| [Objective]The role of breastfeeding in the development of childhood atopic dermatitis is still controversial. Several recent studies have reported that the quantity of selected cytokines/chemokines in breast milk might be associated with atopic dermatitis (AD). In this study,we examined cytokines/chemokines including IL-1, IL-4, IL-10, IL-13, sCD14, TGF β 1, IgE, in human milk in order to identify new biomarkers related to AD as well as their effects on childhood atopic dermatitis and some other common allergic diseases.[Methods]As a prospective cohort study, totally 110 pairs of healthy mothers and their infants born at the International Peace Maternal and Child Health Hospital in Shanghai during the period from March to December,2008 were recruited.By On-site follow-up at 2 week,4,13,26,52 and 104 weeks after birth, we collected data regarding the family allergic background, prevalence of atopic dermatitis,food allergy exposure.From December 2013 to January 2014,as the follow-up infants have grown into age 5 to 6 yrs, we successfully collected data of the prevalence of several childhood atopic diseases like asthma from 89 families of the previous cohort, using the telephone survey method.Milk samples were collected 2weeks and 4weeks postpartum,by electric breast pump at a average time between 9Am to lpm. The collection method of breast milk is standardized,as the one breast for milk collection must not have fed a baby within two hours prior to the collection. The collection was considered complete until the breast pump can not suck the milk for at least one minute. The milk sample was then stored at -80℃.The quantity IL-1, IL-4, IL-10, IL-13, sCD14 in breast milk were detected by an Bioplex system, while TGFβ1 and IgE were detected by the method of ELISA. SPSS 19.0 was used to analyze the baseline background of th cohort, the relationships among family history of allergic diseases as well as childhood eczema and other allergic diseases, and the relationship between the levels of immune factors in breast milk and motheral intake of three major allergen exposure(milk, eggs and seafood).[Results]1.The prevalence of eczema:55 children out of 110 cases developed AD before 2 years old with a percentage around 50.00%.89 out of 110 subjects were successfully surveyed by telephone interviews, of which 47 children have ever suffered from AD before 2-year-old,3 developed AD between age 2 to 6.The prevalence rate of eczema is 56.18%.2.The relationship between family history of allergic diseases and childhood allergic diseases:(1) The family history of allergic diseases between AD group and non-AD group were compared by chi-square test:In eczema group the proportion of mothers with allergic rhinitis is significantly higher than non eczema group (27.6%,9.6%, p= 0.017).(2) Children with a positive family history of allergy, defined as at least one parent ever have sensitization condition, have higher risk of developing infantile eczema compared to the family history negative group(prevalence rate 59% vs 42%, respectively, p=0.012),as well as developing any kind of childhood allergic disease (prevalence rates 100% vs 70.21%, p=<0.001).However, when further stratified by specific allergic diseases like asthma, no significant differences between the two group were found.(3). The predictive value of eczema before the age of 2 years oldChildren who had eczema before the age of 2 years old have higher risk for developing anyone of the common childhood allergic diseases than non-eczema group (p<0.001). For each specific disease:The only 2 children of the total 89 subjects who developed asthma had been suffered from eczema before 2 years old; Children who suffered from eczema before 2 years old has significant higher risk of developing food allergy than non-eczema group at 5-6 years old(prevalence rate was 21.28%, 4.76%, respectively, p= 0.019), while the prevalence of allergic rhinitis, urticaria and other allergic skin diseases found to have no statistically significant differences between the two groups.3. The immune factors levels in breast milk content between transition milk and mature milk:All the 8 cytokines are non-normally distributed data, so paired sample rank sum test was used to compare the quantity differences between transition and mature breast milk. Eotaxin levels in transition milk are significantly higher than that in mature milk (p=< 0.001), whereas TGFβ1, sCD14 levels were significantly lower than mature milk levels (p= 0.009,<0.001). The remaining factor was found to have no significant difference between the transition milk and mature milk content.4.The relationship between breast milk immune factors and the prevalence of eczema and some other childhood allergic diseases:(1) In transitional milk:IL-10 levels are significantly lower than in the group of non-eczema group (M-W test, p0.004), whereas no significant differences in the content of the rest of the immune factors found; In mature milk:IL-1β and Eotaxin were higher in eczema group than non-eczema group (p= 0.020,0.007),whereas no significant differences in the content of the rest of the immune factors found.(2) In non-eczema group:Eotaxin levels in the transitional milk were significantly higher than that of mature milk (p= 0.001), while TGFβ1, sCD14 levels were significantly lower than that of mature milk (p= 0.033,<0.001);In eczema groups:Eotaxin transitional milk was significantly higher than mature milk (p=0.010), while sCD14 levels lower than mature milk (p<0.001). Other immune factors found no differences in content between the transitional milk and mature milk.(3) Relationship between immune factors in breast milk and childhood common allergic diseases (asthma, allergic rhinitis, urticaria, etc.):For children with allergic rhinitis, the TGF(31 levels in mature milk were significantly lower than non-diseased group (z= 2.903, p= 0.004),while none of the rest immune factors found to differ between the two groups.For asthma, food allergies, hives and other allergic skin diseases, the incidence rates were too low to perform statistical analysis.4.The relationship between immune factors in breast milk and the mother’s history of allergies:(1) No significant difference of each cytokines between Transition milk and mature milk when the data was stratified by mother’s history of allergies.(2) For each group, Eotaxin levels in transitional milk were higher than that in mature milk content (p= 0.001,0.013), while sCD14 were lower than mature milk (p <0.001< 0.001);In the group whose mother has negative history of allergy,TGFβ1 levels transitional milk were lower than that in mature milk content.[Conclusions]1 This study included the Shanghai area exclusively breastfed infants. The eczema prevalence rate is 50%.2 For mothers with positive history of allergies, especially those who have allergic rhinitis, prevalence rate of eczema of their babies are higher than history negative group. Children with a positive family history of allergy, defined as at least one parent ever have sensitization condition, have higher risk of developing infantile eczema compared to the family history negative group. Children who had eczema before the age of 2 years old have higher risk for developing anyone of the common childhood allergic diseases than non-eczema group.3 Eotaxin levels in transition milk are significantly higher than that in mature milk, whereas TGFβ1, sCD14 levels were significantly lower than mature milk levels.4 In transitional milk:IL-10 levels are significantly lower than in the group of non-eczema group, which indicated that IL-10 might has certain protective effect towards AD.5 In mature milk:IL-1β and Eotaxin were higher in eczema group than non-eczema group, which indicated that IL-1β and Eotaxin might play a role in the progression of AD.6. For children with allergic rhinitis at the age of 5-6 years old, the TGFβ1 levels in mature milk were significantly lower than non-diseased group, which indicated TGFβ1 might be a protective factor for the progression of atop ic march.7 when stratified by mother’s history of allergies, quantities of each cytokine was found to have no significant difference between transition milk and mature milk content。... |
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