With great interest, we have read the article by Huurre et al. [1] reporting on the impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization. We would like to comment on some of the results of this trial.First, the authors found an increased risk of sensitization in infants with allergic mothers breastfeeding over 6 months or exclusively breastfeeding over 2.5 months. Therefore, they conclude that breastfeeding in atopic mothers is a risk factor for sensitization in infants. However, these results may be biased, because of reversed causation [2]. The authors give no information regarding the prevalence of allergic disease, specifically atopic dermatitis, in the participating infants. It seems likely that the presence of allergic symptoms caused mothers to continue breastfeeding for a longer period of time, which could explain the observed relation between breastfeeding and increased sensitization.Second, considerable attention is given to the observation that TGF-b2 was higher in the probiotic than in the placebo group. However, this difference did not reach significance (CI, 0.96-2.34; P = 0.073). Moreover, this moderate effect was seen only in the colostrum sample and had totally disappeared after 1 month, despite that the probiotic supplementation was still continued at that time. Therefore, it is questionable if probiotic supplementation actually changed the breast milk cytokine pattern.Finally, we regret that no faecal samples of the mothers were analysed to confirm actual colonization with the given probiotic strains. This would have given important information on compliance. References 1 Huurre A, Laitinen K, Rautava S, Korkeamaki M, Isolauri E. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: a double-blind placebo-controlled study. Clin Exp Allergy 2008; 38:1342-48. 2 Laubereau B, Brockow I, Zirngibl A et al. Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life-results from the GINI-birth cohort study. J Pediatr 2004; 144:602-7.Response by Anu Huurre, on behalf of the NAMI (Nutrition, Allergy, Mucosal Immunology and Intestinal Microbiota) research groupWe thank van der Aa et al. for their interest in our study, Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization: A double-blind placebo-controlled study, evaluating possible factors explaining the protective effect of probiotics. The questions van der Aa et al. have brought up concerns the secondary outcomes, not the main outcome of the study, i.e. that the protective potential of the combination of Lactobacillus rhamnosus strain GG and Bifidobacterium lactis Bb12 was best seen in high risk group of infants.We agree with van der Aa et al. that the secondary outcomes may have received disproportionate attention in the final version; in the version originally submitted they were not equally emphasized. The reason why the reviewers wanted to stress these findings may be the fact that th...
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