Three-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study

doi:10.1016/j.jaci.2004.06.057

Journal of Allergy and Clinical Immunology

Volume 114, Issue 4, October 2004, Pages 807-813

https://doi.org/10.1016/j.jaci.2004.06.057 Get rights and content

Background

Two factors thought to influence the risk of asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids. Although house dust mite allergen avoidance has been used as a preventive strategy in several trials, the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known.

Objective

To measure the effects of dietary supplementation with omega-3 fatty acids and house dust mite allergen avoidance in children with a family history of asthma.

Methods

A total of 616 children at high risk of asthma were enrolled antenatally in a randomized controlled trial, and 526 children remained in the trial at age 3 years. The outcomes were symptoms of allergic disease and allergen sensitization.

Results

There was a significant 10.0% (95% CI, 3.7-16.4) reduction in the prevalence of cough in atopic children in the active diet group (P = .003; number needed to treat, 10) but a negligible 1.1% (95% CI, −7.1 to 9.5) reduction cough among nonatopic children. There was a 7.2% (95% CI, 10.11-14.3) reduction in sensitization to house dust mite in the active allergen avoidance group (P = .05; number needed to treat, 14). No significant differences in wheeze were found with either intervention.

Conclusion

These results suggest that our interventions, designed to be used in simple public health campaigns, may have a role in preventing the development of allergic sensitization and airways disease in early childhood. This offers the prospect of reducing allergic disease in later life.

Section snippets

Methods

The CAPS is a randomized controlled trial in which 2 interventions are being tested separately and together by using a factorial design. Details of the study design, recruitment procedures, and effectiveness of the interventions have been reported7., 8. and are briefly described here.

Results

The randomization status and flow of families through the study are shown in Fig 1. The distribution of the important potential confounders, which were well balanced between groups, is summarized in Table I.

Compliance with the interventions was assessed by objective measures. At age 3 years, the proportion of plasma omega-3 plasma fatty acids was higher in the active than in the placebo diet group at 6.3% (95% CI, 6.1-6.6) versus 4.9% (95% CI, 4.7-5.1; P < .0001). In addition, the proportion of

Discussion

We found that, at age 3 years, our dietary intervention of omega-3 supplementation and omega-6 restriction significantly reduced atopic cough, and our allergen avoidance intervention reduced house dust mite atopy, but there was no effect of either intervention on wheeze. Although the etiology and prognosis of cough and wheeze in early childhood are not clear, it seems likely that atopic cough at this age could be associated with allergic inflammation of the airways and that the dietary

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: Supported by the National Health and Medical Research Council of Australia, New South Wales Health Department, Children's Hospital at Westmead, and the Cooperative Research Centre for Asthma.

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Mechanisms of asthma and allergic inflammationThree-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Allergy Clin Immunol

Control Clin Trials

Lancet

J Clin Epidemiol

J Allergy Clin Immunol

J Nutr

Clin Nutr

Prostaglandins Other Lipid Mediat

Am J Clin Nutr

J Nutr

Primary and secondary prevention of allergic airway disease

Paediatr Respir Rev

Consumption of oily fish and childhood asthma risk

Med J Aust

Ratio of omega-6 to omega-3 fatty acids and childhood asthma

J Asthma

Dietary factors and their relation to respiratory symptoms: the second National Health and Nutrition Examination survey

Am J Epidemiol

Dietary n-3 polyunsaturated fatty acids and smoking-related chronic obstructive pulmonary disease

N Engl J Med

Mechanisms of asthma and allergic inflammation
Three-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study