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ARTICLES:
Jill A. Poole, Kathy Barriga, Donald Y.M. Leung, Michelle Hoffman, George S. Eisenbarth, Marian Rewers, and Jill M. Norris
Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy
Pediatrics 2006; 117: 2175-2182 [Abstract] [Full text] [PDF]
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[Read P3R] Breastfeeding patterns and wheat allergy
Miriam H Labbok   (2 August 2006)

Breastfeeding patterns and wheat allergy 2 August 2006
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Miriam H Labbok,
Professor/Physician/Public Health
UNC SPH Dept of MCH, Cente for IYCFC

Send letter to journal:
Re: Breastfeeding patterns and wheat allergy

Labbok{at}unc.edu Miriam H Labbok

Dear Editors:

In reviewing Poole J et al, Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy, Peds, June 2006 117(6):2175-2182, the reader appreciates the academic skills demonstrated, and honest presentation, such as the authors’ upfront declaration that the study population was selected for a family history of diabetes. Unfortunately, this is only one of the many factors that lend doubt to the findings, in spite of the efforts of the authors to include all possible confounders available from this data set in their analyses. While it is interesting to explore this issue in an existing data set, there are simply too many issues with these data to allow the conclusions presented.

The authors start with the recognition that they are using a population of known propensities – therefore not genetically nor probably behaviorally necessarily representative of the general population. Then, due to data constraints, they include a variable for family history of allergy that does not specify severity, type of allergy, or maternal vs paternal. This is further problematic in that such loose familial experience could bias maternal interpretation of a symptom as allergy vs other. Additionally, they rely on maternal diagnosis of allergy as the major outcome variable, without systematic recording of symptoms and with no testing to confirm the negatives. Only 4 of the 16 actually tested positive for wheat-specific IgE. While all four began wheat after 6 months, the authors correctly acknowledge that the timing of the testing may have been a factor increasing the attribution to later onset.

Further, nearly half of the reported cases are eliminated for legitimate reasons, but that are of a sufficient number to mask many other factors. Also, there is control for history of food allergy before six months, eliminating those with an immediate reaction to wheat feeding at 4 -5 months from direct inclusion. The authors note the problems of lack of control for cow’s milk sensitivity, known to have some relationship with maternal perception of wheat sensitivity, and the table shows that the strongest association with the occurrence of wheat allergy was allergic reaction before 6 months.

Finally, and perhaps most importantly, duration of breastfeeding, even after controlling for what factors they could, was not statistically significantly associated with the outcome.

Again, my congratulations to the authors for their careful documentation and their effort to fully utilize an existing data set; it is only the high quality of the authors’ methods section and presentation of the findings that allow for this critique. However, the many points listed above lend significant doubt concerning the reliability of the findings and the conclusions.

In sum, the findings from this secondary analysis do not warrant the epidemiological or clinical interpretation offered in the conclusions. It could be considered very inappropriate, and possibly unconscionable, to offer general clinical recommendations from these data and this analysis, let alone a recommendation that may have a negative impact on support for sustained exclusive breastfeeding.

Thank you for your consideration.

Miriam H Labbok, MD, MPH FACPM, IBCLC, FABM Professor of the Practice of Public Health Director, Center for Infant and Young Child Feeding and Care Department of Maternal and Child Health School of Public Health, CB#7445 The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7445 Tel: 919-966-0928 Fax: 919-966-0458 labbok@unc.edu www.sph.unc.edu/mhch/ciycfc

Conflict of Interest:

None declared