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201 417 1 SM
201 417 1 SM
201 417 1 SM
Original Article
Keywords: cows milk, atopic dermatitis, From the Departments of Child Health, Udayana University Medical
prognostic 6FKRRO6DQJODK+RVSLWDO'HQSDVDU1 and Gadjah Mada University, Sardjito
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to be dropped out from the study, then moved into H[SUHVVHGE\KD]DUGUDWLR+5DQGFRQILGHQFH
the exposed to cows milk group (CM group). These interval (CI). Statistical analysis was performed with
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Subjects unable to be contacted were considered as study was approved by the Research Ethics Committee
lost to follow-up. at the Udayana University Medical School, Sanglah
The incidences of AD in the CM and non- Hospital, Denpasar.
CM groups were calculated as cumulative incidence
and incidence rates. Inferential statistical analyses
were conducted to test the prognostic value of the Results
independent variables in two stages. The first stage
was to construct a univariate Kaplan-Meier curve 'XULQJ WKH VWXG\ SHULRG VXEMHFWV PHW WKH
describing the relationship between each independent HOLJLELOLW\FULWHULDZLWKVXEMHFWVLQWKH&0JURXS
variable and the dependent variable. All variables that DQGVXEMHFWVLQWKHQRQ&0JURXS6HYHQVXEMHFWV
showed uncrossed Kaplan-Meier curves were analyzed dropped out from the non-CM group, then entered
by Coxs proportional hazard function. Significance was the CM group. Two subjects in the CM group were
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Kaplan-Meier curves of all prognostic factors than those not exposed to cows milk. Both results
did not intersect (data not shown), so all prognostic ZHUHQRWVLJQLILFDQWZLWK+5DQG&,
factors were analyzed using Coxs proportional hazard WR,QRXUVWXG\ZHIRXQGWKDWWKH\RXQJHVWFKLOG
analysis multivariate function. with AD was 1-month old. Several studies found that
Table 2VKRZVWKHWKUHHYDULDEOHVZLWK3 AD started to occur at 1 month of age, and later at
however, the confidence intervals were not significant. PRQWKVRIDJH These differences in the time
Subjects in the CM group had a cumulative AD of AD onset may be due to the low production and
LQFLGHQFHKLJKHUDQGRFFXUUHGHDUOLHUWKDQLQ immature function of IgA in newborns. Infants
WKRVHWKHQRQ&0JURXSLQWKHILUVWPRQWKVRIOLIH receive IgA antibodies from breast milk, forming
+5&,WR$QRWKHUSURJQRVWLF a rejection antigen system, some of which may be
IDFWRUV WKDW DOVR VKRZHG 3 ZHUH H[SRVXUH directly against the protein foods in the mothers
to cigarette smoke and subjects with mothers who diet, as well as foreign proteins including cows milk.
FRQVXPHG FKLFNHQ HJJV DQGRU FRZV PLON ZKHQ Infants easily absorb macromolecules because of their
QXUVLQJZLWK+5&,WRDQG+5 immature intestinal mucosa, so the granting of foreign
&,WRUHVSHFWLYHO\ proteins, though in small amounts, may result in the
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may be due to air pollutants which generally have RE, editor. Immunologic disorders in infants and children.
an irritating effect on skin and mucous membranes, 5thHG3KLODGHOSKLD(OVHYLHU,QFS
facilitating the penetration of potential allergens into /HXQJ'<0$WRSLFGHUPDWLWLV,Q/HXQJ'<06DPSVRQ
the body, causing AD symptoms and increasing the HA, editors. Pediatric allergy, principles and practice.
risk of sensitization. 3KLODGHOSKLD0RVE\S
&KLFNHQHJJVDQGRUFRZVPLONFRQVXPSWLRQE\ 4. Williams HC. Clinical practice: atopic dermatitis. N Engl J
mothers when nursing was a prognostic factor for AD, 0HG
but this result was not significant. Food allergens can 5. Wolf RL. Atopic dermatitis. In: Shanahan J, editor. Essential
be detected in breast milk, including peanuts, cows SHGLDWULFDOOHUJ\DVWKPD LPPXQRORJ\1HZ<RUN0F*UDZ
milk protein, and eggs.Avoidance of food allergens +LOOS
in the mothers diet while breastfeeding was reported <XQJLQJHU-:2XWGRRUDOOHUJHQ,Q/HXQJ'<06DPSVRQ
to be a protective factor against the onset of AD. HA, editors. Pediatric allergy, principles and practice.
However, no relationship has been found between 3KLODGHOSKLD0RVE\S
peanuts in the maternal diet and peanut allergies. 7HUU$,7KHDWRSLFGLVHDVHV,Q3DUVORZ*7HGLWRU0HGLFDO
One case report stated that food allergens in breast LPPXQRORJ\thHG6LQJDSRUH0F*UDZ+LOOS
milk may interact with the mucosal immune system,
inducing an allergic reaction in infants who were )LQOD\$<7KHEXUGHQRIDWRSLFHF]HPD,Q5LQJ-HGLWRU
previously clinically suspected of having allergies +DQGERRN RI DWRSLF HF]HPD nd HG 1HZ <RUN 6SULQJHU
against these antigens.14 S
A limitation of our study was that the AD 9. Warner JO. Allergy practice worldwide, a report by the world
symptoms were collected by phone interview of the allergy organization specialty and training council. Allergy
mothers who live in distant places. If AD occurred &OLQ,PPXQRO,QW
before the researcher called the subjects parents 6XJL\DPD0$UDNDZD+2]DZD.0L]XQR70RFKL]XNL
at a predetermined time, a measurement bias could H, Tokuyama K, et al. Early life risk factors for occurrence
be introduced since parents might forget about the of atopic dermatitis during the first year. Pediatrics.
symptoms.
Since we did not find a prognostic factor for 11. Scafer T. Epidemiology of atopic eczema. In: Ring J, editor.
$'LQWKHILUVWPRQWKVRIOLIHWKH$'LQFLGHQFH +DQGERRN RI DWRSLF HF]HPD nd HG 1HZ <RUN 6SULQJHU
may have been too low due to the small sample size. S
A larger sample size and longer observation time +RVW$+DONHQ6-DFREVHQ+3&KULVWHQVHQ$(+HUVNLQG
is needed to assess a more accurate incidence and $03OHVQHU.&OLQLFDOFRXUVHRIFRZVPLONSURWHLQDOOHUJ\
prognostic factors of AD. intolerance and atopic diseases in childhood. Pediatr Allergy
Immunnol.
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Acknowledgments DWRSLFGHUPDWLWLVGXULQJWKHILUVW\HDUVRIOLIHUHVXOWVIURP
WKH*,1,ELUWKFRKRUWVWXG\-3HGLDWU
We extend our sincere gratitude to the physician and nurses 14. Greer FR, Sicherer SH, Burks AW, American Academy of
in charge at the Perinatology Ward at Sanglah Hospital, and Pediatrics Committee on Nutrition. Effects of early nutritional
to I Gde Raka Widiana, MD for his help in methodology interventions on the development of atopic disease in infants
construction and statistical analysis. and children: The role of maternal dietary restriction,
breastfeeding, timing of introduction of complementary foods,
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References 15. Shinohara M, Saito H, Matsumoto K. Different timings of
prenatal or postnatal tobacco smoke exposure have different
1. Beck LA. Atopic dermatitis. In: Lichtenstein LM, editor. HIIHFWV RQ WKH GHYHORSPHQW RI DWRSLF HF]HPDGHUPDWLWLV
Current therapy in allergy, immunology and rheumatology. syndrome (AEDS) during infancy. J Allergy Clin Immunol.
thHG3KLODGHOSKLD(OVHYLHU,QFS 2011;12:813-7.
6LFKHUHU6+6DPSVRQ$+$WRSLFGHUPDWLWLV,Q6WLHKP *GDOHYLFK00LPRXQL''DYLG00LPRXQL0%UHDVW
feeding and the onset of atopic dermatitis in childhood : a =XWDYHUQ $ %URFNRZ , 6FKDDI % %ROWH * YRQ %HUJ $
systematic review and meta-analysis of prospective studies. Diez U, et al. Timing of solid food introduction in relation to
J Am Acad Dermatol. atopic dermatitis and atopic sensitization: results from the
*XVWDIVVRQ'/RZKDJHQ7$QGHUVVRQ.5LVNRIGHYHORSLQJ prospective birth cohort study. Pediatrics.
atopic diseases after early feeding with cows milk based 11.
IRUPXOD$UFK'LV&KLOG 7UDKPV&01XWULWLRQGXULQJLQIDQF\,Q0DKDQ/.HGLWRU
18. Liu AH, Martinez FD, Taussig LM. Natural history of allergic Krauses food, nutrition, & diet therapy. 11th ed. Philadelphia:
GLVHDVHVDQGDVWKPD,Q/HXQJ'<06DPSVRQ+$HGLWRUV 6DXQGHUVS
Pediatric allergy, principles and practice. Philadelphia: Mosby; /RSH]1GH%DUURV0D]RQ69LOHOD006LOYD&05LEHLUR
S JD. Genetic and environmental influences on atopic immune
19. Budiastuti M. Hubungan antara pemberian ASI eksklusif responses in early life. J Investig Allergol Clin Immunol.
dengan kejadian dermatitis atopi pada bayi risiko tinggi alergi
[masters thesis]. ><RJ\DNDUWD@%DJLDQ,OPX.HVHKDWDQ$QDN 9DGDV3:DL<%XUNV:3HUHOPDQ%'HWHFWLRQRISHDQXW
)DNXOWDV.HGRNWHUDQ8QLYHUVLWDV*DGMDK0DGD allergens in breast milk of lactating women. JAMA.
0RRUH005LIDV6KLPDQ6/5LFK(GZDUGV-:.OHLQPDQ
KP, Camargo CA, Gold DR, et al. Perinatal predictors of /RYHJURYH-$+DPSWRQ600RUJDQ-%7KHLPPXQRORJLF
atopic dermatitis occurring in the first six months of life. and long-term atopic outcome of infants born to women
3HGLDWULFV following a milk-free diet during pregnancy and lactation: a
6QLMGHUV%(7KLMV&YDQ5HH5YDQGHQ%UDQGW3$$JH SLORWVWXG\%U-1XWU
at first introduction of cow milk products and other food /DFN*)R['1RUWKVWRQH.*ROGLQJ-$YRQ/RQJLWXGLQDO
products in relation to infant atopic manifestations in the first Study of Parents and Children Study Team. Factors associated
\HDUVRIOLIHWKH.2$/$%LUWK&RKRUWVWXG\3HGLDWULFV with the development of peanut allergy in childhood. N Engl
J Med.
0RUJDQ - :LOOLDPV 3 1RUULV ) :LOOLDPV &0 /DUNLQ 0 <L2.ZRQD+-.LP++D0+RQJ6-/HHP-+et al. Effect
Hampton S. Eczema and early solid feeding in preterm of environmental tobacco smoke on atopic dermatitis among
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