Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood – a longitudinal analysis of long-term follow-up of a randomized controlled trial

Abstract

BackgroundRandomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic disease in childhood. Due to the nature of the atopic march, investigation of any effects of this prenatal intervention may be most informative when consistently assessed longitudinally during childhood.MethodsFollow-up of children (n = 706) with familial risk of allergy from the Docosahexaenoic Acid to Optimize Mother Infant Outcome (DOMInO) trial. The intervention group received fish oil capsules (900 mg of ω-3 LCPUFA) daily from <21 weeks’ gestation until birth; the control group received vegetable oil capsules without ω-3 LCPUFA. This new longitudinal analysis reports previously unpublished data collected at 1 and 3 years of age. The allergic disease symptom data at 1, 3 and 6 years of age were consistently reported by parents using the "International Study of Asthma and Allergies in Childhood" (ISAAC) questionnaire. Sensitization was determined by skin prick test to age specific, common allergen extracts.ResultsChanges over time in symptoms of allergic disease with sensitization (IgE-mediated) and sensitization did not differ between the groups; interaction p = 0.49, p = 0.10, respectively. Averaged across the 1, 3 and 6-year assessments, there were no significant effects of prenatal ω-3 LCPUFA supplementation on IgE-mediated allergic disease symptoms (adjusted relative risk 0.88 (95% CI 0.69, 1.12), p = 0.29) or sensitization (adjusted relative risk 0.97 (95% CI 0.82, 1.15), p = 0.76). Sensitization patterns to common allergens were consistent with the atopic march, with egg sensitization at 1 year strongly associated with house dust mite sensitization at 6 years, (p < 0.0001).DiscussionAlthough there is some evidence to suggest that maternal supplementation with 900mg ω-3 LCPUFA has a protective effect on early symptoms of allergic disease and sensitization in the offspring, we did not observe any differences in the progression of disease over time in this longitudinal analysis. Further investigation into the dose and timing of ω-3 LCPUFA supplementation, including long-term follow up of children using consistent outcome reporting, is essential to determine whether this intervention may be of benefit as a primary prevention strategy for allergic disease.ConclusionMaternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization throughout childhood from 1 to 6 years.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN); DOMInO trial ACTRN12605000569606, early childhood allergy follow up ACTRN12610000735055 and 6-year allergy follow up ACTRN12615000498594.

Allergic sensitization among Danish infants at 13 months of age

“…At 1 year of age 17% of the children were sensitized against at least one food allergen or one inhalant allergen. 10 The Australian children had similar allergic predisposition as the 709 children in our study with atopic predisposition (Table 3), however only 8.2% of our children were sensitized.…”

“…9 A recently published Australian study performed skin prick tests in 706 children at 1, 3, and 6 years of age. 10 All the included children had a mother, father or sibling with an allergic disease (self-reported history of medically diagnosed eczema, asthma, or hay fever). At 1 year of age 17% of the children were sensitized against at least one food allergen or one inhalant allergen.…”

Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology

“…Of them, 25 were cohort or case-control studies 14-38 and 2 were RCTs. 39,40 In total, our systematic review is based on 95 papers (17 RCTs and 78 cohort and case-control studies). The numbers of pregnant women and their offspring studied at different time points and presented in different publications are shown in the supplementary Files S1-S9.…”

Omega-3 Fatty Acids in Pregnancy—The Case for a Target Omega-3 Index

“…In a recent pertinent meta-analysis of seven intervention trials with 2047 children, it was confirmed in a slightly less pronounced manner that EPA and DHA in pregnancy reduce asthma and persistent wheezing in the child [46]. Epidemiologic studies and some, but not all, intervention trials demonstrated that EPA and DHA in pregnancy can reduce the propensity towards allergies in the children [52][53][54][55].…”