Original Article
The Role of Early Life Food Sensitization in Adolescent Lung Function: Results from 2 Birth Cohort Studies

https://doi.org/10.1016/j.jaip.2019.01.050Get rights and content

Background

It is unclear whether early life food sensitization (as opposed to aeroallergen sensitization) is associated with subsequent poor lung function.

Objectives

We investigated the associations between food sensitization in the first 2 years of life and lung function at 12 to 18 years and whether these observed associations are mediated through aeroallergen sensitization or asthma.

Methods

We used data from a high-risk cohort (Melbourne Atopy Cohort Study [MACS]) and a population-based “Influence of life-style–related factors on the development of the Immune System and Allergies in East and West Germany plus the influence of traffic emissions and genetics” (LISAplus) cohort. Food sensitization was assessed at 6, 12, and 24 months in MACS and 24 months in LISAplus. Lung function was evaluated by spirometry at 12 and 18 years in MACS and 15 years in LISAplus. Linear regression models were used to estimate the association with sensitization (food and/or aeroallergen) while adjusting for potential confounders.

Results

Sensitization to food without aeroallergen at 6 months was associated with reduced forced expiratory volume in 1 second (FEV1) at both 12 years (−153 mL; 95% confidence interval [CI] = −256 mL, −51 mL) and 18 years (−206 mL; 95% CI = −347 mL, −65 mL) in MACS. Similar results were observed for sensitization measured at 12 months but not at 24 months. Early-life asthma (but not aeroallergen sensitization) partially mediated these associations. Both cohorts showed that only aeroallergen sensitization at 24 months but not food sensitization was associated with lower adolescent lung function.

Conclusions

This study showed that food sensitization at 6 and 12 months was associated with reduced FEV1 in adolescence. Our finding that this link is not completely mediated by either subsequent asthma or aeroallergen sensitization is novel and suggests that early food sensitization itself can be used to identify high-risk groups for poor lung health.

Section snippets

Study populations

MACS is an Australian allergy high-risk birth cohort study that recruited 620 neonates with a family history of asthma, food allergy, hay fever, or eczema between 1990 and 1994 from Melbourne. Detailed descriptions of the recruitment and data collection have been previously published.13, 14, 15, 16 Baseline information was collected during pregnancy. Questionnaires were completed every 4 weeks until 15 months, at 18 months, 2 years, and then annually until age 7, then at 12 and 18 years.

MACS

Characteristics of participants

The baseline demographic characteristics of the MACS participants have been published previously.35 This analysis was restricted to those who had data on both sensitization and lung function testing (364 participants [59% of original cohort] at 12 years and 399 participants [64% of original cohort] at 18 years). The characteristics of those included participants are presented in Table I. With the exception of a higher proportion of highly educated parents, MACS participants who attended lung

Discussion

We observed that early life sensitization to food allergens at 6 and 12 months was associated with lower spirometry indices during adolescence. Effects were detected mainly for FEV1 and FEV1/FVC ratio. These associations were neither confounded by concurrent wheezing nor modified by subsequent asthma status. Furthermore, these associations were only partially mediated by asthma at 6 years, and not by aeroallergen sensitization at age 2. This is the first study that evaluated the association

Acknowledgments

For MACS study, we thank Dr John Thorburn, FRACP, for assistance in patient recruitment and administrative assistance and the Mercy Maternity Hospital Department of Obstetrics for participant recruitment, and Dr Cliff Hosking for study leadership up to the 12-year follow-up. We thank Anne Balloch for assistance with data management. Most importantly, we thank all of the MACS children and parents for their participation and ongoing support for this study. We thank all the families for their

References (41)

  • I.L. Bernstein et al.

    Allergy diagnostic testing: an updated practice parameter

    Ann Allergy Asthma Immunol

    (2008)
  • J.L. Ménardo et al.

    Skin test reactivity in infancy

    J Allergy Clin Immunol

    (1985)
  • D.M. Fleischer et al.

    Primary prevention of allergic disease through nutritional interventions

    J Allergy Clin Immunol Pract

    (2013)
  • P.J.F.M. Merkus et al.

    Human lung growth: a review

    Pediatr Pulmonol

    (1996)
  • L.A. Lowe et al.

    Lung function at age 3 years: effect of pet ownership and exposure to indoor allergens

    Arch Pediatr Adolesc Med

    (2004)
  • D.J. Gottlieb et al.

    Skin test reactivity to common aeroallergens and decline of lung function. The Normative Aging Study

    Am J Respir Crit Care Med

    (1996)
  • J. Sunyer et al.

    Sensitization to individual allergens as risk factors for lower FEV1 in young adults

    Int J Epidemiol

    (2000)
  • S. Prescott et al.

    Food allergy: riding the second wave of the allergy epidemic

    Pediatr Allergy Immunol

    (2011)
  • M. Kulig et al.

    Long-lasting sensitization to food during the first two years precedes allergic airway disease

    Pediatr Allergy Immunol

    (1998)
  • I. Brockow et al.

    Early allergic sensitizations and their relevance to atopic diseases in children aged 6 years: results of the GINI study

    J Investig Allergol Clin Immunol

    (2009)
  • Cited by (0)

    Initial funding for the Melbourne Atopy Cohort Study (MACS) in the first 6 years of the study was from Nestec (a subsidiary of Nestlé Australia). The 12-year follow-up was supported by the Asthma Foundation of Victoria. The 18-year follow-up was supported by grants from the National Health and Medical Research Council (NHMRC) of Australia (MACS grant no. APP454856). The funding bodies had no role in the study design, collection, analysis, or interpretation of data, nor in writing this paper or the decision to publish. The results, conclusions, and opinions reported in the paper are those of the authors and are independent from the funding sources. The “influence of Life-style–related factors on the development of the Immune System and Allergies in East and West Germany plus the influence of traffic emissions and genetics” (LISAplus) study was mainly supported by grants from the Federal Ministry for Education, Science, Research and Technology and in addition from Helmholtz Zentrum Munich (former GSF), Helmholtz Centre for Environmental Research—UFZ, Leipzig, Research Institute at Marien-Hospital Wesel, Pediatric Practice, Bad Honnef for the first 2 years. The 4-year, 6-year, 10-year, and 15-year follow-up examinations of the LISAplus study were covered from the respective budgets of the involved partners (Helmholtz Zentrum Munich [former GSF], Helmholtz Centre for Environmental Research—UFZ, Leipzig, Research Institute at Marien-Hospital Wesel, Pediatric Practice, Bad Honnef, IUF—Leibniz-Research Institute for Environmental Medicine at the University of Düsseldorf) and in addition by a grant from the Federal Ministry for Environment (IUF Düsseldorf, FKZ 20462296). Furthermore, the 15-year follow-up examination of the LISAplus study was supported by the Commission of the European Communities, the 7th Framework Program: MeDALL project.

    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

    These authors share senior authorship.

    View full text