SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

10/6/03

Is delivery by Cesarean section a risk factor for food allergy?

Summary
Cesarean section (C-section) delivery might delay colonization of the newborn intestine with normal bacterial flora. A delayed or aberrant bacterial colonization of the G-I tract has been postulated to be responsible for the recent increase in the incidence of allergic diseases. Eggesbo et al of the Norwegian Institute of Public Health in Oslo carried out an analysis of records from the Norwegian Birth Registry and parental reports concerning 2803 children with regards to method of delivery, maternal or infant use of antibiotics and subsequent parentally perceived allergic reactivity in those children to egg, fish or nuts. They found that children of allergic mothers who were born by C-section had a 7 fold increased incidence of parentally perceived allergic reactions to egg, fish or nuts. There was a 4 fold increased incidence of allergy to eggs, confirmed objectively at age 21/2 year,s in children previously born by C-section. However, incidences of perceived food allergies were not significantly increased in children born by C-section to women without maternal histories of allergy.

Reference
J Allergy Clin Immunol 2003; 112:420-6

Editor’s Comments
These findings are of interest but I have concerns about two aspects: 1) For the most part, the evidence of allergies in the children was based solely on parental perceptions. It is conceivable that women who have C-section deliveries have lower thresholds for considering their children to be food allergic; 2) the correlation between C-section and perceived food allergy was not observed when the mother had no history of allergy. A maternal history of allergy is a strong risk factor for allergy appearing in the child. It could be that only children predisposed to atopy would be affected directly or indirectly by being born by C-section.

Of note, a report with similar findings by a group in Munich, Germany was recently described in the lay press (see the WYPR section of this AADMC website for our review of that article).

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