Diet Diet during during pregnancy pregnancy and and atopic atopic disease disease 1. 2. 3. 4. Elimination diet Probiotics LCPUFA Conclusions Maternal Maternal elimination elimination diet diet during ? during pregnancy pregnancy? NO NO !! •• Prescription -risk woman Prescriptionof ofan anantigen antigenavoidance avoidancediet dietto tohigh high-risk woman during duringpregnancy pregnancyisisunlikely unlikelyto toreduce reducesubstantially substantiallyher herrisk risk of . ofgiving givingbirth birthto toan anatopic atopicchild child. •• Moreover , such Moreover, suchaadiet dietmay mayhave havean anadverse adverseeffect effecton on maternal maternaland/or and/orfetal fetalnutrition nutrition •• •• Kramer KramerMS, MS,Cochrane CochraneLibrary Library2002 2002 S.S.Salvatore, Salvatore,K. K.Keymolen, Keymolen,B. B.Hauser, Hauser,Y. Y.Vandenplas Vandenplas Intervention spring Interventionduring duringpregnancy pregnancyand andallergic allergicdisease diseaseininthe theoff offspring Paediatric -66 PaediatricAllergy Allergyand andImmunology Immunology2005;16:558 2005;16:558-66 Effects Effectsof ofearly earlynutritional nutritionalinterventions interventionson onthe thedevelopment developmentof of atopic atopicdisease diseasein ininfants infantsand andchildren: children: the , breastfeeding, therole roleof ofmaternal maternaldietary dietaryrestriction restriction, breastfeeding, timing rmulas. timingof ofintroduction introductionof ofcomplementary complementaryfoods, foods,and andhydrolyzed hydrolyzedfo formulas. Greer , AAP ; AAP GreerFR FR, AAPCommittee Committeeon onNutrition Nutrition; AAPSection Sectionon onAllergy Allergyand andImmunology Immunology Pediatrics . 2008;121:183 -91 Pediatrics. 2008;121:183-91 Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. Compliance Compliance ?? ?? The Theimpact impactof ofgovernment governmentadvice adviceto topregnant pregnantmothers mothersregarding regarding peanut peanutavoidance avoidanceon onthe theprevalence prevalenceof ofpeanut peanutallergy allergy in inUK UKchildren childrenat atschool schoolentry. entry. Hourihane . JJAllergy -202 HourihaneJO JO. AllergyClin ClinImmunol Immunol2007;119:1197 2007;119:1197-202 ••Only Only36/957 36/957mothers mothers(3.8%) (3.8%)followed followedthe theGovernment's Government'sadvice adviceby bystopping stopping the theconsumption consumptionof ofpeanuts peanutswhile whilepregnant. pregnant. ••30 , 1.8% 30children children(2.8%; (2.8%;95% 95%CIs CIs, 1.8%to to3.8%): 3.8%):++SPT SPT.. ••20 , 1.1% 20children children(1.8%; (1.8%;95% 95%CIs CIs, 1.1%to to2.7%): 2.7%): peanut peanutallergy. allergy. ==highest highestprevalence prevalencefor forpeanut peanutallergy allergyrecorded recordedto todate. date. ••ItItisisdifficult ative) of difficultto toascertain ascertainany anyimpact impact(either (eitherpositive positiveor orneg negative) ofthe the United llergy UnitedKingdom Kingdomgovernment governmentadvice adviceon onthe theprevalence prevalenceof ofpeanut peanutaallergy in -5 years inBritish Britishchildren childrenaged aged44-5 yearsfrom from2003 2003to to2005. 2005. Confounding … Confounding variables variables… Month Monthof ofbirth birth––allergic allergicdisease disease//sensitization sensitizationto toaeroallergens aeroallergens 755 755Japanese Japanesechildren children Sensitisation Sensitisation ••house housedust dustmites mites ••Crytmeria Crytmeriajaponica japonicapollen pollen Jan uary ––March January March December December––January January rest restof ofyear year(<.01) (<.01) rest restof ofyear year(<.05) (<.05) Asthma , ififborn Asthma, bornin in November -> 17.3 November––December December::26 26% %<<-> 17.3% %rest restyear year (<.05) (<.05) Allergic , ififborn Allergicrhinitis rhinitis, bornin in August -> rest August––October October<<-> restof ofyear year(<.05) (<.05) Allergic , ififborn Allergicconjunctivitis conjunctivitis, bornin in December -> 9.1 December––January January(15.8%) (15.8%)<<-> 9.1% %rest restof ofyear year(<.01) (<.01) No Norelation relationeczema eczema//season seasonof ofbirth birth 1. 2. 3. 4. Elimination diet Probiotics LCPUFA Conclusions Probiotics Probiotics in in human human milk milk • Human milk contains Lactobacilli, Enterococci • Strains are specific to mother-infant pairs • Strains isolated from milk are identical to strains in infant faeces, and different from strains isolated from areola skin Novak FR. Pediatr (Rio J). 2001;77:265-70 Martin R, J. Pediatr 2003; 143:754-8 Innate Innaterecognition recognitionof ofbacteria bacteriain inhuman humanmilk milkisismediated mediatedby byaa milk -derived highly D14 milk-derived highlyexpressed expressedpattern patternrecognition recognitionreceptor, receptor,soluble solubleCCD14 MO . JJExp -12 MOLabeta Labeta. ExpMed Med2000;191:1807 2000;191:1807-12 breast milk of healthy women is a source of commensal bacteria to the infant gut. Cultivation-independent assessment of the bacterial diversity of breast milk among healthy women. Martín R. Res Microbiol. 2007;158:31-7 Diversity of the Lactobacillus group in breast milk and vagina of healthy women and potential role in the colonization of the infant gut. Martín R. J Appl Microbiol. 2007;103:2638-44 Probiotics -feeding might Probioticsduring duringpregnancy pregnancyand andbreast breast-feeding mightconfer confer immunomodulatory . immunomodulatoryprotection protectionagainst againstatopic atopicdisease diseasein inthe theinfant infant. S.S.Rautava . JJAllergy -21 Rautava. AllergyClin ClinImmunol Immunol2002;109:119 2002;109:119-21 Lactobacillus - placebo Lactobacillusrhamnosus rhamnosusstrain strainGG GG(ATCC (ATCC53103) 53103)placebo 44weeks weeksbefore beforebirth birth––during duringbreast breastfeeding feeding(6 (6months monthsafter afterbirth) birth) L.GG control control L.GG Maternal 18/30 Maternalatopic atopicdisease disease 18/30(60%) (60%) 24/32 24/32(75 (75%) %) Exclusive 3.2 3.2 Exclusivebreast breastfeeding feeding 3.2 3.2 months months Total 8.3 8.5 Totalbreast breastfeeding feeding 8.3 8.5 months months Anti-inflammatory transforming -2 2885 1340 Anti Anti-inflammatory transforminggrowth growthfactor factor22TGF TGF-2 2885 1340 pg/ml pg/ml At At22years years eczema 4/27 eczema 4/27(15%) (15%) 14/30 14/30(47%) (47%) GI -symptoms 2/28 2/31 GI-symptoms 2/28(7%) (7%) 2/31(6%) (6%) CMPA 6/29 CMPA 6/29(21%) (21%) 3/31 3/31(10%) (10%) ++-ve -ve skin 6/26 skinprick prick 6/26(23%) (23%) 6/29 6/29(21%) (21%) serum 29 28 serumIgE IgE 29 28 kU/l kU/l Spec ) 8/29 SpecIgE IgEAb Ab(>0.35 (>0.35kU/l kU/l) 8/29(28%) (28%) 11/30 11/30(37%) (37%) .018 .018 SS NS NS NS NS NS NS NS NS NS NS Probiotics Probioticsand andprevention preventionof ofatopic atopicdisease: disease: 44-year -year follow -up of -controlled trial. follow-up ofaarandomised randomisedplacebo placebo-controlled trial. Kalliomaki -71 KalliomakiM. M.Lancet Lancet2003;361:1869 2003;361:1869-71 ••Perinatal . rhamnosus Perinataladministration administrationof ofLactob Lactob. rhamnosusstrain strainGG GG(ATCC (ATCC53103) 53103) reduces -risk children reducesincidence incidenceof ofatopic atopiceczema eczemain inatat-risk children during duringthe thefirst first22years yearsof oflife life(infancy) (infancy) ••??persistence persistenceof ofthe thepotential potentialto toprevent preventatopic atopiceczema eczemaatat44years years ••questionnaire questionnaire++clinical clinicalexamination: examination:atopic atopiceczema eczemain in 14 14//53 53 Lactobacillus Lactobacillus 25 -0.97) 25//54 54 placebo placebo(relative (relativerisk risk0.57, 0.57,95% 95%CI CI0.33 0.33-0.97) ••Skin Skinprick pricktest testreactivity reactivitywas wasthe thesame samein inboth bothgroups groups 10 10//50 50 Lactobacillus Lactobacillus 99//50 50 placebo placebo preventive preventiveeffect effectof ofLactob LactobGG GGon onatopic atopiceczema eczemaextends extendsbeyond beyondinfancy infancy Probiotics : Probioticsduring duringthe thefirst first77years yearsof oflife life: aacumulative cumulativerisk riskreduction reductionof ofeczema eczemain inaa randomized, -controlled trial. randomized,placebo placebo-controlled trial. Kalliom äki M . JJAllergy -21 Kalliomäki M. AllergyClin ClinImmunol Immunol2007;119:1019 2007;119:1019-21 Randomized , Double -Blind, Placebo -Controlled Trial Randomized, Double-Blind, Placebo-Controlled Trialof ofProbiotics Probioticsfor for Primary : No . PrimaryPrevention Prevention: NoClinical ClinicalEffects Effectsof ofLactobacillus LactobacillusGG GGSupplementation Supplementation. Kopp . Pediatrics -6 KoppMV MV. Pediatrics2008 2008:121:e850 :121:e850-6 DBPCR family with 1 member DBPCRtrial, trial,105 105pregnant pregnantwomen women((family with>>1 memberwith withAD) AD) 44-6 -6 weeks weeksbefore beforedelivery delivery––66months monthspostnatal postnatal 9 Lactobacillus day LactobacillusGG GG53103; 53103;55xx10 109CFU CFU2x/ 2x/day placebo placebo 94 94families families(89.5%) (89.5%)completed completedthe thetrial trial Primary : atopic Primaryendpoint endpoint: atopicdermatitis dermatitisatatthe theage ageof of22years years Atopic Atopicdermatitis dermatitis 14/50 14/50(28%) (28%)Lactobacillus LactobacillusGG GGgroup group 12/44 12/44(27.3%) (27.3%)placebo placebogroup group Children > 5) Childrenwith withrecurrent recurrent((> 5)episodes episodesof ofwheezing wheezingbronchitis bronchitis were weremore morefrequent frequentin inthe theLactobacillus LactobacillusGG GGgroup group(26%; (26%;nn==13), 13), as ascompared comparedwith withthe theplacebo placebogroup group(9.1%; (9.1%;nn==4). 4). No Nodifference differencein inIGE IGEor orsensitisation sensitisation Impact Impactof ofmaternal maternalatopy atopyand andprobiotic probioticsupplementation supplementationduring duringpregnancy pregnancy on -blind placebo -controlled study. oninfant infantsensitization: sensitization:aadouble double-blind placebo-controlled study. Huurre . Clin -8 HuurreAA. ClinExp ExpAllergy Allergy2008;38:1342 2008;38:1342-8 171 -infant pairs 171mother mother-infant pairsPCDBR PCDBRstudy study ••Risk Riskof ofsensitization sensitization in ininfants infantswith withallergic allergicmothers mothers breastfeeding breastfeedingover over66months months[odds [oddsratio ratio(OR=4.83, (OR=4.83,P=0.005)], P=0.005)], or orexclusively exclusivelybreastfeeding breastfeedingover over2.5 2.5months months(OR=3.4, (OR=3.4,P=0.018). P=0.018). compared -allergic mothers comparedto tonon non-allergic mothers ••Probiotic Probioticsupplementation supplementationhad hadaaprotective protectiveeffect effectagainst againstsensitization sensitization in tion ininfants infantswith withaahigh highhereditary hereditaryrisk riskdue dueto tomaternal maternalsensitiza sensitization (OR=0.3, (OR=0.3,P=0.023). P=0.023). ••The -β2 tended Theconcentration concentrationof ofTGF TGF-β2 tendedto tobe be in inthe thecolostrum colostrum of ofthe themothers mothersin inthe theprobiotic probioticgroup groupcompared comparedto toplacebo placebo ((probiotic/placebo probiotic/placebo ratio=1.50, ratio=1.50,P=0.073). P=0.073). Also prob/plac ratio=1.56, Alsoin insubgroup subgroupof ofallergic allergicmothers mothers ((prob/plac ratio=1.56,P=0.094) P=0.094) Probiotic supplementation during pregnancy sensitisation infants at 12 months Meta -analysis of Meta-analysis ofclinical clinicaltrials trialsof ofprobiotics probioticsfor for prevention preventionand andtreatment treatmentof ofpediatric pediatricatopic atopicdermatitis dermatitis Lee -121 LeeJ.J.JJAllergy AllergyClin ClinImmunol Immunol2008;121: 2008;121:116 116-121 21 -13 y) 21trials trials(n: (n:1898, 1898,00-13 y) 66prevention preventiontrials trials 44treatment treatmenttrials trials some someefficacy efficacy no noefficacy efficacy 1. 2. 3. 4. Elimination diet Probiotics LCPUFA Conclusions Abnormal Abnormalfatty fattyacid acidcomposition compositionin inumbilical umbilicalcord cordblood bloodof ofinfants infants at athigh highrisk riskof ofatopic atopicdisease disease Beck -84 BeckM. M.Acta ActaPaediatr Paediatr2000;89:279 2000;89:279-84 Breast Breastmilk milkfrom frommothers mothersof ofchildren childrenwith withnewly newlydeveloped developed atopic atopiceczema eczemahas haslow lowlevels levelsof ofLCPUFAs LCPUFAs Businco -9 BusincoL, L,JJAllergy AllergyClin ClinImmunol Immunol1993;91:1134 1993;91:1134-9 House -3 fatty Housedust dustmite miteavoidance avoidanceand andomega omega-3 fattyacids acids protect protectfor forwheezing wheezingatat18 18months months Mihrshahi -8 MihrshahiS.S.JJAllergy AllergyClin ClinImmunol Immunol2003;111:162 2003;111:162-8 616 616pregant pregantwomen women house housedust dustmite miteavoidance avoidance ++omega -3 rich omega-3 richfat fatsources sources//normal normalfood food Omega -3 rich Omega-3 richfat fatsources sourcesresult resultin in 9.8 9.8% %absolute absolutereduction reduction(95 (95% %CI CI1.5 1.5––18.1) 18.1)p=0.02 p=0.02 of any wheeze ” of““any wheeze” 7.8 7.8% %absolute absolutereduction reduction(95% (95%CI CI0.5 0.5––15.1) 15.1)p=0.04 p=0.04 prevalence wheeze 11week ” prevalenceof of““wheeze week” No , atopy , asthma Noeffect effecton onserum serumIgE IgE, atopy, asthma(diagnosis (diagnosisdoctor) doctor) Fish -specific Fishoil oilsupplementation supplementationin inpregnancy pregnancymodifies modifiesneonatal neonatalallergen allergen-specific immune f atopy : immuneresponses responsesand andclinical clinicaloutcomes outcomesin ininfants infantsatathigh highrisk riskoof atopy: aarandomized, randomized,controlled controlledtrial trial(1) (1) Dunstan -84 DunstanJA. JA.JJAllergy AllergyClin ClinImmunol Immunol2003;112:1178 2003;112:1178-84 Objective: Objective: maternal -3 PUFAs maternaldietary dietarysupplementation supplementationwith withωω-3 PUFAsduring duringpregnancy pregnancy modifies modifiesimmune immuneresponses responsesin ininfants infants Methods: Methods: randomized, randomized,controlled controlledtrial trial 98 , pregnant -3 PUFAs 98atopic atopic, pregnantwomen women:: fish fishoil oil(3.7 (3.7ggωω-3 PUFAsper perday) day) placebo placebo from from20 20weeks' weeks'gestation gestationuntil untildelivery delivery Neonatal rth NeonatalPUFA PUFAlevels levelsand andimmunologic immunologicresponse responseto toallergens allergensatatbi birth Results: Results: Fish -specific Fishoil oilsupplementation supplementationin inpregnancy pregnancymodifies modifiesneonatal neonatalallergen allergen-specific immune f atopy : immuneresponses responsesand andclinical clinicaloutcomes outcomesin ininfants infantsatathigh highrisk riskoof atopy: aarandomized, randomized,controlled controlledtrial trial(2) (2) Dunstan -84 DunstanJA. JA.JJAllergy AllergyClin ClinImmunol Immunol2003;112:1178 2003;112:1178-84 Results : 83/98 Results: 83/98women womencompleted completedthe thestudy study nn-3 -3 PUFAs - SD) PUFAs(mean (mean+/ +/SD)(% (%total totalfatty fattyacids) acids) Fish control Fishoil oilsuppl suppl control nn==40 nn==43 40 43 neonatal - 1.85% - 1.22% neonatalerythrocyte erythrocytemembranes membranes 17.75% 17.75%+/ +/1.85% 13.69% 13.69%+/ +/1.22%(<.001) (<.001) All -5, IL -13, IL -10, and -gamma) Allneonatal neonatalcytokine cytokine(IL (IL-5, IL-13, IL-10, andIFN IFN-gamma) responses responses(to (toall allallergens) allergens) tended tendedto tobe belower lowerin inthe thefish fishoil oilgroup group (statistically -10 in (statisticallysignificant significantonly onlyfor forIL IL-10 inresponse responseto tocat) cat) Fish -specific Fishoil oilsupplementation supplementationin inpregnancy pregnancymodifies modifiesneonatal neonatalallergen allergen-specific immune f atopy : immuneresponses responsesand andclinical clinicaloutcomes outcomesin ininfants infantsatathigh highrisk riskoof atopy: aarandomized, randomized,controlled controlledtrial trial(3) (3) Dunstan -84 DunstanJA. JA.JJAllergy AllergyClin ClinImmunol Immunol2003;112:1178 2003;112:1178-84 Although , Althoughthis thisstudy studywas wasnot notdesigned designedto toexamine examineclinical clinicaleffects effects, we wenoted notedthat thatinfants infantsin inthe thefish fishoil oilgroup groupwere were 33times timesless lesslikely likelyto tohave haveaapositive positiveskin skinprick pricktest test to toegg eggatat11year yearof ofage age (odds 5). (oddsratio, ratio,0.34; 0.34;95% 95%confidence confidenceinterval, interval,0.11 0.11to to1.02; 1.02;PP=.05 =.055). Although Althoughthere therewas wasno nodifference differencein inthe thefrequency frequency of ofatopic atopicdermatitis dermatitisatat11year yearof ofage, age, infants infantsin inthe thefish fishoil oilgroup groupalso alsohad hadsignificantly significantlyless lesssevere severedisease disease (odds 5) (oddsratio, ratio,0.09; 0.09;95% 95%confidence confidenceinterval, interval,0.01 0.01to to0.94; 0.94;PP=.04 =.045) Comparison -like receptor - and -/Th-2 related Comparisonof ofToll Toll-like receptorandTh1 Th1-/Th-2 relatedmRNA mRNAlevels levels in inSpanish Spanishversus versusGerman Germanpregnant pregnantwomen womenand andneonates neonates D. . JPGN D.Hartl Hartl. JPGN2004;39(Suppl1):S13 2004;39(Suppl1):S13 Toll -like receptors Toll-like receptorsbind bindmicrobial microbialcompounds compounds thereby therebytriggering triggeringinnate innateimmune immuneresponse response ••Toll -like receptor Toll-like receptor(TLR) (TLR)22//44 Spanish Spanish>> >>German Germanwomen womenand andneonates neonates ••Spanish -4 (Th -2) Spanishwomen womenlower lowerIL IL-4 (Th-2) ••Correlation Correlationbetween betweenTLR2 TLR2and andTLR4 TLR4between betweenmothers/neonates mothers/neonates ••Difference ) Differencedue dueto todifferent differentmicrobial microbialexposure exposurein inboth bothcities cities(Granada (Granada/ /Munchen Munchen) ••??Role Roleof ofdifferent differentdietary dietaryintake intake(low (low//high highfish fishintake) intake) In InSpanish Spanishwomen women more morebifidobacteria bifidobacteria less than lessallergy allergy thanin inGerman Germanwomen women Maternal Maternaldiet dietduring duringpregnancy pregnancyin inrelation relationto to eczema . eczemaand andallergic allergicsensitization sensitizationin inthe theoffspring offspringat at22yyof ofage age. Sausenthaler . Am -7 SausenthalerSS. AmJJClin ClinNutr Nutr2007;85:530 2007;85:530-7 During Duringlast last44weeks weekspregnancy pregnancy High OR 95% Highintake intakeof of OR 95%CI CI margarine 1.49 margarine 1.49 1.08 1.08--2.04 2.04 vegetable 1.48 vegetableoils oils 1.48 1.14 1.14--1.91 1.91 positively positivelyassociated associatedwith witheczema eczemain inchildren childrenatat22years years fish 0.75 fish 0.75 0.57 0.57––0.98 0.98 negatively negativelyassociated associatedwith witheczema eczemain inchildren childrenatat22years years celery 1.85 celery 1.85 1.18 1.18––2.89 2.89 citrus 1.73 citrusfruit fruit 1.73 1.18 1.18––2.53 2.53 increased increasedrisk riskfor forsensitization sensitizationfood foodallergens allergens deep -frying vegetable deep-frying vegetablefat fat 1.61 1.61 1.02 1.02––2.54 2.54 raw 2.16 rawsweet sweetpepper pepper 2.16 1.20 1.20––3.90 3.90 citrus 1.72 citrusfruit fruit 1.72 1.02 1.02––2.92 2.92 increased increasedrisk riskfor forsensitization sensitizationinhalent inhalentallergens allergens Maternal Maternaldiet dietduring duringpregnancy pregnancyin inrelation relationto to eczema . eczemaand andallergic allergicsensitization sensitizationin inthe theoffspring offspringat at22yyof ofage age. Sausenthaler . Am -7 SausenthalerSS. AmJJClin ClinNutr Nutr2007;85:530 2007;85:530-7 Intake Intake during during pregnancy pregnancy food -6 PUFA food rich rich in in ω ω-6 PUFA may may food -3 PUFA food rich rich in in ωω-3 PUFA may may the the risk risk of of allergic allergic disease disease in in the the offspring offspring.. Maternal Maternalfish fishintake intakeduring duringpregnancy pregnancyand andatopy atopyand andasthma asthmain ininfancy. infancy. Romieu . Clin -25 RomieuII. ClinExp ExpAllergy Allergy2007;37:518 2007;37:518-25 Cohort of women (n=462) enrolled during pregnancy - offspring followed up to 6 years • 34 % infants: eczema at age 1 year 14.3% atopic [SPT + at 6 years] 5.7% atopic wheeze at 6 years • After adjusting for confounding factors, fish intake during pregnancy was protective against the - risk of eczema at age 1 year OR=0.73; 95% CI 0.55-0.98 - + SPT house dust mite (6 yrs) OR=0.68; 95% CI 0.46-1.01 - atopic wheeze (6 yrs) OR=0.55; 95% CI 0.31-0.96 ! • For • …. in fish intake from 1 x to 2.5 x per week, the risk of eczema at age 1 year decreased by 37%, and the risk of positive SPT at age 6 years by 35%. Maternal Maternalfish fishintake intakeduring duringpregnancy pregnancyand andatopy atopyand andasthma asthmain ininfancy. infancy. Romieu . Clin -25 RomieuII. ClinExp ExpAllergy Allergy2007;37:518 2007;37:518-25 …. • Stratification by breastfeeding showed that fish intake was significantly related to a decrease risk in persistent wheeze among non-breastfed children (P for interaction<0.05). • No protective effect was observed among breastfed children. ! Mediterranean Mediterraneandiet dietin inpregnancy pregnancyisisprotective protectivefor forwheeze wheezeand andatopy atopyin inchildhood. childhood. Chatzi . Thorax. -13 ChatziLL. Thorax.2008;63:507 2008;63:507-13 460 460children childrenfrom fromMenorca Menorcaage age6.5 6.5years years(prospective (prospectivetrial) trial) ••Prevalence Prevalencerates ratesatat6.5 6.5years yearsof of persistent 13.2 persistentwheeze wheeze 13.2% % atopic 5.8 atopicwheeze wheeze 5.8% % atopy 17.0 atopy 17.0% % rd ••1/3 (36.1%)of ofmothers mothershad hadaalow lowquality qualityMediterranean Mediterraneandiet diet 1/3rd(36.1%) during duringpregnancy pregnancyaccording accordingto tothe theMediterranean MediterraneanDiet DietScore, Score, while whilethe therest resthad hadaahigh highscore. score. …… .. …….. Mediterranean Mediterraneandiet dietin inpregnancy pregnancyisisprotective protectivefor forwheeze wheezeand andatopy atopyin inchildhood. childhood. Chatzi . Thorax. -13 ChatziLL. Thorax.2008;63:507 2008;63:507-13 …… .. …….. ••AA““high” high” Mediterranean MediterraneanDiet DietScore Scoreduring duringpregnancy pregnancy:: protective protectivefor for ••persistent persistentwheeze wheeze(OR (OR0.22; 0.22;95% 95%CI CI0.08 0.08to to0.58) 0.58) ••atopic atopicwheeze wheeze(OR (OR0.30; 0.30;95% 95%CI CI0.10 0.10to to0.90) 0.90) ••atopy atopy(OR (OR0.55; 0.55;95% 95%CI CI0.31 0.31to to0.97) 0.97) after afteradjusting adjustingfor forpotential potentialconfounders. confounders. ! ••Childhood Childhoodadherence adherenceto toaaMediterranean Mediterraneandiet dietwas was negatively negativelyassociated associatedwith withpersistent persistentwheeze wheezeand andatopy atopy although . althoughthe theassociations associationsdid didnot notreach reachstatistical statisticalsignificance significance. 1. 2. 3. 4. Elimination diet Probiotics LCPUFA Conclusions Conclusion Conclusion • No data to recommend elimination diet during pregnancy • ? Harmfull • Probiotic supplementation • only evaluated strains • conflicting data • Meditarrean diet: • food rich in ω-3 PUFA may atopic disease