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ORIGINAL ARTICLE
Year : 2021 | Volume
: 41
| Issue : 2 | Page : 67-70
Does breastfeeding delay the onset of eczema in infants?
Mohammed Al-Abadie1, Greg Beer1, Mohammed Al-Rubaye1, Faris Oumeish1, Dina Al Abadie2
1 Royal Wolverhampton NHS Trust, Wolverhampton, University of West London, London, United Kingdom
2 Department of Health Promotion and Public Health, University of West London, London, United Kingdom
Correspondence Address:
PhD, FRCP Mohammed Al-Abadie
Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP
United Kingdom
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ejdv.ejdv_47_20
Background Cow’s milk has been shown to contribute to flare-up of atopic dermatitis, whereas breastfeeding was thought to help reduce the severity of the flare-ups of the condition.
Aim To investigate whether breastfeeding or cow’s milk (bottle formula) has an influence on the course of and onset of atopic dermatitis symptoms. Three feeding modalities were evaluated. These are ‘breastfed,’ ‘bottle-fed,’ or ‘breast and bottle-fed.’
Patients and methods Medical records from general practice of patients aged 2 years or less with diagnosis of eczema, atopic dermatitis, atopic eczema, and infantile eczema were reviewed. A cohort of 131 patients was divided into three categories: (a) breastfed, (b) bottle-fed, and (c) breast and bottle-fed. These data were studied according to the data recorded at the 6-week infant health checkup. The age of the child at their first eczematous diagnosis was then calculated in accordance with their date of birth.
Result New eczema diagnosis showed a similar trend in ‘breast-fed’ babies; however, onset of eczema was significantly delayed in the ‘breast and bottle-fed’ group when compared with bottle-fed alone. Most bottle-fed babies (58% of patients) were diagnosed at 31–60 days, whereas most ‘breast and bottle-fed’ babies (56%) were diagnosed at 91–120 days (P≥0.0001).
Conclusion Babies from the two groups (‘breast’ and ‘breast and bottle-fed’) experienced a delayed onset of their eczema compare with ‘bottle-fed’ infant group. Breastfeeding can delay the onset of atopic dermatitis.
Keywords: atopic eczema, bottle-fed, breastfeeding
Atopic dermatitis is a common skin disorder, which affects ∼1% of any population [1] and 10–12% in infants [2]. The clinical picture is more complicated as atopic dermatitis can be associated with allergies of both food and other substances [3]. It was found that low food allergen diet leads to the reduction in the prevalence of infantile atopic dermatitis by a third of those who were diagnosed [4],[5]. On the contrary, 40–50% of children under the age of 1 year experiencing cow’s milk allergy are misdiagnosed with atopic dermatitis [4]. The American Academy of Paediatrics suggests that lactating mothers with infants at high risk of developing atopic dermatitis should avoid peanuts and tree nuts, and should also consider eliminating eggs, cow’s milk, and fish from their diets [3],[6]. The WHO also recommends breast-feeding infants up to 2 years of age [6],[7]. On the contrary, prolonging strictly exclusive breast-feeding for more than or equal to 9 months was not helpful in atopy prevention; instead, it was associated with increased atopic dermatitis and food hypersensitivity symptoms in childhood [8],[9]. Although such research and conclusion was previously criticized, as such strange messages could have a potential negative public health effect on infant feeding as it would require a precise, prospective and frequent documentation of breast-feeding practices [10]. There was significant evidence to support concerns regarding formula-fed infants and the association with altered intestinal microbiotic variety in addition to lower bacterial diversity in the first few weeks of life as this can lead to increased risk of eczema and asthma [11].
Patients and methodsMedical records from primary care centers of patients aged 2 years or less with a diagnosis of eczema, atopic dermatitis, atopic eczema, and infantile eczema were obtained and then reviewed. Cohorts of 131 patients were divided into three categories (breast-fed, bottle-fed, and breast+bottle-fed). The data were analyzed and divided according to the data recorded at the 6-week infant health check. The age of the child at their first eczematous diagnosis was then calculated in accordance with their date of birth.
ResultsWithin the cohort of 131 patients included in the study, 62 were bottle-fed and 21 received combined breast and milk formula. [Table 1] demonstrates that eczema is 1.73 times more prevalent in babies exposed to bottle-fed/formula milk (83 vs. 48).
Table 1 The group of patients studied, the prevalence of eczema was higher in those who were exposed to bottle/formula milk in comparison with the infants who were not exposed to itPrevalence of eczema in breast and bottle-fed babies showed that they both follow a similar trend with initially a higher prevalence of eczema in the bottle-fed group up to the ‘60-day’ age group. However, breastfed babies then catch up with them showing a relatively similar prevalence at the ‘more than 120-day’ age group ([Figure 1]).
Figure 1 Breastfeeding delays the onset of eczema, as the number of patients diagnosed was significantly lower up to the 60-day age mark; however this did not result in a reduction at the 120-day age group as the number was similar.The onset of eczema is delayed significantly in patients who are ‘breast and bottle-fed’ when compared with children who are only ‘bottle-fed.’ This is shown in [Figure 2], which demonstrated that most children in this study who were bottle-fed were diagnosed before the age of 60 days, which is contrast to the ‘breast and bottle-fed’ group, where the majority of children showed a later or delayed age of onset of more than 60 days.
Figure 2 The results that were demonstrated in this study which are that breastfeeding delays the onset of eczema as the incidence is significantly lower in the ‘breast-fed’ group before the 60-day mark.Furthermore, to the discussion of the onset of eczema, our study also showed that 11% of the patients from the ‘breast and bottle-fed’ group presented at 31–60 days.
This is in contrast to 58% of patients who presented at 31–60 days from the ‘bottle-fed’ group alone. This shows that breastfeeding may give a protective factor for the development or early development of eczema. Overall, 56% of patients from the ‘breast and bottle-fed’ group presented at 91–120 days in contrast to only 23% of patients from the ‘bottle-fed’ group alone. The P value was calculated at less than 0.0001, which indicates that these results were statistically significant and unlikely to be owing to chance. It was found that the prevalence of eczema in babies who received bottle-fed/formula milk is 1.73 times more than breastfed (83 vs. 48). The onset of eczema at the fourth-month milestone of life was delayed for the ‘breast and bottle-fed,’ that is, 11% of patients present at 31–60 days, 56% present at 91–120 days vs. ‘bottle-fed,’ that is, 58% of patients present at 31–60 days and 23% present at 91–120 days (P≤0.0001).
DiscussionAtopic dermatitis is a chronic inflammatory itchy skin condition with more than one contributing factor to its presence and symptoms [1],[2]. Frequently, it is associated with history of hay fever, asthma, and family history of allergic diseases [1]. In children, there is an established link of cow’s milk and dairy product allergy in increasing the severity of atopic dermatitis [6]. In studying the induced allergic responses by allergen challenge in atopic dermatitis, an increased number of eosinophils and eosinophil granule problems in tissue showed significant correlation between numbers of eosinophils and markers of severity [3],[6]. In a well-controlled study of 487 children examining the relationship between atopic dermatitis and immunoglobulin E (IgE)-medicated food allergy and atopic dermatitis, it was also found that a low food allergen diet associated with a significant reduction in prevalence of atopic dermatitis of infancy [12]. However, public health and policy makers argued that food allergy has little significance in the pathogenesis of atopic dermatitis in childhood. In 2004, Pourpak et al. [3] found a significant influence for cow’s milk allergy to enhance total serum IgE in children with atopic dermatitis. Furthermore, it was found that half of the children younger than 24 months of age with atopic dermatitis and cow’s milk allergy could tolerate cow’s milk at 67 months of age. The peak cow’s milk-specific IgE level within the first 24 months of birth is useful to predict the prognosis of cow’s milk allergy in children with atopic dermatitis [6]. Much evidence has been published in support of breastfeeding in infancy [11], whereas others showed no evidence for protection provided by breastfeeding against childhood eczema at any age, from infancy through adolescence [13]. The different patterns of feeding in the first 6 months of life showed a long-term effect on children with eczema at the age of 6 years. Mixed-feeding pattern in the first months of life poses a moderate 1.46-fold increase risk of the child to develop eczema any time before being 6 years old [13].In our study, we focused on the feeding modalities, that is, breast, bottle, or mixed feeding of infants who were diagnosed with atopic dermatitis, trying to identify if breastfeeding those infants with potential atopic dermatitis is going to delay the starting of symptoms.
Conclusion‘Breast-fed’ and ‘breast and bottle-fed’ babies experienced a delayed onset of their eczema compared with ‘bottle-fed’ infants.The exclusive consumption of bottle milk changes the age and pattern of diagnosis of eczema.Exclusive bottle feeding does not alter the proportions of patients diagnosed at different time periods (compared with those ‘breast-fed’), but it significantly increases the total prevalence of disease.The above may be a direct result of breast milk being protective against infantile eczema. Alternatively, the contents of bottle-fed supplements may be responsible for the increased risk of developing childhood eczema owing to the difference in composition and potential allergies present. This study stresses the importance of health care professionals promoting breastfeeding. Although genetics cannot be modified, environmental exposure can be, thus targeted primary and secondary prevention policies are required to reduce the disease burden. Furthermore, mothers should be taught that even partial breastfeeding has health benefits for both mother and child.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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