The data indicate that infants born by C-section and having a high hereditary risk for allergies might have a lower risk to manifest IgE-associated eczema at 2 years, but not 5 years of age, when fed breast milk with FUT2-dependent milk oligosaccharides. Further studies with larger cohorts and especially randomized controlled intervention trials are required to build on these preliminary observations.

Background: Whether breast milk (BM) can protect against allergy has been studied extensively, with conflicting results. Variations in mothers’ BM composition may explain some of the conflicting results. Our aim was to assess the impact of maternal allergy and probiotic intervention on BM food antibodies, transforming growth factor (TGF)-β₂ and interleukin (IL)-10 and their impact on allergy development in children until the ages of 2 and 5. Methods: We measured total IgA, IgA antibodies to cow’s milk (CM), casein, β-lactoglobulin and ovalbumin (OVA), TGF-β₂ and IL-10 in 364 colostrum samples and 321 BM samples taken at 3 months from mothers participating in a prospective study evaluating the allergy-preventive effect of probiotics in a cohort with an increased risk for allergy. Results: CM, casein and OVA antibodies, TGF-β₂ and IL-10 were detectable in most samples. Maternal allergy was associated with raised levels of IgA to casein (p = 0.04) and lower levels of TGF-β₂ (p = 0.006) in mature BM. Probiotic supplementation was associated with increased IL-10 (p = 0.046) and decreased casein IgA antibodies (p = 0.027) in mature BM. High OVA IgA antibodies in colostrum were associated with the development of atopy by the age of 2, while low levels in mature BM were a significant risk factor for the development of eczema by the age of 2. TGF-β₂ levels in BM constituted a risk for development of allergy by the age of 2. Conclusions: The immunologic composition of BM was only slightly affected by maternal atopy and could be altered by probiotic supplementation. Small effects of BM components on allergy development in children were evident.

Background: Environmental and lifestyle factors such as breast-feeding and pets seem to affect atopic disease prevalence. We identified risk factors for allergic diseases. Methods: We prospectively followed until the age of 5 years a cohort of 1,223 children born into allergic families, who participated in a randomized placebo-controlled trial of probiotics as preventive against allergic disease. We evaluated the cumulative incidence of allergic diseases with questionnaires and examined all children at the ages of 2 and 5 years. Results: Compared to allergy in one parent only, allergy in both parents conferred an increased risk of allergic disease at the ages of 2 (OR 1.64; 95% CI 1.11–2.42, p = 0.013) and 5 (OR 1.83; 95% CI 1.24–2.70, p = 0.002) and at the age of 2 for eczema (OR 1.74; 95% CI 1.17–2.58, p = 0.006). Exclusive breast-feeding over 2 months elevated the risk of eczema at the ages of 2 (OR 1.73; 95% CI 1.15–2.61, p = 0.009) and 5 (OR 1.51; 95% CI 1.03–2.23, p = 0.036). Cat or dog exposure at 0–2 years and at 0–5 years protected against IgE sensitization until 5 years of age (OR 0.60; 95% CI 0.37–1.00, p = 0.048, and OR 0.61; 95% CI 0.39–0.96, p = 0.033), and exposure at the ages of 0–5 years protected against allergic rhinitis until the age of 5 (OR 0.46; 95% CI 0.25–0.85, p = 0.013) in the probiotic group. Conclusions: Allergy in both parents is an independent predictor of eczema and of allergic disease until the ages of 2 and 5. Long, exclusive breast-feeding was associated with increased eczema at the ages of 2 and 5, and cat or dog exposure was associated with decreased IgE sensitization and allergic rhinitis in the probiotic group.

Background The safety and efficacy of long‐term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open‐label, non‐randomized study. Methods During the 11‐year study, 296 children aged 5 years or older with immunoglobulin E (IgE)‐mediated CMA started milk OIT. Follow‐up data were collected at three time points: the post‐buildup phase, 1 year thereafter, and at the cross‐sectional long‐term follow‐up between January 2016 and December 2017. Patients were divided according to baseline milk‐specific IgE (sIgE) level and by the amount of milk consumption at the long‐term follow‐up. The high‐dose group consumed ≥2 dL of milk daily, while the failure group consumed <2 dL of milk or were on a milk‐avoidance diet. Results Out of the initial study group, 244/296 (83%) patients participated in the long‐term follow‐up. Among these patients, 136/244 (56%) consumed ≥2 dL of milk daily. The median follow‐up time was 6.5 years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P < 0.001). Respiratory symptoms in the post‐buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5‐8.1, P = 0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8‐114, P = 0.01). Conclusion More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long‐term outcome and safety of milk OIT.

Aim: This study examined the efficacy and the safety of peanut oral immunotherapy (OIT). Methods: We recruited 60 patients aged six years to 18 years who had a moderate-tosevere reaction to a double-blind placebo-controlled peanut challenge: 39 received OIT during an eight-month build-up phase and maintenance phase and 21 controls avoided peanuts. We measured specific immunoglobulin E and G4 (IgE and IgG4) to peanuts and to Ara h 1, 2, 3, 8 and 9 and monitored adverse events, bronchial hyper-responsiveness (BHR) to methacholine and fractional concentrations of exhaled nitric oxide (FeNO). The median follow-up period was 30 months.Results: Most (85%) of the OIT patients passed the build-up phase and 67% tolerated 5 g of peanuts during the post-treatment challenge. No controls were desensitised, with a risk ratio of 29 and 95% confidence interval of 1.9-455. During OIT, IgE to peanut, Ara h 1, 2 and 3 decreased and IgG4 increased. Consuming peanuts had no harmful effects on BHR or FeNO. The annual incidence rate of emergency visits during the follow-up period was 11% or 3.0 per 10 000 patient-days.