Prolonged breastfeeding and protective effects against the development of allergic rhinitis: a systematic review and meta-analysis

Hoang, Minh P; Samuthpongtorn, J; Seresirikachorn, Kachorn; Snidvongs, Kornkiat

doi:10.4193/rhin21.274

Cited by 4 publications

(3 citation statements)

References 54 publications

(146 reference statements)

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“…Moreover, the microorganisms in breast milk are an important link in initiating the immune function of the infant gut and driving the colonization of intestinal microorganisms; its short-chain fatty acids, a metabolite produced by microorganisms, can affect peripheral blood T cells, especially regulatory T (Treg) cells, by inhibiting histone deacetylases to achieve immune effects [ 105 ]. The meta-analysis by Hoang et al [ 42 ] included in this study showed that either extended exclusive breastfeeding or extended non-exclusive breastfeeding (≥ 6 months) reduced the risk of AR, which is in line with the WHO recommendation that every infant should be breastfed for at least 6 months [ 102 ].…”

Section: Discussionsupporting

confidence: 77%

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

Xu,

Liu,

et al. 2023

Clinic Rev Allerg Immunol

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Many potential environmental risk factors, protective factors, and biomarkers of AR have been published, but so far, the strength and consistency of their evidence are unclear. We conducted a comprehensive review of environmental risk, protective factors, and biomarkers for AR to establish the evidence hierarchy. We systematically searched Embase, PubMed, Cochrane Library, and Web of Science electronic database from inception to December 31, 2022. We calculated summary effect estimate (odds ratio (OR), relative risk (RR), hazard ratio (HR), and standardized mean difference (SMD)), 95% confidence interval, random effects p value, I2 statistic, 95% prediction interval, small study effects, and excess significance biases, and stratification of the level of evidence. Methodological quality was assessed by AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). We retrieved 4478 articles, of which 43 met the inclusion criteria. The 43 eligible articles identified 31 potential environmental risk factors (10,806,206 total population, two study not reported), 11 potential environmental protective factors (823,883 total population), and 34 potential biomarkers (158,716 total population) for meta-analyses. The credibility of evidence was convincing (class I) for tic disorders (OR = 2.89, 95% CI 2.11–3.95); and highly suggestive (class II) for early-life antibiotic use (OR = 3.73, 95% CI 3.06–4.55), exposure to indoor dampness (OR = 1.49, 95% CI 1.27–1.75), acetaminophen exposure (OR = 1.54, 95% CI 1.41–1.69), childhood acid suppressant use (OR = 1.40, 95% CI 1.23–1.59), exposure to indoor mold (OR = 1.66, 95% CI 1.26–2.18), coronavirus disease 2019 (OR = 0.11, 95% CI 0.06–0.22), and prolonged breastfeeding (OR = 0.72, 95% CI 0.65–0.79). This study is registered in PROSPERO (CRD42022384320).

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Section: Discussionsupporting

confidence: 77%

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

Xu,

Liu,

et al. 2023

Clinic Rev Allerg Immunol

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“…A recent SRMA revealed that exclusive or non‐exclusive breastfeeding for 6 or more months may have protective effects on the development of AR up to 18 years of age 995 . A 2019 systematic review that included one cluster RCT and five prospective cohort studies examined the relationship between shorter versus longer durations of any human milk feeding (whether or not it was fed at the breast) and AR in childhood 996 .…”

Section: Risk Factors and Protective Factors For Allergic Rhinitismentioning

confidence: 99%

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

157

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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“…However, the limited number of included studies and substantial heterogeneity have diminished the reliability of this result. In their recent study, Hoang et al found that long-term exclusive breastfeeding did not exhibit a protective effect against AR in children, with the overall evidence quality being relatively low [16]. Despite recent original studies exploring the link between breastfeeding and the risk of AR and FA, no conclusive findings have been drawn.…”

Section: Introductionmentioning

confidence: 98%

Breastfeeding and risk of food allergy and allergic rhinitis in offspring: a systematic review and meta-analysis of cohort studies

Ding,

Zhu,

et al. 2024

Eur J Pediatr

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The association between breastfeeding and the occurrence of allergic rhinitis (AR) and food allergy (FA) in offspring remains inconclusive. This review aims to comprehensively explore the potential relationships between various patterns and durations of breastfeeding and allergic diseases in offspring. We systematically searched PubMed, EMBASE, Cochrane, WOS databases, and Google Scholar for observational studies published up to March 30, 2023, that investigated the link between breastfeeding and allergies in offspring. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI). Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated employing an appropriate model based on the degree of heterogeneity. A total of 68 studies, encompassing 772,142 children, were ultimately included. The findings indicated that breastfeeding for more than 6 months was associated with a reduced risk of AR (OR = 0.88, 95% CI: 0.79 to 0.98) but posed a risk for FA (OR = 1.69, 95% CI: 1.27 to 2.25). Exclusive breastfeeding exhibited a protective effect against AR (OR = 0.94, 95% CI: 0.90 to 0.97), whereas non-breastfeeding was identified as a risk factor for AR (OR = 1.48; 95% CI: 1.03 to 2.12). No significant association was observed between breastfeeding patterns and FA. Conclusion: Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, large prospective high-quality studies are needed to investigate the potential risk of FA in children with prolonged breastfeeding. What is Known:• The impact of breastfeeding on allergic rhinitis and food allergy in offspring is controversial.• Previous meta-analyses fail to prove the effect of breastfeeding on food allergy in offspring of all ages. What is New:• Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, it potentially elevates the risk of FA in children. Non-breastfeeding is linked to an increased risk of AR in children, but there is no evidence of an association between breastfeeding patterns and FA in children.• The impact of breastfeeding on allergic rhinitis and food allergy in offspring may vary with the time and pattern of breastfeeding.

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Prolonged breastfeeding and protective effects against the development of allergic rhinitis: a systematic review and meta-analysis

Cited by 4 publications

References 54 publications

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

Environmental Risk Factors, Protective Factors, and Biomarkers for Allergic Rhinitis: A Systematic Umbrella Review of the Evidence

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Breastfeeding and risk of food allergy and allergic rhinitis in offspring: a systematic review and meta-analysis of cohort studies

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