The Long-term Effects of Breast-feeding on Asthma and Atopic Disease

  • W. H. Oddy
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 639)

In this review, the primary objective is to assess the evidence of whether breastfeeding protects against asthma and atopic disease for the long-term (long-term is defined here as >5 years of age). Two main types of observational epidemiological studies have been used to test this hypothesis. These are cohort studies of random samples of children and cohort studies of children with a family history of asthma or atopy. In each study type, exposure and outcome data are collected either prospectively or retrospectively. The 12 criteria for assessing the adequate measurement of exposure, outcome and statistics of cohort studies in this context are given in Table 17-1.1


Atopic Dermatitis Human Milk Exclusive Breastfeed Atopic Disease Breastfed Infant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kramer MS (1988) Does breastfeeding help protect against atopic disease? Biology, methodology, and a golden jubilee of controversy. J Pediatr 112:181–190.PubMedCrossRefGoogle Scholar
  2. 2.
    Taylor B, Wadsworth J, Golding J, Butler N (1982) Breast-feeding, bronchitis, and admissions for lower respiratory illness and gastroenteritis during the first five years of life. Lancet 1:1227–1229.PubMedCrossRefGoogle Scholar
  3. 3.
    Strachan DP, Anderson HR, Johnston IDA (1995) Breastfeeding as prophylaxis against atopic disease (letter). Lancet 346:1714.PubMedCrossRefGoogle Scholar
  4. 4.
    Schwartz J, Gold D, Dockery DW, Weiss ST, Speizer FE (1990) Predictors of asthma and persistent wheeze in a national sample of children in the United States. Am Rev Resp Dis 142:555–562.PubMedGoogle Scholar
  5. 5.
    Wjst M, Dold S, Reitmeier P (1992) Does breast-feeding prevent asthma and allergies? Results of the Munich asthma and allergy study. Monatsschrift Kinderheilkunde 140:769–774.PubMedGoogle Scholar
  6. 6.
    Kramer MS (1981) Do breastfeeding and delayed introduction of solid foods protect against subsequent obesity? J Pediatr 98:883.PubMedCrossRefGoogle Scholar
  7. 7.
    Neuspiel DR, Rush D, Butler NR, Golding J, Bijur PE, Kurzon M (1989) Parental smoking and post-infancy wheezing in children: a prospective cohort study. Am J Pub Health 79:168–171.PubMedGoogle Scholar
  8. 8.
    Aberg N, Engstrom L, Lindberg U (1989) Allergic diseases in Swedish school children. Acta Paediatrica Scand 78:246–252.CrossRefGoogle Scholar
  9. 9.
    Glaser J, Johnstone DE (1953) Prophylaxis of allergic disease in newborn. JAMA 153:620–622Google Scholar
  10. 10.
    Astarita C, Harris RI, de Fusco R et al (1988) An epidemiological study of atopy in children. Clin Allergy 18:341–350.PubMedCrossRefGoogle Scholar
  11. 11.
    Halpern SR, Sellars WA, Johnson RB, Anderson DW, Saperstein S, Reisch JS (1973) Development of childhood allergy in infants fed breast, soy, or cow milk. J Allergy Clin Immunol 51:139–151.PubMedCrossRefGoogle Scholar
  12. 12.
    Sears MR, Greene JM, Willan AR et al (2002) Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 360:901–907.PubMedCrossRefGoogle Scholar
  13. 13.
    Saarinen UM, Kajosaari M (1995) Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 346:1065–1069.PubMedCrossRefGoogle Scholar
  14. 14.
    Wright AL, Holberg CJ, Taussig LM, Martinez FD (1995) Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adol Med 149:758–763.Google Scholar
  15. 15.
    Wright AL, Holberg CJ, Taussig LM, Martinez FD (2001) Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax 56:192–197.PubMedCrossRefGoogle Scholar
  16. 16.
    World Health Organisation (1981) Report on the WHO Collaborative Study of Breastfeeding: Contemporary patterns of breastfeeding. Geneva: World Health Organisation.Google Scholar
  17. 17.
    Wilson AC, Stewart Forsyth J, Greene SA, Irvine L, Hau C, Howie PW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316:21–25.PubMedGoogle Scholar
  18. 18.
    Oddy WH, Holt PG, Sly PD et al (1999) Association between breastfeeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 319:815–819.PubMedGoogle Scholar
  19. 19.
    Oddy WH, Peat JK, de Klerk NH (2002) Maternal asthma, infant feeding and the risk of asthma in childhood. J Allergy Clin Immunol 110:65–67.PubMedCrossRefGoogle Scholar
  20. 20.
    Newnham JP, Evans SF, Michael CA, Stanley FJ, Landau LI (1993) Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 342:887–891.PubMedCrossRefGoogle Scholar
  21. 21.
    Oddy WH, de Klerk NH, Sly PD, Holt PG (2002) The effects of respiratory infections, atopy and breastfeeding on childhood asthma. Eur Resp J 19:899–905.CrossRefGoogle Scholar
  22. 22.
    Peat JK, Li J (1999) Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol 103:1–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Bloch AM, Mimouni D, Mimouni M, Gdalevich M (2002) Does breastfeeding protect against allergic rhinitis during childhood? A meta-analysis of prospective studies. Acta Paediatrica 91:275–279.CrossRefGoogle Scholar
  24. 24.
    Gdalevich M, Mimouni D, David M, Mimouni M (2001) Breast-feeding and the onset of atopic dermatitis in childhood: A systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 45:520–527.PubMedCrossRefGoogle Scholar
  25. 25.
    Gdalevich M, Mimouni D, Mimouni M (2001) Breast-feeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies. J Pediatr 139:261–266.PubMedCrossRefGoogle Scholar
  26. 26.
    Burr ML, Limb ES, Maguire MJ et al (1993) Infant feeding,wheezing,and allergy: a prospective study. Arch Dis Child 68:724–728.PubMedGoogle Scholar
  27. 27.
    Chandra RK (1998) Five-year follow up of high-risk infants with family history of allergy exclusively breast-fed or fed partial whey hydrolysate, soy and conventional cow’s milk formulas. Nut Res 18:1395–1411.CrossRefGoogle Scholar
  28. 28.
    Chandra RK, Singh G, Shridhara B (1989) Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic disease in high risk infants. Ann Allergy 63:102–106.PubMedGoogle Scholar
  29. 29.
    Peat JK (1998) Can asthma be prevented? Evidence from epidemiological studies of children in Australia and New Zealand in the last decade. Clin Exp Allergy 28:261–265.PubMedCrossRefGoogle Scholar
  30. 30.
    Burton PR (1994) Helping doctors to draw appropriate inferences from the analysis of medical studies. Stat Med 13:1699–1713.PubMedCrossRefGoogle Scholar
  31. 31.
    Burton PR, Gurrin LC, Campbell MJ (1998) Clinical significance not statistical significance: a simple Bayesian alternative to p values. J Epidemiol Community Health 52:318–323.PubMedGoogle Scholar
  32. 32.
    Cogswell JJ, Mitchell EB, Alexander J (1987) Parental smoking, breastfeeding, and respiratory infection in development of allergic diseases. Arch Dis Child 62:338–344.PubMedGoogle Scholar
  33. 33.
    Bradford Hill A (1965) The environment and disease: association or causation?. Proc Royal Soc Med 58:295–300.Google Scholar
  34. 34.
    Goldman AS (1993) The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J 12:664–672.PubMedGoogle Scholar
  35. 35.
    Hanson LÅ (2000) The mother-offspring dyad and the immune system. Acta Paediatrica 89:252–258.PubMedCrossRefGoogle Scholar
  36. 36.
    Wold AE, Adlerberth I (1998) Does breastfeeding affect the infant’s immune responsiveness? Acta Pædiatrica 87:19–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Xanthou M (1998) Immune protection of human milk. Biol Neonate 74:121–133.PubMedCrossRefGoogle Scholar
  38. 38.
    Garza C, Butte NF, Goldman AS (1993) Human milk and infant formula. In: Susskind RM, Lewinter-Suskind L, editors. Textbook of Pediatric Nutrition. 2nd ed. New York: Raven Press Ltd.Google Scholar
  39. 39.
    Xanthou M, Bines J, Walker WA (1995) Human milk and intestinal host defense in newborns: an update. Adv Pediatrics 42:171–208.Google Scholar
  40. 40.
    Siafakas C, Sanderson A, Walker WA (1998) Breast milk cells and their interaction with intestinal mucosa. In: Bellanti JA, Bracci C, Prindull G, Xanthou M, editors. Third Neonatal Hematology and Immunology Symposium. Amsterdam: Elsevier; p.121–126.Google Scholar
  41. 41.
    Garofalo RP, Goldman AS (1999) Expression of functional immunomodulatory and anti-inflammatory factors in human milk. ClinPerinatol 26:361–378.Google Scholar
  42. 42.
    Ellis LA, Mastro AM, Picciano MF (1997) Do milk-borne cytokines and hormones influence neonatal immune cell function? J Nutr. 127(5 Suppl):985S–988S.PubMedGoogle Scholar
  43. 43.
    Bernt KM, Walker WA (1999) Human milk as a carrier of biochemical messages. Acta Paediatrica 430:S27–S41.Google Scholar
  44. 44.
    Garofalo RP, Goldman AS (1998) Cytokines, chemokines, and colony-stimulating factors in human milk: the 1997 update. Biol Neonate 74:134–142.PubMedCrossRefGoogle Scholar
  45. 45.
    Höst A (1994) Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol 5(5 Suppl):5–36.CrossRefGoogle Scholar
  46. 46.
    Lifschitz CH, Hawkins HK, Guerra C, Byrd N (1988) Anaphylactic shock due to cow’s milk protein hypersensitivity in a breast-fed infant. J Pediatr Gastroenterol Nutr 7:141–144.PubMedCrossRefGoogle Scholar
  47. 47.
    Businco L, Dreborg S, Einarsson R et al (1993) Hydrolysed cow’s milk formulae. Allergenicity and use in treatment and prevention. An ESPACI position paper. Pediatr Allergy Immunol 4:101–111.PubMedCrossRefGoogle Scholar
  48. 48.
    Taylor B (1973) Transient IgA deficiency and pathogenesis of infantile atopy. Lancet ii:111–113.CrossRefGoogle Scholar
  49. 49.
    Saarinen K, Juntenen-Backman K, Järvenpää AL, Kuitman P, Renlund M (1997) Early feeding of cow’s milk formula — a risk for cow’s milk allergy. J Pediatr Gastroenterol 24:461(A).Google Scholar
  50. 50.
    Holt PG, Sly PD, Björksten B (1997) Atopic versus infectious diseases in childhood: a question of balance? Pediatr Allergy Immunol 8:53–58.PubMedCrossRefGoogle Scholar
  51. 51.
    Heufler C, Koch F, Stanzl U et al (1996) Interleukin-12 is produced by dendritic cells and mediates T helper 1 development as well as interferon-gamma production by T helper 1 cells. Eur J Immunol 26:659–668.PubMedCrossRefGoogle Scholar
  52. 52.
    Ridge JP, Fuchs EJ, Matzinger P (1996) Neonatal tolerance revisited: turning on newborn T cells with dendritic cells. Science 271:1723–1726.PubMedCrossRefGoogle Scholar
  53. 53.
    Murphey E, Shibuya K, Hosken N (1996) Reversibility of T-helper 1 and 2 populations is lost after long term stimulation. J Exp Med 183:901–913.CrossRefGoogle Scholar
  54. 54.
    Carlson SE (1985) N-acetylneuraminic acid concentrations in human milk oligosaccharides and glycoproteins during lactation. Am J Clin Nutr 41:720–726.PubMedGoogle Scholar
  55. 55.
    Moya FR (1991) In: Suskind R, Suskind L, editors. Textbook in neonatal nutrition. New York: Raven.Google Scholar
  56. 56.
    Thorell L, Sjoberg LB, Hernell O (1996) Nucleotides in human milk: sources and metabolism by the newborn infant. PediatrRes 40:845–852.CrossRefGoogle Scholar
  57. 57.
    Ebrahim GJ (1998) Breastmilk nucleotides. J Trop Paediatr 44:318–319.CrossRefGoogle Scholar
  58. 58.
    Gil A, Pita M, Martinez A, Molina J, Sanchez-Pozo A (1986) Effect of dietary nucleotides on the plasma fatty acids in at-term neonates. Hum Nutr:Clin Nutr 40:185–195.PubMedGoogle Scholar
  59. 59.
    Uauy R, Stringel G, Thomas R, Quan R (1990) Effect of dietary nucleosides on growth and maturation of the developing gut in the rat. J Pediatr Gastroenterol Nutr 10:497–503.PubMedGoogle Scholar
  60. 60.
    Pickering LK, Granoff DM, Erickson JR et al (1998) Modulation of the immune system by human milk and infant formula containing nucleotides. Pediatrics 101:242–249.PubMedCrossRefGoogle Scholar
  61. 61.
    Koletzko B, Aggett PJ, Bindels JG et al (1998) Growth, development and differentiation: a functional food science approach. Br J Nutr 80(Suppl 1):S5–S45.PubMedCrossRefGoogle Scholar
  62. 62.
    Graber R, Sumida C, Nunez EA (1994) Fatty acids and cell signal transduction. J Lipid Mediat Cell Signal 9:91–116.PubMedGoogle Scholar
  63. 63.
    Clarke SD, Jump DB (1994) Dietary polyunsaturated fatty acid regulation of gene transcription. Ann Rev Nutr 14:83–98.CrossRefGoogle Scholar
  64. 64.
    Miles EA, Calder PC (1998) Modulation of immune function by dietary fatty acids. Proc Nutr Soc 57:277–292.PubMedCrossRefGoogle Scholar
  65. 65.
    Yu G, Björkstén B (1998) Serum levels of phospholipid fatty acids in mothers and their babies in relation to allergic disease. Eur J Pediatr 157:298–303.PubMedCrossRefGoogle Scholar
  66. 66.
    Yu G, Duchén K, Björkstén B (1998) Fatty acid composition in colostrum and mature milk from non-atopic and atopic mothers during the first 6 months of lactation. Acta Pædiatrica 87:729–736.PubMedCrossRefGoogle Scholar
  67. 67.
    Wright AL, Holberg CJ, Taussig LM, Halonen M, Martinez FD (1999) The relation of infant feeding to asthma in childhood is altered by maternal asthma status. In: Society ALAAT, editor. American Thoracic Society 1999; San Diego, California.Google Scholar
  68. 68.
    van Houwelingen AC, Sorensen JD, Hornstra G et al (1995) Essential fatty acid status in neonates after fish-oil supplementation during late pregnancy. Br JNutr 74:723–731.PubMedCrossRefGoogle Scholar
  69. 69.
    Pabst HF, Spady DW Pilarski LM, Carson MM, Beeler JA, Krezolek MP (1997) Differential modulation of the immune response by breast- or formula-feeding of infants. Acta Paediatrica 86:1291–1297.PubMedCrossRefGoogle Scholar
  70. 70.
    Chiba Y, Minagawa T, Mito K et al (1987) Effect of breast-feeding on responses of systemic interferon and virus-specific lymphocyte transformation in infants with respiratory syncytial virus infection. J Med Virol 21:-14.CrossRefGoogle Scholar
  71. 71.
    Barros MD, Carneriro-Sampaio MMS (1984) Milk composition of low birth weight infants’ mothers. Acta Pædiatrica Scandinavia 73:693–694.CrossRefGoogle Scholar
  72. 72.
    Mayer EJ, Hamman RF, Gay EC, Lezotte DC, Savitz DA, Klingensmith GJ (1988) Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry. Diabetes 37:1625–1632.PubMedCrossRefGoogle Scholar
  73. 73.
    Davis MK, Savitz DA, Grauford B (1988) Infant feeding and childhood cancer. Lancet ii:365–368.CrossRefGoogle Scholar
  74. 74.
    Koletzko S, Griffiths A, Corey M, Smith C, Sherman P (1991) Infant feeding practices and ulcerative colitis in childhood. BMJ 302:1580–1581.PubMedCrossRefGoogle Scholar
  75. 75.
    Koletzko S, Sherman P, Corey M, Griffiths A, Smith C (1989) Role of infant feeding practices in development of Crohn’s disease in childhood. BMJ 298:1617–1618.PubMedGoogle Scholar
  76. 76.
    Machtinger S, Moss, R (1986) Cow’s milk allergy in breast-fed infants: the role of allergen and maternal secretory IgA antibody. J Allergy Clini Immunol 77:341–347.CrossRefGoogle Scholar
  77. 77.
    Hanson LÅ, Mattsby-Baltzer I, Engberg, I (1995) Anti-inflammatory capacities of human milk: lactoferrin and secretory IgA inhibit endotoxin-induced cytokine release. In: Mestecky J, editor. Mucosal Immunology. New York: Plenum Press; p. 669–672.Google Scholar
  78. 78.
    He J, Furmanski P (1995) Sequence, specificity and transcriptional activation in the binding of lactoferrin to DNA. Nature 373:721–724.PubMedCrossRefGoogle Scholar
  79. 79.
    Bentzen K (1994) Cytokines and natural regulators of cytokines. Immunol Letts 43:111–123.CrossRefGoogle Scholar
  80. 80.
    Goldman AS, Chheda S, Garofalo R, Schmalstieg FC (1996) Cytokines in human milk: properties and potential effects upon the mammary gland and the neonate. J Mamm Gland Biol Neoplasia 1:251–258.CrossRefGoogle Scholar
  81. 81.
    Chinoy MR, Zgleszewski SE, Cilley RE et al (1998) Influence of epidermal growth factor and transforming growth factor beta-1 on patterns of fetal mouse lung branching morphogenesis in organ culture. Pediatric Pulmonol 25:244–256.CrossRefGoogle Scholar
  82. 82.
    Koldovsky O, Goldman A (1998) Growth factors in human milk. In: Ogra P, Mestecky J, Lamm M. et al Editors. Mucosal Immunology. Second ed. Orlando: Academic Press.Google Scholar
  83. 83.
    World Health Organisation (2001) The optimal duration of exclusive breastfeeding, results of a WHO systematic review. Note for the Press 7(2 April).=New reference as provided by Dewey in Chapter 5 also to be added here.Google Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • W. H. Oddy
    • 1
    • 2
  1. 1.Centre for Child Health ResearchUniversity of Western Australia, Telethon Institute for Child Health ResearchPerthAustralia
  2. 2.Department of Nutrition, Dietetics and Food ScienceCurtin University of TechnologyAustralia

Personalised recommendations