Maternal Modification and Breastfeeding
Outcome of Maternal Modification Intervention and the Role of Breastfeeding in Allergy Prevention in Children
Introduction There has been a widespread increase in the incidence of atopic disease around the world in the last decade (Hill et al., 1997). The incidence of food allergy had been reported to be 4- 6% in children (Zeiger, 2003) with the most common food allergies being egg, milk and peanut (Hill et al., 1997). Food allergy in children is a major heath risk with the possibility of life threatening anaphylaxis (Clark & Ewan, 2003). To lessen this burden, the causes of allergy and possible means for allergy prevention in children need to be assessed.
Hereditary factors have been shown to be a major influence in the incidence of atopic disease. A positive family history of allergy has been shown to be a significant risk factor in the development of eczema, asthma, allergic rhinitis and for a positive Skin Prick Test (SPT) result (Arshad, Stevens & Hide, 1993). A twin study demonstrated hereditary factors to be a major influence in the incidence of peanut allergy where 64.3% of monozygotic twin pairs showed concordance compared to 6.8% of dizygotic twin pairs (Sicherer, 2000). Allergy still occurs, however, in high proportions of children born to non atopic parents (Arshad et al., 1993).
Food allergy is most often begins within the first two years of life (Wood, 2003). It is acquired through the process of sensitisation whereby the immune system produces allergen specific immunoglobulin E antibodies in response to specific food proteins (Wood, 2003). Children may be vulnerable to sensitisation due to the immaturity of the immune system at this age (Wood, 2003). It has also been suggested that abnormal permeability of the intestine wall to larger molecules may be a causative factor to sensitisation and is typical of atopic individuals (Jackson et al., 1981). Childhood, therefore, may be a critical time of increased risk of sensitisation in those possessing a genetically programmed predisposition.