Does concurrent breastfeeding alongside the introduction of solid food prevent the development of food allergy?

The timing of introduction of solid food on the subsequent development of food allergy is under debate and the role of concurrent breastfeeding is unclear. The aim of the present study was to investigate the role of solid food introduction whilst concurrently breastfeeding on food allergy outcome, with a specific focus on cows’ milk allergy. Prospectively collected infant feeding data from a birth cohort were analysed. Participants with histories suggestive of food allergy underwent diagnostic food challenges. Children with food allergy were matched to control participants for age and sex. Mann–Whitney U tests, χ2, Fisher exact tests and logistic regression calculations were undertaken. A total of thirty-nine food-allergic children and seventy-eight matched controls were identified, including twenty-two cows’ milk-allergic children and forty-four matched controls. The control group introduced solid food earlier than the food-allergic group (P < 0·05). There was no effect of concurrent breastfeeding alongside cows’ milk introduction or other food allergens on the development of food allergy. Due to small numbers, it was not possible to explore differences for food allergy phenotype. We have therefore found no evidence that introducing solids, or food allergens, whilst breastfeeding has an allergy-preventative effect; however, the results should be interpreted with caution due to sample size. Recommendations regarding infant feeding and food allergy should be carefully considered. Although breastfeeding should be promoted for many health reasons, larger studies looking at the introduction of food allergens on the development of food allergy are needed to make a final conclusion

Fussy eating and feeding difficulties in infants and toddlers consuming a cows’ milk exclusion diet

Cows’ milk allergy (CMA) is the most common infant food allergy in the United Kingdom, requiring a strict exclusion diet. Feeding difficulties and fussy eating are also very common problems in young children and can negatively influence feeding and dietary intake in an infant with CMA. The aim of this study was to compare the levels of fussy eating and feeding difficulties in two groups of young children: a group consuming an exclusion diet for CMA and a control group of children consuming an unrestricted diet.MethodParticipants were recruited from allergy and health visitor clinics on the Isle of Wight. Parents completed a number of questionnaires about their child's feeding behaviour.ResultsOne hundred and twenty-six participants (mean age 13 months) were recruited. Participants consuming an exclusion diet for CMA had significantly higher scores for both fussy eating and feeding difficulties (p < 0.05), although overall both groups were within the normal range. A number of symptoms were found to be positively moderately correlated with higher feeding difficulty score (p < 0.05). A higher consumption of milk/milk substitute consumed per day was positively correlated to both feeding difficulties and fussy eating (p < 0.05).ConclusionParticipants consuming an exclusion diet for CMA have higher scores for feeding difficulties and fussy eating than those consuming an unrestricted diet; however, the majority of participants’ scores were within the normal range and did not affect the growth

Literature searches and reviews related to the prevalence of food allergy in Europe

In 2011, the European Food Safety Authority (EFSA) received a mandate from the Food Safety Authority of Ireland (FSAI) to review the available scientific data on the prevalence of each food allergy in Europe, to derive threshold concentrations for each allergen in foods when possible, and to review the analytical methods available for the detection/quantification of food allergens. This report presents the findings of a series of systematic reviews of the literature related to these aims. Systematic searches of relevant bibliographic databases and the grey literature were conducted, studies were selected for inclusion according to pre-specified criteria, relevant data was extracted from all included studies, and the quality of included studies assessed. The first systematic review examined the literature on the prevalence of food allergy (IgE-mediated and non-IgE mediated) in different regions of the World and in individual European countries for different age groups in relation to each of the following food allergens: milk/dairy, eggs, cereals, peanuts, nuts, celery, crustaceans, fish, molluscs, soy, lupin, mustard and sesame. For each of these allergens changes in prevalence trends over time were also examined. Additionally, emerging food allergens in different European countries were identified. Of the 7333 articles identified by the searches, data from 92 studies was included, 52 of which reported on studies conducted within Europe. The second systematic review examined the effects of food processing on the allergenicity of foods in relation to each of the following food allergens: milk/dairy, eggs, cereals, peanuts, nuts, celery, crustaceans, fish, molluscs, soy, lupin, mustard and sesame. From 1040 articles identified by the searches, 25 studies were included in this review. The final systematic review examined the evidence regarding the new analytical methods available to analyse/detect the food allergens considered in the previous systematic reviews in processed foods. From 1475 articles identified by the searches, 84 studies were included

A qualitative study of mothers’ perceptions of weaning and the use of commercial infant food in the United Kingdom

Background: Commercially produced infant food has a different taste profile and nutritional content to homemade baby food and its consumption is now very widespread. This change in early food experience may lead to a reduced dietary variety and a decreased microbial load exposure.Objective: The purpose of this study was to gain insight into parental perceptions of complementary feeding, specifically opinions of commercially produced baby food, using qualitative research methods. Methods: Four focus group discussions took place (n = 24), with mothers of infants aged 4-7 months. Half of participants were first time mothers and a third had experience weaning infants with symptoms of cows' milk allergy. Participants were prompted with questions about complementary feeding and shown several different products to stimulate discussion. Results: Thematic analysis of focus groups indicated that three distinctive groups of mothers exis

Mobile health as a primary mode of intervention for women at risk of, or diagnosed with, gestational diabetes mellitus: a scoping review.

OBJECTIVE: The objective of this review was to map the knowledge related to the use of mHealth as a primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of or diagnosed with gestational diabetes mellitus. We also sought to understand if mHealth for women at risk of or diagnosed with gestational diabetes mellitus incorporated relevant behavior change theory and techniques. INTRODUCTION: Prevention and management of gestational diabetes mellitus and its associated adverse outcomes are important to maternal and infant health. Women with gestational diabetes mellitus report high burden of disease management and barriers to lifestyle change post-delivery, which mHealth interventions may help to overcome. Evidence suggests apps could help gestational diabetes mellitus prevention and management, however, less is known about broader applications of mHealth from preconception to interconception and whether relevant behavior change techniques are incorporated. INCLUSION CRITERIA: Studies published in English that focused on mHealth use as primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications were considered for inclusion. Telehealth or telemedicine were excluded as these have been reviewed elsewhere. METHODS: Six databases were searched: MEDLINE (Ovid), CINAHL (EBSCO), Embase (Ovid), Cochrane Database (Wiley), Scopus, and TRIP. No limits were applied to database exploration periods to ensure retrieval of all relevant studies. Gray literature sources searched were OpenGrey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials Register, and ANZCTR. Two reviewers independently screened abstracts and assessed full texts against the inclusion criteria. Data were extracted using an adapted version of the JBI data extraction instrument. Data are presented in narrative form accompanied by tables and figures. RESULTS: This review identified 2166 sources, of which 96 full texts were screened. Thirty eligible reports were included, covering 25 different mHealth interventions. Over half (n = 14) were for self-managing blood glucose during pregnancy. Common features included tracking blood glucose levels, real-time feedback, communication with professionals, and educational information. Few (n = 6) mHealth interventions were designed for postpartum use and none for interconception use. Five for postpartum use supported behavior change to reduce the risk of type 2 diabetes and included additional features such as social support functions and integrated rewards. Early development and feasibility studies used mixed methods to assess usability and acceptability. Later stage evaluations of effectiveness typically used randomized controlled trial designs to measure clinical outcomes such as glycemic control and reduced body weight. Three mHealth interventions were developed using behavior change theory. Most mHealth interventions incorporated two behavior change techniques shown to be optimal when combined and those delivering behavior change interventions included a wider range. Nevertheless, only half of the 26 techniques listed in a published behavior change taxonomy were tried. CONCLUSIONS: mHealth for gestational diabetes mellitus focuses on apps to improve clinical outcomes. This focus could be broadened by incorporating existing resources that women value, such as social media, to address needs, such as peer support. Although nearly all mHealth interventions incorporated behavior change techniques, findings suggest future development should consider selecting techniques that target women's needs and barriers. Lack of mHealth interventions for prevention of gestational diabetes mellitus recurrence and type 2 diabetes mellitus suggests further development and evaluation is required

Pastoralism may have delayed the end of the green Sahara

The climate deterioration after the most recent African humid period (AHP) is a notable past example of desertification. Evidence points to a human population expansion in northern Africa prior to this, associated with the introduction of pastoralism. Here we consider the role, if any, of this population on the subsequent ecological collapse. Using a climate-vegetation model, we estimate the natural length of the most recent AHP. The model indicates that the system was most susceptible to collapse between 7 and 6 ka; at least 500 years before the observed collapse. This suggests that the inclusion of increasing elements of pastoralism was an effective adaptation to the regional environmental changes. Pastoralism also appears to have slowed the deterioration caused by orbitally-driven climate change. This supports the view that modern pastoralism is not only sustainable, but beneficial for the management of the world's dryland environments

Cows’ milk exclusion diet during infancy: is there a long term effect on children's eating behaviour and food preferences?

Background: Dietary restriction during infancy may influence later eating behaviour. The aim of this study was to determine if consuming a cows’ milk exclusion (CME) diet during infancy affects eating habits in later childhood, once cows’ milk has been reintroduced into the diet. Methods: Children were recruited from two large birth cohort studies in the UK. A small number of participants were recruited from allergy clinic. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group, who had consumed an unrestricted diet during infancy. Parents and children completed questionnaires regarding eating behaviour and food preferences. Results: 101 children of mean age 11.5 years were recruited (28 CME and 73 control). The CME group scored significantly higher on “slowness of eating” and on the combined “avoidant eating behaviour” construct (p < 0.01). The number of foods avoided and symptoms were associated with higher levels of avoidant eating behaviour (p < 0.05). The CME group rated liking for several dairy foods (butter, cream, chocolate, full fat milk and ice cream) significantly lower than the control group (p < 0.05), although there were no significant differences seen for any other category of food. Conclusion: This study demonstrated that consuming a CME diet during infancy has persistent and long-term effects on eating habits and food preferences. To reduce future negative eating behaviours, children’s exclusion diets need to be as varied as possible and reintroduction of cows’ milk products closely monitored

Very low prevalence of IgE mediated wheat allergy and high levels of cross-sensitisation between grass and wheat in a UK birth cohort

BackgroundPatients often report adverse reactions to wheat. Interpretation of sensitization to wheat pollen and flour with/without sensitization to grass pollen is a clinical problem.AimWe set out to determine the prevalence of wheat allergy in a birth cohort (10/11 year olds) and investigate the usefulness of performing skin prick tests (SPT), specific IgE tests and component resolved diagnostics to wheat pollen and flour.MethodsThe Food Allergy and Intolerance Research (FAIR) birth cohort included babies born on the Isle of Wight (UK) between September 2001–August 2002 (n = 969). Children were followed up at 1, 2, 3 and 10/11 years. 588 children had SPTs to wheat pollen and grass during the 10 year follow-up. 294 children underwent further SPT to wheat flour and 246 had specific IgE testing to wheat and grass.ResultsEight children underwent oral food challenges (OFC). We diagnosed 0.48 % (4/827; 95 % CI 0–1 %) children with wheat allergy based on OFC. 16.3 % (96/588) were sensitized to grass pollen, 13.4 % (79/588) to wheat pollen; 78 % (75/96) sensitized to both. Only one child was sensitized to wheat flour and wheat pollen, but not grass pollen. For specific IgE, 15.0 % (37/246) and 36.2 % (89/246) were sensitized to wheat and grass pollen, with 40.5 % (36/89) sensitized to both. Of the 37 children sensitized to wheat, 3 (8.1 %) were sensitized to omega 5 gliadin, 1 (2.7 %) to wheat lipid transfer protein and 1 to wheat gliadin.ConclusionClinicians should be aware of the high level of cross-sensitization when performing tests to wheat and grass pollen i.e. sensitisation to wheat specific IgE and wheat pollen SPT should be assessed in the presence of grass pollen SPT and/or specific IgE