Effects of regular soy formula intake between 1 and 2 months of age on food sensitization in infancy.

BACKGROUND: The effects of regular soy formula (SF) intake on the development of food sensitization in infancy remain unclear. This study aimed to assess the effects of regular SF intake between 1 and 2 months of age on food sensitization development by 6 months of age. METHODS: Using data from a randomized controlled trial of a birth cohort from four Japanese hospitals that assessed cow's milk allergy development, we performed a retrospective cohort study of 235 infants who avoided cow's milk formula and supplemented breastfeeding with SF as required between 1 and 2 months of age. Regular SF intake was defined as SF consumption of ≥14 days per month and ≥1350 ml per month. Food sensitization was defined as positive skin prick test reactions to hen's egg, cow's milk, wheat, and/or soy. Using multivariable logistic regression models that adjusted for parental, perinatal, and environmental factors, we calculated the adjusted odds ratios of regular SF intake for food, hen's egg, and cow's milk sensitization by 6 months of age. RESULTS: From the 235 participants, 114 (48.5%) had regular SF intake. The adjusted odds ratios of regular SF intake for food, hen's egg, and cow's milk sensitization were 0.32 (95% confidence interval: 0.16-0.62, p = .0007), 0.42 (0.20-0.88, p = .02), and 0.33 (0.14-0.81, p = .02), respectively. CONCLUSION: Regular SF intake between 1 and 2 months of age in infants avoiding cow's milk formula was significantly associated with a reduced risk of food sensitization in infancy.

Effects of delivery mode and labor duration on the development of food sensitization in infancy.

BACKGROUND: The effects of delivery mode and labor duration on the development of food sensitization (FS) in infancy remain unclear. OBJECTIVE: To elucidate the potential effects of delivery mode and labor duration on FS development by 6 months of age. METHODS: Using data from a randomized controlled trial of a birth cohort from 4 Japanese hospitals that assessed cow's milk allergy development by 6 months of age, we performed a nested case-control trial of 462 participants who had undergone the final assessment at 6 months of age. FS was defined as positive skin prick test reactions to hen's egg, cow's milk, wheat, or soy. For the primary outcome, we calculated the adjusted odds ratio of vaginal delivery (VD) relative to cesarean delivery for FS development by 6 months of age using a multivariable logistic regression analysis. For the secondary outcome, we compared labor durations between participants with and without FS using the Mann-Whitney U test. RESULTS: The adjusted odds ratio of VD for FS development was 2.54 (95% confidence interval, 1.32-4.87; P = .005). The median labor duration was significantly longer in participants with FS (5.7 hours, interquartile range, 2.7-10.1) than in participants without FS (4.5 hours, 1.1-8.2) (P = .01). CONCLUSION: VD was considerably associated with an increased risk of FS in infancy, and longer labor durations may promote FS development.

Randomized trial of early infant formula introduction to prevent cow's milk allergy.

BACKGROUND: Previous research has produced conflicting evidence on the preventive effects of early introduction of cow's milk protein on cow's milk allergy (CMA). OBJECTIVE: Through a randomized controlled trial, we sought to determine whether the early introduction of cow's milk formula (CMF) could serve as an effective strategy in the primary prevention of CMA in a general population. METHODS: We recruited newborns from 4 hospitals in Okinawa, Japan. Participants were randomly allocated to ingest at least10 mL of CMF daily (ingestion group) or avoid CMF (avoidance group) between 1 and 2 months of age. In the avoidance group breast-feeding was supplemented with soy formula as needed. Oral food challenge was performed at 6 months of age to assess CMA development. Continuous breast-feeding was recommended for both groups until 6 months of age. RESULTS: We identified 504 infants for randomization into the 2 groups. In all, the parents of 12 participants declined to receive the intervention, and the study sample comprised 491 participants (242 in the ingestion group and 249 in the avoidance group) for a modified intention-to-treat analysis. There were 2 CMA cases (0.8%) among the 242 members of the ingestion group and 17 CMA cases (6.8%) among the 249 participants in the avoidance group (risk ratio = 0.12; 95% CI = 0.01-0.50; P < .001). The risk difference was 6.0% (95% CI = 2.7-9.3). Approximately 70% of the participants in both groups were still being breast-fed at 6 months of age. CONCLUSIONS: Daily ingestion of CMF between 1 and 2 months of age prevents CMA development. This strategy does not compete with breast-feeding.

[A case of anaphylaxis caused by enokitake (Flammulina velutipes) ingestion].

Enokitake (Flammulina velutipes, winter mushroom) is a common edible mushroom in Japan. We experienced a case of anaphylaxis after enokitake ingestion. There are no reports describing anaphylaxis caused by the ingestion of this mushroom. Enokitake allergen has also not been reported. We thus attempted to identify enokitake allergen using the patient's serum. The patient was a seventeen-year-old woman who had had no episodes of food allergy and experienced anaphylaxis after the ingestion of sukiyaki (beef, pork, tofu, vegetables, enokitake, etc.). She had previously eaten sukiyaki (the same ingredients) without any symptoms. The result of enokitake skin prick to prick test was positive. Oral food challenge was positive, inducing anaphylaxis. We performed western blotting with enokitake extract and the patient's serum. Three enokitake protein bands (18 kDa, 39 kDa, 50 kDa) reacted specifically with the patient's IgE.

Continuous cow's milk protein ingestion during infancy may promote casein-specific IgG4 production.

Background: Early supplementation and subsequent discontinuation of cow's milk formula (CMF) may increase the risk of cow's milk allergy in breast-fed infants, but little is known about the relationship between continuous CMF ingestion and cow's milk protein-specific immunoglobulin production. Objective: This study aimed to clarify the aforesaid relationship in cow's milk-sensitized infants. Methods: Using data from a randomized controlled trial of a Japanese birth cohort, we performed a subgroup analysis of participants who had ingested CMF in the first 3 days of life and exhibited a positive skin prick test response to cow's milk at age 6 months. We compared the differences in median titers of cow's milk-specific IgE, casein-specific IgE, and casein-specific IgG4 levels between participants who continued daily or intermittent CMF ingestion up to age 6 months (the "continuous group") and participants who discontinued CMF ingestion before age 6 months (the "discontinued group"). Results: From among 462 trial participants, 49 (10.6%) were included in this study (21 in the continuous group and 29 in the discontinued group). The median titer of cow's milk-specific IgE was 0.17 kUA/L (interquartile range [IQR] = <0.10 to 0.57) in the continuous group and 0.66 kUA/L (IQR = 0.49-1.18) in the discontinued group (P = .0008). The median titer of casein-specific IgE was <0.10 kUA/L (IQR = <0.10 to 0.15) in the continuous group and <0.10 kUA/L (IQR = <0.10 to 0.37) in the discontinued group (P = .51). The median titer of casein-specific IgG4 was 2.58 mgA/L (IQR = 0.77-6.73) in the continuous group and 0.09 mgA/L (IQR = 0.07-0.13) in the discontinued group (P < .0001). Conclusion: Continuous CMF ingestion may promote casein-specific IgG4 production in cow's milk-sensitized infants.

Early Discontinuation of Cow's Milk Protein Ingestion Is Associated with the Development of Cow's Milk Allergy.

BACKGROUND: Although early supplementation with cow's milk formula (CMF) reportedly increases the risk of cow's milk allergy (CMA) in breast-fed infants, little is known about the association between the timing of CMF discontinuation and subsequent CMA development. OBJECTIVE: To elucidate the relationship between the timing of CMF discontinuation and CMA development in infants who received CMF in the early days of life. METHODS: Using data from a randomized controlled trial of a birth cohort from 4 Japanese hospitals, we performed a subgroup analysis of participants who ingested CMF in the first 3 days of life. We compared the proportions of participants who developed CMA at age 6 months in those who discontinued CMF ingestion before age 1 month ("DISC <1-month group"), during age 1 to 2 months ("DISC 1-2-month group"), and during age 3 to 5 months ("DISC 3-5-month group") with those who continued CMF ingestion until age 6 months ("continuous group"). The risk ratios (RRs) and 95% CIs for CMA development were calculated. RESULTS: CMA incidence was significantly higher in the DISC <1-month group (n = 7 of 17, 41.2%; RR, 65.7; 95% CI, 14.7-292.5; P < .001), DISC 1-2-month group (n = 3 of 26, 11.5%; RR, 18.4; 95% CI, 3.2-105.3; P = .003), and DISC 3-5-month group (n = 7 of 69, 10.1%; RR, 16.2; 95% CI, 3.4-76.2; P < .001) than in the continuous group (n = 2 of 319, 0.6%). CONCLUSIONS: Early CMF discontinuation, particularly in the first month of life, was associated with CMA development in infants who received CMF in the first 3 days of life.

[Clinical evaluation of ω-5 gliadin-specific IgE test].

OBJECTIVE: To reveal the clinical utility of an IgE test specific to ω-5 gliadin in the diagnosis of immediate-type wheat allergy. METHODS: We detected ω-5 gliadin-specific IgE in sera from all patients examined for wheat-specific IgE in our allergy clinic between January and October, 2008. The diagnostic value of the test was analyzed against the true diagnosis of wheat allergy based on oral wheat challenge or convincing clinical history. Subjects comprised 233 patients (median age, 3.6 years), 59 patients were diagnosed with wheat allergy, and 174 were judged to have no wheat allergy. RESULTS: The prevalence of being diagnosed as wheat allergy was 68% in the patients with CAP score 2 to ω-5 gliadin IgE (n=31), and 87% in those with CAP score 3 (n=15). All of the 3 patients with CAP score 4 or more were wheat allergic. However, 24% of patients with wheat allergy showed negative results (<0.35 UA/ml). According to the data, we proposed the probability curve of ω-5 gliadin-specific IgE. CONCLUSIONS: IgE testing specific to ω-5 gliadin can offer a useful clinical marker for the diagnosis of immediate-type wheat allergy. But the data should always be evaluated with wheat-specific IgE titers, because of the low clinical sensitivity to detect the patients with wheat allergy.

[Effects of "Skin Care School," a parental education program on childhood atopic dermatitis conducted during short hospitalization stays].

BACKGROUND: We have been conducting a two-day in-hospital parental education program -"Skin Care School"- on childhood atopic dermatitis since April 2007. The program comprises three lecture- and- practical session courses on skin care, the correct skin-cleaning procedure, and the application of ointments based on the "Finger Tip Unit." The program addresses caregivers of patients less than six years old suffering from moderate to severe atopic dermatitis. METHODS: To evaluate the effectiveness of this program, questionnaires were administered to 56 participants before, immediately after, one month after, and six months after completion of the program. RESULTS: Although the participants had received doctors' instructions on the amount of the ointments to be applied, most of them recognized on completing the program that they had been applying less amounts than prescribed. They added that the symptoms of the skin conditions, such as pruritus and sleeplessness, improved in one month after proper application and stabilized for six months. Moreover, the amounts of topical corticosteroid ointments required decreased following one month of treatment and reduced further in six months. CONCLUSION: This educational program was effective in imparting a sound understanding of skin care to the caregivers during their wards' short hospitalization. Appropriate skin care comprises cleaning the skin properly and applying adequate amounts of corticosteroid ointment and skin moisturizer, which results in improvements in conditions like eczema and a reduced requirement for corticosteroids.