The Link Between Breastfeeding & Asthma – Tenuous or Trustworthy

Authors

  • Benji Lim
  • Ruaidhrí McCormack
  • Clare O’Loughlin
  • Meenakshi Ramphul
  • Benjamin Sehmer

Keywords:

medicine

Abstract

Aim: The primary aim of this review was to examine the evidence for and against breastfeeding as a protective
factor in the development of asthma in childhood. Methods: A literature search was carried out using the PubMed
database, yielding 304 papers between the dates of 1-Jan-1999 and 2-Feb-2007. An English language restriction
was imposed. Reviewers assessed study quality and extracted data. Relevant data were obtained from Irish,
European and international bodies with respect to asthma, the percentage of mothers breastfeeding, and current
recommendations for breastfeeding. Results: The prevalence of childhood asthma in Ireland is estimated to be
15%, and approximately 30% of children under the age of five have had at least one attack of asthma2.
Approximately one in three Irish mothers breastfeed, at least initially, and amongst this group 36% did so
exclusively3. A number of constituents of breastmilk have been proposed to decrease the risk of asthma,
including CD14 and omega fatty acids. A 1995 prospective follow-up study reported that exclusive breastfeeding
of greater than one month’s duration resulted in a significant reduction in respiratory allergy at age seventeen4.
Of the four randomized controlled trials (RCTs) analyzed in this review, two reported that exclusive breastfeeding,
of at least four months duration, significantly reduced the risk of childhood asthma 5,6. A third RCT found no
evident link between breastfeeding and asthma7, while the final RCT reported that breastfeeding may in fact
increase the risk of asthma8. Conclusion: Given the genetic and environmental variables at play in the
phenotypic expression of asthma as a disease, the relationship between breastfeeding and asthma is still
somewhat unclear. Four high-quality RCTs yield conflicting results. The World Health Organisation (WHO) and
the Department of Health and Children in Ireland both recommend breastfeeding for the first six months of life9,10.
These evidence-based recommendations consider the benefits of breastfeeding, including reducing the risk of
asthma.

References

1. Kramer MS. Does breast feeding help protect against atopic
disease? Biology, methodology, and a golden jubilee of
controversy. J.Pediat Feb 1998;112(2):181-90.
2. Irish Asthma Society “Asthma – In Children”. Available from:
http://www.asthmasociety.ie/asthma_pdfs/Children%20and%20
asthma.PDF
3. – HIPE & NPRS Unit ESRI (2002). Report on Perinatal
Statistics for 1999.
4. – Saarinen UM & Kajosaari M. Breastfeeding as prophylaxis
against atopic disease: prospective follow-up study until 17 years
old. Lancet 1995;346: 1065-1069.5. – Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ
et al . Association between breastfeeding and asthma in 6 year
old children: findings of a prospective birth cohort study. BMJ
1999;319: 815-819.
6. – Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G. Breast
feeding and allergic diseases in infants--a prospective birth
cohort study. Arch Dis Child 2002; 87: 478-481.
7. – American Academy of Pediatrics, Committee on Nutrition.
Hypoallergenic infant formulas. Pediatrics 2002; 106: 346–349.
8. – Allardyce RA, Wilson A. Breast milk cell supernatants from
atopic donors stimulate cord blood IgE secretion in vitro. Clin
Allergy 1984;14:259-267.
9. World Health Organisation (2003). Global Strategy on Infant
and Young Feeding.
10. Department of Health and Children. Press release dated 5-
August-2003. Available from: URL:
http://www.dohc.ie/press/releases/2003/20030805.html
11. – Baker D, Taylor H, Henderson J . Inequality in infant
morbidity: causes and consequences in England in the 1990s. J.
Epidemiol Community Health 1998; 52: 451-8.
12. – International Consensus report on the Diagnosis and
Management of Asthma. CLIN Exper Allergy 1992; 22 suppl 1.
13. – Duchen K, Casas R, Fageras-bottcher M, Yu G, Bjorksten
B. Human milk polyunsaturated longchain fatty acids and
secretory immunoglobulin A antibodies and early childhood
allergy, Pediatr Allergy Immunol 2000; 11: 29–39.
14. - Bergner A. and Bergner RK. The international consensus
report on diagnosis and treatment of asthma: a call to action for
US practitioners. Clin.Ther.1994 Jul-Aug;16(4):694-706
15. – Sears MR, Greene JM, Willan AR, Taylor DR, Flannery EM,
Cowan JO et al. Long-term relation between breastfeeding and
development of atopy and asthma on children and young adults:
a longitudinal study. The Lancet 2002; 360: 901-07.
16. – Kay A. The role of T lymphocytes in asthma. Chem
Immunol Allergy 2006; 91:59-75.
17. – Oddy WH. A review of the effects of Breastfeeding on
Respiratory Infections, Atopy, and Childhood asthma. Journal of
Asthma 2004; 41 (6) : 605-621.
18. – Friedman NJ, Zeiger RS. The Role of Breast Feeding in the
development of allergies and asthma. Journal of Allergy and
Clinical Immunology 2005; 115 (6)
19. – Medzhitov R, Janeway. C. Innate immunity. N Engl J Med
2000; 343:338-44.
20. – Vidal K, Labeta MO, Schiffrin EJ, Donnet-Hughes A.
Soluble CD14 in human breast milk and its role in innate immune
responses. Acta Odontol Scand 2001; 59:330-4.
21. J Filipp D, Alizadezadeh-Khiavi, Richardson C, Palma A,
Paredes N, Takeuchi Osamu et al. Soluble CD14 enriched in
colostrum and milk induces B cell growth and differentiation.
Proc Natl Acad Sci USA 2001; 98:603-8.
22. – Jones CA, Holloway JA, Popplewell EJ, Diaper ND,
Holloway JW, Vance GH et al. Reduced soluble CD14 levels in
amniotic fluid and breast milk are associated with the
subsequent development of atopy, eczema, or both. J Allergy
Clin Immunol 2002; 109:858-66.
23. – Black PN, Sharpe S. Dietary fat and asthma: is there a
connection? Eur Respir J 1997; 10:6-12.
24. – Kumar GS and U.N. Das. Effect of prostaglandins and their
precursors on the proliferation of human lymphocytes and their
secretion of tumour necrosis factor and various interleukins.
Prostaglandins Leukot Essent Fatty Acids 1994; 50: 331.
25. – Fan YY; Chapkin RS. Importance of dietary gammalinolenic acid in human health and nutrition. J Nutr 1998;
128:1411-1414.
26. – Yoshioka H, Iseki K, Fujita K. Development and differences
of intestinal flora in the neonatal period in breast-fed and bottlefed infants. Paediatrics 1983;72:317-321.
27. – Wold AE, Adlerberth I. Does breastfeeding affect the
infant’s immune responsiveness? Acta Paediatr 1998;87:19-22.
28. – Wright AL, Holberg CJ, Taussig LM and Martinez FD.
Factors influencing the relation of infant feeding to asthma and
recurrent wheeze in childhood, Thorax 2001; 56: 192–197.
29. – Oddy WH, Peat JK, de Klerk NH. Maternal asthma, infant
feeding, and the risk of asthma in childhood, J Allergy Clin
Immunol 2002; 110: 65–67.
30. – Host A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett
P et al. Dietary products used in infants for treatment and
prevention of food allergy. Joint Statement of the European
Society for Paediatric Allergology and Clinical Immunology
(ESPACI) Committee on Hypoallergenic Formulas and the
European Society for Paediatric Gastroenterology, Hepatology
and Nutrition (ESPGHAN) Committee on Nutrition, Arch Dis
Child 1999; 81: 80–84.
31. – Rothenbacher D, Weyermann M, Beermann C , Brenner H.
Breastfeeding, soluble CD14 concentration in breast milk and
risk of atopic dermatitis and asthma in early childhood: birth
cohort study, Clin Exp Allergy 1005; 35: 1014-1021.
32. – Oddy WH, De Klerk NH, Sly PD & Holt PG. The effect of
respiratory infection, atopy and breastfeeding on childhood
asthma. ERS Journal 2002; 19: 899-905.

Downloads

Published

2007-01-01

How to Cite

Lim, B. ., McCormack, R. ., O’Loughlin, C. ., Ramphul, M. ., & Sehmer, B. . (2007). The Link Between Breastfeeding & Asthma – Tenuous or Trustworthy. Trinity Student Medical Journal , 8(1). Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1843