of life. This transient protective effect is consistent with the anti‐infective properties of maternal milk mediated via direct effects of anti‐microbial molecules on incoming pathogens. In contrast, transient positive associations were observed between milk levels of these anti‐bacterial proteins and rates of lower respiratory infections, and with early atopic outcomes such as eczema and atopy defined by skin rick test. Significant associations between asthma risk and anti‐bacterial protein levels in breast milk were not observed. The authors concluded that breast milk feeding may influence the expression of inflammatory symptoms associated with respiratory infections and atopy in early life but these effects appear to be inconsistent and transient. This study provided data supporting that the long‐term benefits of breast milk feeding in relation to these atopy‐ and asthma‐associated phenotypes are limited. The impact of exclusively breast feeding on asthma and allergy should further be clarified. However considering the known benefits of breastfeeding on other conditions in children, current recommendations encouraging breast feeding should remain. Reintroduction failure after negative peanut challenges in children Francine C. van Erp To prevent unnecessary (psychosocial) burden on families with food allergic children, it is important to diagnose the culprit foods accurately. The double blind placebo controlled food challenge (DBPCFC) is considered to be the gold standard. If no objective symptoms to one of the active doses occur, a DBPCFC is considered negative and reintroduction of the challenged food is advised. However, in some children reintroduction fails and despite negative DBCPFC those children and parents may still have a decreased quality of life. In the follow‐up study of Van Erp et al. parents of children with negative DBPCFC for peanut were systematically interviewed about the current diet, symptoms and problems during reintroduction and reactions to peanut after the reintroduction period. Their results point out that reintroduction failure is a common problem in children after negative peanut challenge (32%). Parents continued to carefully read labels of products possibly containing peanut and reported refusal, fear and uncertainty about the diagnosis as reasons for failure. An elimination diet for more than three other foods, a long elimination diet for peanut and peanut related symptoms at home were significant risk factors for reintroduction failure. Based on the results of the present study, the authors strongly advise to guide parents and children and monitor the occurrence of (peanut related) symptoms during follow‐up after food challenges. Moreover, when typical food allergic symptoms re‐occur revision of food challenge outcome should be considered. Autoimmune disease comorbidities in patients with atopic dermatitis: a nationwide case–control study in Taiwan Lung‐Chi Wu As we all know, the immunological aberrations play a fundamental role in the pathogenesis of atopic dermatitis (AD) in addition to the intricate interactions among genetic mutation, skin barrier dysfunction and environmental factors. It is been an interesting question that whether the immunological aberrations make AD patients more susceptible to other autoimmune diseases. Unfortunately, only one descriptive cross‐sectional study in previous literature demonstrated the association between AD and autoimmune diseases. In this study, Lung‐chi and Chian‐Yaw et al. adopted the National Health Insurance Research Database (NHIRD) from the National Health Insurance (NHI) program, a public healthcare system enrolled more than 99% population in Taiwan, to examine the association of AD and several autoimmune diseases. In total, 41,950 patients with AD (19,175 males and 22,775 females) were identified. Four age‐ and gender‐matched individuals without AD were randomly selected for each study subject to serve as the control group. The authors found the study subjects had higher prevalence of asthma, allergic rhinitis, lupus erythematosus (LE), rheumatoid arthritis, and diabetes mellitus than control group. They further evaluated the association of AD and autoimmune diseases by multivariate analyses. Patients with AD have significantly higher risk of LE and it is more prominent in females than males. The risk of thyroid disease only significantly increased in male AD subjects. They also performed age‐stratified analysis to elucidate the relationship between the onset age of AD and various autoimmune diseases, The results showed that patients younger than or equal to 18 years had higher risk of LE, particular in female subjects when compared with control group. In conclusion, patients with AD, especially female patients, are at increased risk of LE, and those aged younger than 18 years are at even higher risk. Clinicians should be alert to this condition to avoid misdiagnosing LE in these populations at risk.

Journal

Pediatric Allergy and Immunology – Wiley

Published: Oct 1, 2014

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