Clinical Reviews in Allergy & Immunology

, Volume 41, Issue 1, pp 36–66

Atopy Risk in Infants and Children in Relation to Early Exposure to Fish, Oily Fish, or Long-Chain Omega-3 Fatty Acids: A Systematic Review

  • Lefkothea-Stella Kremmyda
  • Maria Vlachava
  • Paul S. Noakes
  • Norma D. Diaper
  • Elizabeth A. Miles
  • Philip C. Calder
Article

Abstract

There are two main families of polyunsaturated fatty acids (PUFAs), the n−6 and the n−3 families. It has been suggested that there is a causal relationship between n−6 PUFA intake and allergic disease, and there are biologically plausible mechanisms, involving eicosanoid mediators of the n−6 PUFA arachidonic acid, that could explain this. Fish and fish oils are sources of long-chain n−3 PUFAs and these fatty acids act to oppose the actions of n−6 PUFAs. Thus, it is considered that n−3 PUFAs will protect against atopic sensitization and against the clinical manifestations of atopy. Evidence to examine this has been acquired from epidemiologic studies investigating associations between fish intake in pregnancy, lactation, infancy, and childhood, and atopic outcomes in infants and children and from intervention studies with fish oil supplements in pregnancy, lactation, infancy, and childhood, and atopic outcomes in infants and children. All five epidemiological studies investigating the effect of maternal fish intake during pregnancy on atopic or allergic outcomes in infants/children of those pregnancies concluded protective associations. One study investigating the effects of maternal fish intake during lactation did not observe any significant associations. The evidence from epidemiological studies investigating the effects of fish intake during infancy and childhood on atopic outcomes in those infants or children is inconsistent, although the majority of the studies (nine of 14) showed a protective effect of fish intake during infancy or childhood on atopic outcomes in those infants/children. Fish oil supplementation during pregnancy and lactation or during infancy or childhood results in a higher n−3 PUFA status in the infants or children. Fish oil provision to pregnant women is associated with immunologic changes in cord blood and such changes may persist. Studies performed to date indicate that provision of fish oil during pregnancy may reduce sensitization to common food allergens and reduce prevalence and severity of atopic dermatitis in the first year of life, with a possible persistence until adolescence with a reduction in eczema, hay fever, and asthma. Fish oil provision to infants or children may be associated with immunologic changes in the blood but it is not clear if these are of clinical significance and whether they persist. Fish oil supplementation in infancy may decrease the risk of developing some manifestations of allergic disease, but this benefit may not persist as other factors come into play. It is not clear whether fish oil can be used to treat children with asthma as the two studies conducted to date give divergent results. Further studies of increased long-chain n−3 PUFA provision in during pregnancy, lactation, and infancy are needed to more clearly identify the immunologic and clinical effects in infants and children and to identify protective and therapeutic effects and their persistence.

Keywords

Atopy Allergy Asthma Eczema Immune function Inflammation Eicosanoid Cytokine Fatty acid Fish oil Pregnancy 

Abbreviations

AA

Arachidonic acid

ALA

α-Linolenic acid

CAPS

Childhood Asthma Prevention Study

COX

Cyclooxygenase

DHA

Docosahexaenoic acid

EPA

Eicosapentaenoic acid

FFQ

Food Frequency Questionnaire

IFN

Interferon

Ig

Immunoglobulin

IL

Interleukin

ISAAC

International Study of Asthma and Allergies in Childhood

LA

Linoleic acid

LOX

Lipoxygenase

LT

Leukotriene

PG

Prostaglandin

PUFA

Polyunsaturated fatty acid

RCT

Randomized controlled trial

SPT

Skin prick test

TNF

Tumor necrosis factor

TX

Thromboxane

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Lefkothea-Stella Kremmyda
    • 1
  • Maria Vlachava
    • 1
  • Paul S. Noakes
    • 1
  • Norma D. Diaper
    • 1
  • Elizabeth A. Miles
    • 1
  • Philip C. Calder
    • 1
  1. 1.Institute of Human Nutrition and Institute of Developmental Sciences, School of MedicineUniversity of SouthamptonSouthamptonUK

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