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The Effects of Breastfeeding on the Development of Allergies
October 5, 2009
Allergies have become an ever-growing problem in our advancing world. According to La Leche League, one out of every five Americans today will experience some type of allergic reaction by the age of 20 (Zeretzke, 1998). With this large increase in the prevalence of allergies, people have begun to search for ways to prevent, or at least delay, the onset of allergic tendencies in their newborn children. Many studies have looked into the effects of environmental and lifestyle factors on the development of allergies, most predominantly the importance of breastfeeding. This paper will review the public and scientific literature available pertaining to the practice of breastfeeding as a protective factor against allergies, and will determine the relative effectiveness of this prevention method.
Retrieved from http://www.youniquehealthcare.com/allergy.jpg
What are allergies?
An allergic reaction is a term used to describe the body’s response to environmental factors, called allergens, which it perceives as potential threats (Zeretzke, 1998). Common allergens include pollen, dust, and even certain foods. When an allergen enters the body, the immune system sends out antibodies, aimed to attack the invader. The antibodies release chemicals, called mediators, to eliminate the allergen. These mediators are inflammatory particles and when present, they cause the mucous glands, capillaries, and smooth muscles to react, creating what is called an allergic reaction in the affected person. These reactions can affect multiple systems in the body, causing a variety of physical symptoms, as seen in the chart below. Allergies can have mild symptoms, or stronger, more life altering effects, creating the importance of their prevention.
[Retrieved from La Leche League (http://www.llli.org/NB/NBJulAug98p100.html) (Zeretzke, 1998)]
Information on breastfeeding
Breastfeeding has been recommended by the US Surgeon General for at least the first six months of an infant’s life (http://www.womenshealth.gov/breastfeeding/benefits/). It is not only beneficial for the infant, but the mother and the family as well. The initial breast milk of a mother, colostrum, contains vital nutrients and anti-bodies, which are delivered to the infant when ingested. The concentrations of nutrients in the breast milk vary over time, to accommodate the changing needs of the developing infant. Breastfed babies are less likely to develop ear infections, diarrhea, obesity, allergy related issues, and diabetes, to name a few benefits. Mothers who breastfeed their infants lose excess weight from pregnancy more rapidly and are at a decreased risk for type 2 diabetes, breast and ovarian cancer, and postpartum depression. Breastfeeding is also an easier, more natural process, with no need for measuring formulas or cleaning bottles. Additionally, families who breastfeed their children save large sums of money per year. Overall, the process of breastfeeding is said to increase the bond between the mother and the infant, contributing to a healthier relationship initially and later in life.
As with most practices, there are common drawbacks that deter people from breastfeeding. Breastfeeding can be painful for the mother, especially on the nipples, which can become raw, flat, or very large (http://www.womenshealth.gov/breastfeeding/concerns/). There are also infections associated with breastfeeding and continuous contact with the nipple. Additionally, many women are not able to breastfeed for the full, recommended length of time, because they stop producing enough milk. Finally, infants are much more perceptible to environmental factors, such as alcohol and cigarette smoke, when being breastfed. However, most organizations in support of breastfeeding claim that these issues can all be resolved, to come to the best solution for both the mother and the infant.
How could breastfeeding help reduce the risk of allergies?
In the last several years, the AAP – American Academy of Pediatrics – has promoted extended and exclusive breastfeeding of newborns for the first six months of life as a method of reducing the risk of food allergies, and other allergy-related complications, later in childhood (More, 2009). Breastfeeding is a protective factor against allergies for two reasons (Zeretzke, 1998). First, the initial milk of the mother, called the colostrum, is not only nutrient-rich, but also filled with antibodies. These antibodies are intended to supplement the infant’s weak immune system and help protect them against foreign cells, such as allergens. The second reason breastfeeding is said to be a protective factor is that it limits the diet of the infant. For as long as the baby is breastfed, they are only exposed to the allergens that enter the milk through the mother’s diet. Extending the length of the breastfeeding period will delay the introduction of solid foods, which could be possible sources of allergens.
The effectiveness of breastfeeding as a protective factor is also reliant on the parents. When weaning the infant off of breast milk, the AAP suggests to introduce solid foods gradually and one at a time (More, 2009). This will allow the parent to more easily pinpoint the source of any possible allergic reaction. Mothers must also pay attention to their diet, because of the possibility of passing the allergens through breast milk. If parents notice the infant becoming fussy or having any sort of negative reaction after feeding, mothers should try eliminating common allergens, one at a time, out of their diet. Parents should track the response of the infant in order to find the source of the allergen (Hand, 2008).
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Although those who promote breastfeeding as a prevention of allergies present many statements claiming that it is an effective method, few actually cite solid numbers or specific studies in support of their claims. About.com vaguely stated that when solid foods are added to an infant’s diet within the first four months of life, the child is more likely to develop atopic dermatitis, an allergic reaction of the skin, in childhood (More, 2009). These children also show breathing problems more frequently as an infant. It is also stated that if a child is solely breastfed for at least six months, they have a decreased risk of atopic dermatitis and asthma. It is also asserted that when an allergen is removed from a mother’s diet, the infant shows signs of improvement within a week (Zeretzke 1998). This short recovery period was used as proof of the influence of breastfeeding on the allergic reactions of an infant. These claims do not specifically show the effectiveness of breastfeeding, but rather the combined effects of breastfeeding and delaying solid foods in the diet. Most articles simply support their claims in promotion of breastfeeding by citing the APA recommendations.
Support of breastfeeding to prevent allergies
The main supporter of breastfeeding, which is quoted in most articles on the matter, is the American Academy of Pediatrics. The AAP is an organization whose sole purpose is to promote the health of children and infants. It is a nationally recognized and respected institution in the area of childcare. Their support is used to give legitimacy to the claims made by other organizations.
Most articles written in support of breastfeeding as a protective factor, are written for new mothers, or mothers to be. The majority of the websites on which the claims are posted are created specifically for mothers. La Leche League is a strong supporter of breastfed children, not only for the prevention of allergens, but also as a way to make motherhood easier for females. The organization’s slogan is “Happy Mothers, Breastfed Babies” (Zeretzke, 1998). Within their article claiming that breastfeeding is a protective factor against allergies, they also mention that when a baby is breastfed, they are less fussy, making the mother’s life easier. The article also lists several incentives for women to breastfeed, including a lower risk of illness and yeast infections and increased weight loss. La Leche League seems to be promoting breastfeeding from the perspective of other mothers, who aim to make pregnancy and motherhood easier. More of their article is spent discussing the benefits of breastfeeding for the mother and the family, than actually examining the benefits for the infant. It seems that the possible protective factor of breastfeeding against allergies is simply mentioned to further convince mothers to breastfeed their infants.
Other websites that promote breastfeeding to reduce allergies, such as About.com and WebMD, aim to present medical articles and information in a simple format, which is easy to read and understand. They’re main goal is to present the material for the general public in order to promote beneficial lifestyle choices, such as breastfeeding. Although their articles are informative, they may be oversimplified and may leave out complicated, yet vital, information. These simplified articles often show only one side of an argument and therefore become biased. Often they give data in support of breastfeeding, but do not show the inconclusive studies, or they emphasize the negative findings and fail to mention the other benefits. Because the general public reads these articles as medical fact, the people are easily persuaded by them, which could be dangerous when the recommendations of the articles are used before the guidance of a physician.
What do the experts say?
In reaction to the increase of allergy-related issues, researchers have extensively studied the effects of breastfeeding on the reduction of allergies. In the past, most studies have supported exclusive breastfeeding, along with the delay of solid foods, as a preventative method against allergies. In 2002, a study in Sweden of 4089 infants was done to determine the connection between breastfeeding and allergies (Kull et al., 2002). The results showed that for the group exclusively breastfed for four months or more, asthma, atopic dermatitis, and allergic rhinitis were less prevalent. Although partial breastfeeding proved to decrease the risk of asthma, those who were exclusively breastfed were less likely to have more than one type of allergic condition until age two. The study concluded that exclusive breastfeeding was a protective factor against allergy-related conditions in the first two years of life. Another, similar European study found the same benefits of exclusive breastfeeding for the first four months of life; however, the study also emphasized that the effectiveness of the prevention was dependent on the practices of delayed introduction of solid foods and the avoidance of other environmental allergens (Chandra, 2002). Although these studies were informative, neither provided enough information to differentiate between the effectiveness of breastfeeding and the delay of solid food intake.
Recently, studies have been conducted whose results question the long-term effectiveness of exclusive breastfeeding on the development of allergies. In 2007, a Canadian study of 13,889 mother-infant pairs was conducted to test the outcome of breastfeeding on allergies in children after 6.5 years of life (Kramer et al., 2007). The experimental group, of the children who were breastfed, had no significant reduction in allergic reactions at age six and a half. The scientists concluded that extended and exclusive breastfeeding showed little evidence of being a protective factor against allergy-related diseases later in childhood. This research does not oppose breastfeeding, it merely shows that breastfeeding cannot be used as the sole means of allergy prevention and must be accompanied by medications later in life.
In 2008, the journal of the AAP, Pediatrics, published a study, which tested the influence of the introduction of solid foods on allergic tendencies (Zutavern et al. 2008). The study compared 2073 6-year-old children to determine the long-term effects of the delay of solid foods in an infants diet. The results concluded that there was not a significant correlation between delayed solid foods and a reduced risk of allergic affliction. The study did not support earlier recommendations, which stated that parents should introduce solid foods into an infant’s diet one at a time, after 4 months of age. This strengthens the claim that breastfeeding for the first 4 months of life is beneficial in reducing the risk of allergies, because it eliminates the issue of delayed solid food introduction as an alternative protective factor. After the publication of this study, the AAP revised its recommendations for parents, emphasizing that breastfeeding, over avoidance of solid, allergenic foods by both the mother and baby, was a more effective protective factor (Boyles, 2008). However, the AAP did stress that these guidelines were primarily created for infants with a high risk of inherited allergies. Overall, the AAP strongly encouraged mothers to adhere to a strict breastfeeding regimen for the first four months, instead of focusing on their diet or on the introduction of solid foods.
Common Food Allergens
Retrieved from http://blog.bioethics.net/Allergy.jpg
After reviewing the claims and the research, it is evident that breastfeeding does have a beneficial effect on the allergy-related health of an infant. The strongest proof for this claim is found in the revisions of the breastfeeding guidelines of the AAP. Despite the exclusion of the gradual introduction of solid foods, the AAP maintains that exclusive breastfeeding for the first four months of life is the greatest protective factor against allergies in infants. Although some organizations stress the importance of a variety of factors, such as the diet of the mother, the diet of the baby, and the length of the breastfeeding period, the evidence suggests that breastfeeding is, by far, the most influential factor in allergy prevention (Zutavern et al. 2008). The studies show that the recommendations of organizations, such as La Leche League and BabyFit, put unnecessary stress on the importance of the actions of the parents. Parents should not be burdened with anxiety over their diets, or that of their baby, as these factors show little influence in the allergenic health of the infant. Some studies have also concluded that breastfeeding has limited long-term effects on a child’s allergies; however, this evidence is not strong enough to recommend that a mother should eliminate breastfeeding. Overall, the numerous benefits of breastfeeding, for both the mother and the infant, are far more significant than the inconclusive studies against the strength of these protective benefits, and breastfeeding should be practiced as a measure to prevent, or delay, allergies.
Benefits of breastfeeding. Retrieved October 3, 2009, from Womenshealth.gov Web site: http://www.womenshealth.gov/breastfeeding/benefits/
Boyles, S. (2008). Breastfeeding may lower allergy risk. Retrieved September 29, 2009 from WebMD Web site: http://children.webmd.com/news/20080107/breastfeeding-may-lower-allergy-risk
Chandra, RK. (2002). Food hypersensitivity and allergic diseases. European Journal of Clinical Nutrition, 56 (Suppl 3), 54-56. doi: 10.1038/sj.ejcn.1601487.
Common concerns. Retrieved October 3, 2009, from Womenshealth.gov Web site: http://www.womenshealth.gov/breastfeeding/concerns/
Hand, B. (2008). Breastfeeding: food allergies and irritants. Retrieved September 29, 2009 from BabyFit.com by SparkPeople Web site: http://babyfit.sparkpeople.com/articles.asp?id=41&page=1
Kramer, M.S., McGill, J., Matush, L., Vanilovich, I., Platt, R., Bogdanovich, N., et al. (2007). Effect of prolonged and exclusive breastfeeding on risk of allergy and asthma: cluster randomised trial. BMJ. doi: 10.1136/bmj.39304.464016.AE.
Kull, I., Wickman, M., Lilja, G., Nordvall, S.L., Pershagen, G. (2002). Breast feeding and allergic diseases in infants – a prospective birth cohort study. Arch Dis Child, 87, 487-481.
More MD, D. (2009). Prevention of feed allergy in infants: delayed introduction of solid foods. Retrieved September 29, 2009, from About.com Web site: http://allergies.about.com/od/foodallergies/a/delayedintro.htm
Zeretzke, K. (1998). Allergies and the breastfeeding family. New Beginnings,15(4), 100. Retrieved September 29, 2009 from La Leche League Web site: http://www.llli.org/NB/NBJulAug98p100.html.
Zutavern, A., Brockow, I., Schaaf, B., von Berg, A., Diez, U., Borte, M., et al. (2008). Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics, 121, e44-e52. doi: 10.1542/peds.2006-3553.
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