Bibliographic updates

January 2017

Claude Molina et Jacques Gayraud

1. Fish-oil derived Poly-Unsatured Fatty Acids in pregnancy and wheeze and Asthma in offspring
2. Egg-Allergy: prevention in high risk infants with eczema
3. Egg Allergy in infants: How appreciate tolerance


1. Fish-oil derived Poly-Unsatured Fatty Acids (PUFA) in pregnancy and wheeze and Asthma in offspring

3 articles are devoted to this topic : 2 are favorable, one is unfavorable.

1)    Favorable effects :
H.Bisgaard et al NEJM 2016 December 29  
a)     In this Danish and American double-blind trial among 736 women in the third trimester of pregnancy, n-3 long-chain of PUFA (2,4g/j of fish-oil or placebo olive oil) reduce the absolute risk of persistent wheeze and asthma and infections of lower respiratory tract in offspring (605 children followed 3 years then 2 years) by approximately 7 points or one third.
b) The second article from Danish and Canadian authors
S.Hansen et al   JACI 2017 January139 1104-11                       
In a randomized controlled trial from 1980 with 24 years of follow-up, including 533 women who received fish-oil during the third trimester of pregnancy, the offspring were invited to complete a questionnaire and attend a clinical examination at age 18 to 19 years.
Maternal supplementation showed, that the probability of having ad asthma medication or lung function outcomes or allergic sensitization was significantly reduced in offspring and confirm the prophylactic potential for long term prevention of asthma or allergy

2)    Unfavorable effects:                                                           
H.T.Waldytillake & al, Allergy 26 December 2016 Article accepted                   
This Australian group hypothesized that n-3 PUFA in breast milk may assist immune and lung development and the aim of the study was to investigate associations between n-3 and n-6 levels in 194 colostrum samples and 118 breast milk, from mothers enrolled in the Melbourne atopy cohort and allergic diseases and lung function in offspring at ages 12 and 18 years.
Higher levels of n-3PUFAs were significantly associated with increased risks of allergic rhinitis and eczema up to 18 years and sensitization and reduced lung function at 12 years.        
In conclusion the authors, in spite of possible residual confounding in these associations, the strategy that increase maternal n-3PUFA may not aid in allergic disease prevention

3)    Clinical decision
R.Ramaswami NEJM 2017 11January.
Which of the following options would you recommend for this 30 years woman who is 20 weeks of her 2nd pregnancy, healthy, with a history of well-controlled asthma, and without any ultra-sound screening fetal anomalies. Her 4 years son is frequent seen in the emergency department for persistent wheezing and lower respiratory tract infections?
She wants to discuss the risks of similar symptoms in her unborn child.
a) Start n-3 PUFA supplementation, which according to guidelines of FDA administration and a recent published trial on the Web, is a potential therapeutic option at little risk, cost, or inconvenience.                              
b) Do not start n-3 PUFA supplementation: divergent opinion reflects the difference between clinical decision making, based on inadequate evidence, aims to benefit to individual patient and scientific decision making more rigorous but aiming at population-wide benefit.
As long as the family knows that the benefit is unclear it is hard to see the downside to giving fish oil and the first option is recommended

2.   Egg-Allergy : prevention in high risk infants with eczema

O.Natsume & al, The Lancet9 December in press on line.
It is well known that early consumption of a food allergen is more beneficial than is delayed introduction. The Japanese authors investigated whether or not, early double step in 147 infants with eczema combined with optimal treatment, would prevent egg allergy at 1 year.                                                         

In a double blind controlled study they administered orally 50mg of heated egg powder /day from 6 to 9 months of age, then 250mg till 12 months. In a primary analysis 4 (9%) of 47 egg group had an egg allergy compared with 23 (38% ) in the placebo group. The risk ratio confirmed the efficacy of this strategy even in high risk infants with aggressive eczema treatment. The only difference is in adverse effects, more frequent in the egg group. This is however a practical approach to overcome an allergic epidemic

3.   Egg Allergy in infants : How appreciate tolerance

(without the use of challenge test which is often harmful)
2 articles tried to answer:                                                    
1) J. Gradman & al : Ped.Allergy.Immunol 2016 27 825-830
By a long-term follow-up of specific IgE to egg white and ovomucoid and their decrease : study done in 130 Danish infants followed 26 months.                                    
2) C. Caffarelli & al: Ped.Allergy.Immunol 2016 27871-884                
By skin tests to white egg and yolk (ALK extracts) which become negative et when in the same time, introduction of egg provoke only weak reactions : study in 75 Italian infants of average 14 months of age.

Your comments and questions are welcome at the following addresses:
With our best wishes for an happy new year

Claude Molina
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Jacques Gayraud
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Last updated 17 February 2017