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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

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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.

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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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Acknowledgment

L-SK, MV, PSN, NDD, and EAM are supported by funding from the European Commission under Framework 6 (FOOD-CT-2006-16249).

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  1. Institute of Human Nutrition and Institute of Developmental Sciences, School of Medicine, University of Southampton, IDS Building, MP887 Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

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

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  1. Lefkothea-Stella Kremmyda
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  2. Maria Vlachava
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  3. Paul S. Noakes
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  4. Norma D. Diaper
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  5. Elizabeth A. Miles
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  6. Philip C. Calder
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Correspondence to Elizabeth A. Miles.

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Lefkothea-Stella Kremmyda and Maria Vlachava made an equal contribution to this article

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Kremmyda, LS., Vlachava, M., Noakes, P.S. et al. 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. Clinic Rev Allerg Immunol 41, 36–66 (2011). https://doi.org/10.1007/s12016-009-8186-2

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