Atopy

Aims: To analyze risk conferred by family history of asthma, rhinitis and eczema for the development of childhood asthma. Study Design: Survey of school children in 3 cities of Saudi Arabia using a questionnaire. Place and Duration of Study: Methodology: A cross-sectional, population based study was carried out in 1601 school children, in 3 cities of Saudi Arabia. A questionnaire comprising 35 questions were used for this study. Risk for developing asthma was estimated in terms of odds ratio by bivariate analysis using the chi-squared test with P < 0.05 being considered significant. Results: While 18.0% and 20.6% of asthmatics, respectively, did not have a positive history of asthma in the immediate family and in relatives, 48.1% and 46.1% had immediate family and relatives with a positive history. History of asthma in the immediate family (parents, siblings) conferred a 4.2-fold and in relatives (aunts, uncles) a 3.3-fold risk (P < 0.0001) increased risk. The risk with a history of rhinitis or eczema in the immediate family was increased ≥ 3 times (P < 0.0001) and for rhinitis in the relatives (P < 0.0001). Exposure to cigarette smoke conferred a 2-fold increased risk (P < 0.0001). Neither exposure to household pets (cats and birds) nor the history of eczema in relatives was significant risk factors. Conclusion: The findings suggest that the presence of strong familial aggregation and atopy in the immediate family and relatives can be a considerable increased risk factor for the development of childhood asthma.

Background
Normal newborns have a limited immunocompetence therefore they need breast milk (BM), which represent an excellent immune protection for the neonate during the critical period of intestinal vulnerability, owing to a great variety of functionally interactive immunological, antibacterial, antiviral, anti-inflammatory and immuno-modulating factors. Evidence suggests that the protection afforded by BM to the recipient infant is greatest when breastfeeding is exclusive and of substantial duration. BM is not always available, but it is not surprising that cow’s milk (CM) can induce a whole spectrum of allergic manifestations, even life-threatening or fatal, especially a minute CM amount, in addition to sensitize genetically atopy-prone infants.

Considerations
For both pediatricians and allergists the management of infants with CM allergy (CMA) is a challenge. In the first years of life of many children CM represents the primary source of nutrients with high biological value insuring almost the whole dietary supply of proteins, carbohydrates, and
fat: its high nutritional value and low cost should be noted. Children with CMA older than two years can avoid CM without nutritional loss if the nutrients necessary to cover daily requirements are provided by other foods. In the first years of life, dietary treatment of CMA is necessary for
evident reasons. Accordingly, the choice of an adequate CM substitute among several hypoallergenic formulas is mandatory for infants with CMA.

Conclusion
In this paper we will discuss the nutritional adequacy, the immunogenicity and the allergenicity of the available CM substitutes, including soy-protein, home-made, meat-based, hydrolysate, goat and mare, and amino acid-derived formulas, as well as the challenges posed by both
genetically modified foods (GMFs), and bovine spongiform encephalopathy (BSE). According to recent data, the above formulas can be also useful for feeding “high risk” babies, when BM is unavailable for the prevention of atopic diseases, and the stopping of the atopic march.