Elsevier

The Journal of Pediatrics

Volume 209, June 2019, Pages 139-145.e1
The Journal of Pediatrics

Original Article
High-Dose Vitamin D Supplementation Does Not Prevent Allergic Sensitization of Infants

https://doi.org/10.1016/j.jpeds.2019.02.021Get rights and content

Objective

To investigate the effect of vitamin D supplementation dose on allergic sensitization and allergic diseases in infants, and to evaluate whether vitamin D status in pregnancy and at birth are associated with infant allergy outcomes.

Study design

Altogether, 975 infants participated in a randomized, controlled trial of daily vitamin D supplementation of 10 μg (400 IU) or 30 μg (1200 IU) from the age of 2 weeks. At 12 months of age, food and aeroallergen IgE antibodies were measured, and the occurrence of allergic diseases and wheezing were evaluated.

Results

We found no differences between the vitamin D supplementation groups in food (OR, 0.98; 95% CI, 0.66-1.46) or aeroallergen sensitization at 12 months (OR, 0.76; 95% CI,0.34-1.71). Allergic diseases or wheezing did not differ between groups, except for milk allergy which occurred more often in infants administered 30 μg vitamin D compared with the 10 μg dose (OR, 2.23; 95% CI, 1.00-4.96). Infants with high cord blood 25-hydroxyvitamin D (≥100 nmol/L) had a higher risk of food allergen sensitization compared with those with lower 25(OH)D concentration (75-99.9 nmol/L; OR, 2.00; 95% CI, 1.19-3.39).

Conclusions

High-dose vitamin D supplementation did not prevent allergic sensitization, allergic diseases, or wheezing during the first year of life. In contrast, we observed an increased risk of milk allergy in infants randomized to higher vitamin D supplementation, and an increased risk of allergic sensitization in infants with high cord blood vitamin D status, indicating a possible adverse effect of high concentrations of vitamin D.

Section snippets

Methods

A total of 987 healthy infants, born in Kätilöopisto Helsinki Maternity Hospital, Finland, were randomized to receive daily vitamin D3 supplementation of 10 μg (400 IU) or 30 μg (1200 IU) from 2 weeks to 24 months of age.12 Mothers were of northern European ethnicity without regular medication and with a singleton pregnancy. Infants included in the study were born at term (370/7 to 420/7 weeks of gestation) with a birth weight appropriate for gestational age (birth weight SDS between −2.0

Characteristics

A total of 975 infants fulfilled the trial inclusion criteria; 489 were randomized to 10 μg and 486 to 30 μg daily vitamin D supplementation. Study enrollment, allocation, and follow-up is presented (Figure; available at www.jpeds.com).

At 12 months, a total of 865 infants (91.5%) attended the follow-up visit. Parental history of allergic diseases or other baseline characteristics did not differ between intervention groups (Table I). Breastfeeding was continued for >6 months for 78.9% of the

Discussion

In this randomized, controlled trial comparing daily vitamin D supplementation of 10 μg and 30 μg in infancy, we observed no differences in allergic sensitization between the groups at 12 months of age. Physician-diagnosed allergic diseases and occurrence of wheezing were similar in both intervention groups. Exception was for cow's milk allergy, which was reported more often in infants administered 30 μg vitamin D daily compared with the 10 μg dose. In addition, we observed that infants with

Conclusions

We observed that, in vitamin D-sufficient infants, higher vitamin D supplementation did not decrease allergic sensitization, allergic diseases, or wheezing during the first year of life. However, the risk for allergic sensitization was higher in infants with high cord blood 25(OH)D concentration, suggesting that high vitamin D levels at birth may modify the immune response related to allergy development. However, the connection of vitamin D and allergy is complex and requires further studies.

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    Supported by the Foundation for Pediatric Research, Finska Läkaresällskapet, the Finnish Medical Foundation, Governmental Subsidy for Clinical Research, the Päivikki and Sakari Sohlberg Foundation, Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perkléns minne, the Academy of Finland, the Sigrid Jusélius Foundation, the Folkhälsan Research Foundation, the Novo Nordisk Foundation, the Orion Research Foundation, Barncancerfonden, and Allergy Research Foundation. The funders had no role in the design and conduct of the study; collection, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The authors declare no conflicts of interest.

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