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Allergies, Asthma and Money

 

Who makes money when children are sick, when children have chronic disease such as asthma or allergies, the pharmaceutical industry of course.

When research appeared in newspapers across the world that breastfeeding contributed to the risk of allergy and asthma in children, those working in infant and young child health were astounded. The McMaster based research was so out of line with what other centers had reported, that the first response by those who questioned the doubtful results, was “who funded this research?” as well as questions of “conflict of interest” and how this negative information gets published in newspapers around the world, including Africa, where artificial feeding can be deadly, so readily?

 

Well, after numerous telephone calls, e-mails and some net searches, certain information has emerged. It appears that the pharmaceutical giant GlaxoSmithKline has an interest in allergies and asthma. It recently announced a $1million investment to establish a McMaster University Research Chair in pediatric asthma at the Firestone Institute for Respiratory Health, St. Joseph Healthcare Hamilton. The department is positively swimming in corporate sponsorships!

 

And that’s not the only asthma connection for the seemingly generous GlaxoSmithKline. There’s the Asthma Society of Canada, the Lung Association and check out the Asthma Landmark SurveyTM all “linked” to the maker of various inhalators, dilators, sprays etc to treat asthmas and allergies with not a word about prevention.

 

“The creation of this Chair is part of the GlaxoSmithKline Pathfinders Fund for Leaders in Canadian Health Science Research, a $10 million initiative to help fight the brain drain in Canada by providing opportunities for leading medical researchers… and potentially lead to pioneering new treatments (our emphasis) for Canadian children with asthma”.

 

This is certainly one brain drain, the mother’s of Canada would welcome. Anyone who receives corporate funds to tell us that our milk is inadequate, so that the pharm corp can use our babes for their research trials to find profitable “treatments”, is welcome to take a hike. 

 

INFACT Canada, together with our IBFAN partners, advocates for independent research in infant and young child health.

 

Also of importance are the questions raised regarding the ease of publication of research with apparent methodological flaws and outcomes that bear no resemblance to previously published research on asthma and infant feeding.

Firstly the breastfeeding cohort was not exclusively breastfed and the infant feeding practices of the “breastfeeding” cohort is very poorly defined. Recalls and third party documentation of infant feeding practices can hardly be deemed a reliable method to verify exclusivity of breastfeeding. Additionally, infants received cow’s milk formulas for the postnatal hospital duration and mixed feeding was the usual practice at the time the data was collected (1972 to 1973). Exclusive breastfeeding was not defined let alone promoted until 1988. Is it possible that another conclusion can be made noting the long-term danger of supplements given during the neonatal period?

 Secondly, why the rush to publish, when the results are so out of line with what others have reported? Surely a concerned scientist would discuss with the wider research community these “unanticipated” results. Dialogue with others in the field a thorough peer review of methods used, the need for accurate infant feeding definitions and an independent review of the raw data would be the ethical and scientifically honest means to proceed. The worldwide sensational dissemination of these results can only be regarded with suspicion. 

Thirdly, it seems that each year here in Canada where World Breastfeeding Week is celebrated from October 1 to 7 there are media reports attempting to sabotage the efforts by many health care workers, public health facilities and mothers groups to highlight the importance of breastfeeding for mothers and children. We log this as another attempt.

 

Research confirming the risk of atopic eczema and asthma when infants are not breastfed (a partial list)

 

 

Burr, M. L. Infant feeding, wheezing, and allergy: a prospective study. ARCH Dis in Childhood 68:724-728, 1993

 

To study the determinants of wheezing and allergy, 453 British children were followed up to the age of 7 years. Children who had ever been breastfed had a lower incidence of wheeze (59%) than those who had not (74%). This effect persisted until the age of 7 years in the non-atopic children. The risk of wheeze was reduced by 50% in breastfed children after eliminating confounding factors. The researchers concluded that breastfeeding may confer long-term protection against respiratory infection

 

 

Dell S, To T. Breastfeeding and Asthma in Young Children. ArchPediatr Adolesc Med 155: 1261-1265, 2001

 

This Canadian population-based study with a sample size of 2,184 children, between 12 to 24 months found that the longer the duration of breastfeeding the greater the protection against the development of asthma and wheeze in young children.

 

Kabesch, M. Von Mutius, E. [Prevention of asthma in childhood] Dtsch Med Wochenschr 127: 1506-1508, 2002

 

Approximately 10% of children in Germany suffer from the onset of asthma. Primary prevention strategies to reduce the incidence are breastfeeding and the reduction of environmental tobacco smoke.

 

Kramer MS et al. A Randomized trial in the Republic of Belarus Promotion of Breastfeeding Intervention Trial (PROBIT)JAMA 285: 413-20, 2001

Over 17,000 Belarus mother and baby pairs were followed for one year to determine the impact of duration and exclusivity of breastfeeding on gastrointestinal disease, respiratory infections and atopic eczema. No significant reduction in respiratory disease was noted. A striking impact was found in the reduction of gastrointestinal disease (40% lower risk) and in atopic eczema (47% lower risk).

Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. CD003517, 2002

The researchers concluded that there is no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed countries.  

Ruuska, T. Occurance of acute diarrhea in atopic and non-atopic Infants: the role of prolonged breastfeeding. J. Peadiatr Gastroenterol Nutr 14: 27-33,1992

A cohort of 336 was followed from birth for two years to study the development of atopy and the occurrence of acute diarrhea. Breastfeeding reduced the number of episodes and severity of diarrhea for infants with atopic disease.

Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet  346:1065-1069, 1995

One hundred and fifty healthy infants were followed during their first year and then at ages 1, 3, 5, 10, and 17 years to determine the effect on atopic disease of breastfeeding. The researchers concluded that breastfeeding is prophylactic against atopic disease -- Including atopic eczema, food allergies and respiratory allergy -- throughout childhood and adolescence.

 

Oddy, W.H. et al. Association between breast feeding and asthma in 6 year old children: findings of a prospective cohort study. BMJ  319: 815-818, 1999

 

A cohort of 2,602 Australian children were enrolled prior to birth and followed prospectively, for respiratory illness and method of feeding in the first year of life. The researchers concluded that exclusive breastfeeding for four months protects against asthma and reduces the risk by 40%.

 

 

Oddy, W. H., Peat, J. K., de Klerk, N.H. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Asthma Clin Immunol 110: 65-67, 2002

 

To settle the controversy regarding breastfeeding and asthma, this study looked at a cohort of 2,602 Australian children prospectively. They found that the risk of asthma increased if exclusive breastfeeding was stopped before 4 months. They recommend that infants with or without a maternal history of asthma be exclusively breastfed for 4 months and beyond

 

Oddy, W. H. et al. The effects of respiratory infections, atopy, and breastfeeding on childhood asthma. Eur Respir J 19: 899-905, 2002

 

The Australian cohort of 2, 602 children followed prospectively, were studied to quantify the association between atopy, respiratory infections and asthma, and exclusive breastfeeding. Multiple episodes of wheezing (lower respiratory) increased the risk for developing of asthma for both non-atopic and atopic children. Having three or less upper respiratory infections had a negative association, while four or more episodes showed a positive risk fore asthma. Both wheezing and atopy were independently associated with increased risk for asthma, suggesting their effects are via different pathways. Exclusive breastfeeding protected against asthma via effects on both pathways as well as through as yet undefined mechanisms.

 

Romieu, I. Et al. Breastfeeding and asthma among Brazilian children. J Asthma 37: 575-583, 2000

 

This Pan American Health Organization study examined 5,182 Brazilian school children as part of the International Study on Asthma and Allergies in Childhood. Over 90% of the children had been breastfed. The authors attribute the low prevalence of asthma and wheeze in this population to be related to the high incidence of breastfeeding. Children who had not been breastfed were more likely to have a medical diagnosis of asthma, experience wheezing, than children who had been breastfed for 6 months or longer.

 

Ruiz-Charles, M.G. et al. [Risk factors associated with bronchiolitis in children under 2 years of age]. Rev Invest Clin 54:125-132, 2002

 

To determine the risk factors for bronchiolitis in children less than 2 years, this case controlled study examined the children attending a pediatric emergency ward in Mexico. Risk factors included prematurity and a family history of bronchial asthma. Present-day breastfeeding was found to have a protective effect.

 

Tang, M. L. Is prevention of childhood asthma possible? Allergens, infection and animals. Med J Aust 177:S75-77, 2002

 

This review article notes that the current recommendations for the primary prevention of asthma include exclusive breastfeeding for the first six months of life, avoidance of maternal smoking during pregnancy and infancy and reducing the levels of house mites in some environments.

 

 

Elisabeth Sterken, BSc, MSc, nutritionist

Director INFACT Canada, October 2002

 

 

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