Food, drug, insect sting allergy, and anaphylaxis
Increased food diversity in the first year of life is inversely associated with allergic diseases

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Background

The role of dietary factors in the development of allergies is a topic of debate, especially the potential associations between infant feeding practices and allergic diseases. Previously, we reported that increased food diversity introduced during the first year of life reduced the risk of atopic dermatitis.

Objective

In this study we investigated the association between the introduction of food during the first year of life and the development of asthma, allergic rhinitis, food allergy, or atopic sensitization, taking precautions to address reverse causality. We further analyzed the association between food diversity and gene expression of T-cell markers and of Cε germline transcript, reflecting antibody isotype switching to IgE, measured at 6 years of age.

Methods

Eight hundred fifty-six children who participated in a birth cohort study, Protection Against Allergy Study in Rural Environments/EFRAIM, were included. Feeding practices were reported by parents in monthly diaries during the first year of life. Data on environmental factors and allergic diseases were collected from questionnaires administered from birth up to 6 years of age.

Results

An increased diversity of complementary food introduced in the first year of life was inversely associated with asthma with a dose-response effect (adjusted odds ratio with each additional food item introduced, 0.74 [95% CI, 0.61-0.89]). A similar effect was observed for food allergy and food sensitization. Furthermore, increased food diversity was significantly associated with an increased expression of forkhead box protein 3 and a decreased expression of Cε germline transcript.

Conclusion

An increased diversity of food within the first year of life might have a protective effect on asthma, food allergy, and food sensitization and is associated with increased expression of a marker for regulatory T cells.

Section snippets

Study design and population

The PASTURE/EFRAIM study is a prospective birth cohort involving children from rural areas in 5 European countries (Austria, Finland, France, Germany, and Switzerland) designed to evaluate risk factors and preventive factors for atopic diseases.15 Pregnant women were recruited during the third trimester of pregnancy between August 2002 and March 2005 and divided into 2 groups. Women who lived on family-run farms where any kind of livestock was kept were assigned to the farm group. Women from

Characteristics and prevalence of allergic diseases

Among the 856 children included in this study, 51.5% were farmer children, and 53.6% had at least 1 allergic parent (Table I). The description of food diversity was mentioned in our previous study.14 Farmer children received a higher number of different food items in the first year of life compared with nonfarmer children. Differences between centers were observed regarding the diversity score, with a higher proportion of French and German children having a low score. A higher proportion of

Discussion

Our data show that an increased diversity of food introduced in children's diet within the first year of life is negatively associated with the development of asthma and food allergy up to 6 years of age and on sensitization to food allergens at 4.5 or 6 years of age. Moreover, among children with a low food diversity score, we found an increased expression of marker for antibody isotype switching to IgE and a reduced expression of the regulatory T cell–associated gene Foxp3 measured at 6 years

References (30)

  • A.N. Payne et al.

    The composition and metabolic activity of child gut microbiota demonstrate differential adaptation to varied nutrient loads in an in vitro model of colonic fermentation

    FEMS Microbiol Ecol

    (2012)
  • C. De Filippo et al.

    Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa

    Proc Natl Acad Sci U S A

    (2010)
  • R. Frei et al.

    Microbiota and dietary interactions: an update to the hygiene hypothesis?

    Allergy

    (2012)
  • C.E. West et al.

    Role of diet in the development of immune tolerance in the context of allergic disease

    Curr Opin Pediatr

    (2010)
  • C. Agostoni et al.

    Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition

    J Pediatr Gastroenterol Nutr

    (2008)
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    Supported by European Union research grants PASTURE/EFRAIM (QRLT4-CT 2001-00250, KBBE-2-2-06) and the Kühne Foundation.

    Disclosure of potential conflict of interest: M. Depner has received one or more grants from or has one or more grants pending with the European Research Council. B. Schaub has received one or more grants from or has one or more grants pending with DFG, European Union. J. Genuneit has been supported by one or more grants from the European Union. J.-C. Dalphin has received one or more consulting fees or honoraria from and has received support for travel from Chiesi; has consultancy arrangements with Novartis and Intermune; has received one or more grants from or has one or more grants pending with Novartis; has received one or more payments for lecturing from or is on the speakers' bureau for Novartis, GlaxoSmithKline, AstraZeneca, and Chiesi; has received one or more payments for the development of educational presentations for Novartis, Chiesi, GlaxoSmithKline, AstraZeneca, Intermune, and Boehringer Ingelheim; and has received one or more payments for travel/accommodations/meeting expenses from Novartis, Chiesi, and GlaxoSmithKline. E. von Mutius has been supported by one or more grants from the European Commission; is a Board member for the American Academy of Allergy, Asthma & Immunology; has consultancy arrangements with GlaxoSmithKline, Novartis, Protectimmun, ALK-Abelló, and Astellas Pharma Europe; has provided expert testimony for the UK Research Excellence Framework; and has received one or more payments for lecturing from or is on the speakers' bureau for InfectoPharm and for Nestlé Research. R. Lauener has been supported by a European Union Research Grant and a Kühne Foundation Research Grant; has received support for travel from the European Union and from the Kühne Foundation; has consultancy arrangements with the National Advisory Boards of ALK-Abelló, Nestlé, Novartis, MSD, MEDA, Allergopharma, and Menarini; has received one or more grants from or has one or more grants pending with Study Nestec; and has received one or more payments for lecturing from or is on the speakers' bureau for ALK-Abelló and for Nestlé. The rest of the authors declare that they have no relevant conflicts of interest.

    The members of the PASTURE study group are (in alphabetical order by study center): Maija-Riitta Hirvonen, Sami Remes, Marjut Roponen, and Pekka Tiittanen (Finland); Marie-Laure Dalphin and Vincent Kaulek (France); Gisela Büchele, Markus Ege, Michael Kabesch, and Harald Renz (Germany); and Gert Doekes (The Netherlands).

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