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Asthma and Diet in Early Childhood

A guide for health professionals

Current suggestions   
Quality of the evidence   
Identifying high-risk infants
Maternal diet during lactation
Polyunsaturated fatty acids 
Probiotics  
Levels of evidence 
References    
Content created MAR 2005
Content updated MAR 2005

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NextBackLevels of evidence

I           Evidence obtained from a systematic review of all relevant randomised controlled trials
II Evidence obtained from at least one properly designed randomised controlled trial
III-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method)
III-2 Evidence obtained from comparative studies with concurrent controls and allocation not randomised (cohort studies), case-control studies, or interrupted time series with a control group
III-3 Evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group
IV Evidence obtained from case series, either post-test or pre-test and post-test  

These levels of evidence ratings have been adapted from US Preventive Services Task Force (1989) Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions (ed M Fisher), Williams and Williams, Baltimore, Appendix A, p 388.

Source: NHMRC. 1999.
A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines. Commonwealth of Australia.

References

1 Tang MLK. 2002. Is prevention of childhood asthma possible? Allergens, infections and animals. MJA 177(Suppl): S75-S77.
2 Mellis CM. 2002. Is asthma prevention possible with dietary manipulation? MJA 177(Suppl): S78-S80.
3 Peat JK. 1996. Prevention of asthma. Eur J Respir 9: 1545-55.
4 Peat JK, Mellis CM. 2002. Early predictors of asthma. Curr Opin Allergy Clin Immunol 2: 167-73.
5 Peroni DG, Chatzimichail A, Boner AL. 2002. Food allergy: what can be done to prevent progression to asthma? Ann Allergy Asthma Immunol 89(Suppl): 44-51.
6 Mallet E, Henocq A. 1992. Long-term prevention of allergic diseases by using protein hydrolysate formula in at-risk infants. J Pediatr 121: S95-S100.
7 Chandra RK, Hamed A, Prasad C et al. 1997. Five-year follow-up of high-risk infants with family history of allergy who were exclusively breast fed or fed partial whey hydrolysate, soy and conventional cow’s milk formulas. J Pediatr Gastroenterol Nutr 24: 380-88.
8 Kull I, Wickman M, Lilja G et al. 2002. Breast feeding and allergic diseases in infants — a prospective birth cohort study. Arch Dis Child 87: 478-81.
9 Kramer MS, Kakuma R. 2004. Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
10 Osborn DA, Sinn J. 2004. Formulas containing hydrolysed protein for the prevention of allergy and food intolerance in infants (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
11 Oddy W, Holt P, Sly P et al. 1999. Association between breastfeeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 319: 815-19.
12 Oddy WH. 2000. Breastfeeding and asthma in children: findings from a West Australian study. Breastfeed Rev 8: 5-11.
13 Dell S, To T. 2001. Breastfeeding and asthma in young children: findings from a population-based study. Arch Pediatr Adolesc Med 155: 1261-65.
14 Gdalevich M, Mimouni D, Mimouni M. 2001. Breastfeeding and the risk of bronchial asthma in childhood: a systematic review and meta-analysis of prospective studies. J Pediatrics 139: 261-66.
15  Oddy WH, de Klerk NH, Sly PD et al. 2002. The effects of respiratory infections, atopy, and breastfeeding on childhood asthma. Eur Respir J 19: 899-905.
16 Oddy WH, Peat JK, de Klerk NH. 2002. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol 110: 65-67.
17 Oddy WH, Peat JK. 2003. Breastfeeding, asthma, and atopic disease: an epidemiological review of the literature. J Hum Lact 19: 250-61.
18 Chulada PC, Arbes SR Jr, Dunson D et al. 2003. Breast-feeding and the prevalence of asthma and wheeze in children: analyses from the Third National Health and Nutrition Examination Survey, 1988-1994. J Allergy Clin Immunol 111: 328-36.
19 Ram FSF, Ducharme FM, Scarlett J. 2004. Cow’s milk protein avoidance and develop-ment of childhood wheeze in children with a family history of atopy (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
20 Mihrshahi S, Peat JK, Webb K et al. 2001. The childhood asthma prevention study (CAPS): design and research protocol of a randomized trial for the primary prevention of asthma. Control Clin Trials 22: 333-54.
21 Dunstan JA, Mori TA, Barden A et al. 2003. Maternal fish oil supplementation in pregnancy reduces interleukin-13 levels in cord blood of infants at high risk of atopy. Clin Exp Allergy 33: 442-48.
22 Dunstan JA, Mori TA, Barden A et al. 2003. Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomised, controlled trial. J Allergy Clin Immunol 112: 1178-84.
23 Haby MM, Peat JK, Marks GB et al. 2001. Asthma in preschool children: prevalence and risk factors. Thorax 56: 589-95.
24 Bolte G, Frye C, Hoelscher B et al. 2001. Margarine consumption and allergy in children. Am J Respir Crit Care Med 163: 277-79.
25 Kankaanpää P, Nurmela K, Erkkilä A et al. 2001. Polyunsaturated fatty acids in maternal diet, breast milk, and serum lipid fatty acids of infants in relation to atopy. Allergy 2001 56: 633-38.
26 Duchén K. 2001. Are human milk polyunsaturated fatty acids (PUFA) related to atopy in the mother and her child. Allergy 56: 587-92.
27 Kalliomaki M, Salminen S, Arvilommi H et al. 2001. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet 357: 1076-79.
28 Laiho K, Owehand A, Salminen S. 2002. Inventing probiotic functional foods for patients with allergic disease. Ann Allergy Asthma Immunol 89(Suppl): 75-82.
29 Kalliomaki M, Isolauri E. 2003. Role of intestinal flora in the development of allergy. Curr Opin Allergy Clin Immunol 3: 15-20.
30 Hatakka K, Savilahti E, Pönkä A et al/ 2001. Effect of long term consumption of probiotic milk on infections in children attending day centres: double blind, randomised trial. BMJ 322: 1327-29.
31 Wanke CA. 2001. Do probiotics prevent childhood illness? BMJ 322: 1318-19.
32 Kalliomaki M, Salminen S, Poussa T. 2003. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 361: 1869-71.
33 Rautava S, Kalliomaki M, Isolauri E. 2002. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol 109: 119-21.
34 Peat JK, Mihrshahi S, Kemp AS et al. In press. Three year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study (CAPS). J Allergy Clin Immunol.
35 Kramer MS, Kakuma R. 2004. Optimal duration of exclusive breastfeeding (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
36 Peat JK, Li J. 1999. Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol 103: 1-10.
37 Oddy WH. 2002. The impact of breastmilk on infant and child health. Breastfeed Rev 10: 5-18.
38  NHMRC. 2003. Dietary Guidelines for Children and Adolescents in Australia incorporating the Infant Feeding Guidelines for Health Workers. Commonwealth of Australia.
39 Butte NF, Lopez-Alarcon MG, Garza C. 2002. Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant during the First Six Months of Life. World Health Organization.
40 van Odijk J, Kull I, Borres MP et al. 2003. Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy 58: 833-43.
41 Sears MR, Greene JM, Willan AR et al. 2002. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 360: 901-07.
42 Wright AL, Holberg CJ, Taussig LM et al. 2001. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax 56: 192-97.
43 Kemp A & Kakakios. 2004. Asthma prevention: breast is best? J Paediatr Child Health 40: 337-39.
44 Black PN, Sharp S. 1997. Dietary fat and asthma: is there a connection? Eur Respir J 10: 6-12.
45 Simopoulos AP. 2002. Omega-3 fatty acids in inflammation and autoimmune disease. J Am Coll Nutr 21: 495-505.
46 Simopoulos AP. 2002. The importance of omega-6/omega-3 essential fatty acids. Biomed Pharmacother 56: 365-79.
47 Hodge L, Salome CM, Hughes JM et al. 1998. Effect of dietary intake of omega-3 and omega-6 fatty acids on severity of asthma. Eur Respir J 11: 361-65.
48 De Luca S, Woods R, Thien FCK et al. 2004. Dietary marine fatty acids (fish oil) for asthma in adults and children (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
49 Peat JK, Salome CM, Woolcock AJ. 1992. Factors associated with bronchial hyperresponsiveness in Australian Adults and children. Eur Respir J 5: 921-29.
50 Simpson A, Custovic A. 2004. Allergen avoidance in primary prevention of asthma. Curr Opin Allergy Clin Immunol 4: 45-51.
51 Chan-Yeung M, Manfred J, Dimich-Ward H et al. 2000. A randomised controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med 154: 657-63.
52 Arshad SH, Bateman B, Matthews SM. 2003. Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax 58: 489-93.
53 Halmerbauer G, Gartner C, Schierl M et al. 2003. Study on the Prevention of Allergy in Children in Europe (SPACE): allergic sensitisation at 1 year of age in a controlled trial of allergen avoidance from birth. Pediatr Allergy Immunol 14: 10-17.

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