Editorial
Breastfeeding and asthma: Where are we?
R.T. Cohen
Corresponding author
Section of Pulmonology and Allergy, Dept. of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
J.C. Celedón
Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Dept. of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Each symbol represents a centre. For each country, the percentage of children who were breast fed is stated in brackets. Countries are ordered by average prevalence.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Björkstén, N. Aït-Khaled, M. Innes Asher, T.O. Clayton, C. Robertson" "autores" => array:6 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Björkstén" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Aït-Khaled" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Innes Asher" ] 3 => array:2 [ "nombre" => "T.O." "apellidos" => "Clayton" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Robertson" ] 5 => array:1 [ "colaborador" => "the ISAAC Phase Three Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611001224?idApp=UINPBA00004N" "url" => "/03010546/0000003900000006/v1_201304101057/S0301054611001224/v1_201304101057/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Breastfeeding and asthma: Where are we?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "315" "paginaFinal" => "317" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "R.T. Cohen" "autores" => array:1 [ 0 => array:4 [ "nombre" => "R.T." "apellidos" => "Cohen" "email" => array:1 [ 0 => "robyn.cohen@drexelmed.edu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Section of Pulmonology and Allergy, Dept. of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] 1 => array:3 [ "autoresLista" => "J.C. Celedón" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Celedón" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Dept. of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma and atopic diseases are major public health problems worldwide.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Identifying modifiable factors associated with the pathogenesis of asthma, allergies, and eczema is important for developing targeted interventions for the prevention of these conditions, particularly among children at highest risk. The relation between breastfeeding and atopy has long been a subject of both interest<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and debate.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In describing a “golden jubilee of controversy” in 1988, Kramer proposed 12 methodological and biological criteria to evaluate studies of breastfeeding and allergy or asthma, including (but not limited to): non-reliance on late maternal recall of breastfeeding, duration and exclusivity of breastfeeding, strict diagnostic criteria of the outcome, ascertainment of severity, age of onset, and risk of the outcome; and assessment of dose-response effects.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the current issue of <span class="elsevierStyleItalic">Allergologia et immunopathologia</span>, Bjorksten et al. report a lack of association between breastfeeding and current wheeze, current rhinoconjunctivitis or current eczema among children of school age in Phase III of ISAAC (the International Study of Asthma and Allergy in Childhood).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The authors noted an inverse association between breastfeeding and symptoms of severe rhinoconjunctivitis or severe eczema.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The strengths of this study include its large global sample size (206,453 children from 32 countries including 103,716 children with complete data) from a school-based random sample<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as well as the extent to which the ISAAC questionnaires have been translated into multiple languages and validated around the world.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> The fact that the multivariable models included adjustment for maternal smoking during infancy is also important, as maternal smoking may modify any effects of breast feeding on risk of lower respiratory tract infections and asthma.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Unfortunately, several elements of the study design prevented the authors from definitively putting this controversy to rest. First, as mentioned by the authors, data on breastfeeding were limited to a yes/no response to the question “Was your child breast fed?” Such a limited ascertainment of breastfeeding precludes any ability to identify a dose-response or a threshold of exposure necessary to detect an effect. Does exclusive breast feeding confer more protection compared to breastfeeding supplemented with formula? Is a specific duration (4 months being the standard in most studies) required for a beneficial impact? Perhaps. Second, family history of atopy was not included. As multiple studies have asserted<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> there may be a differential effect of breastfeeding on the risk of developing asthma and/or allergies depending on whether or not the mother herself is atopic.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In a prospective birth cohort of 2602 children in Western Australia, exclusive breastfeeding for at least 4 months was associated with a decreased risk of asthma at age six years, regardless of maternal history of asthma.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Data from over 4000 children in a prospective birth cohort in Sweden suggest that the association between breastfeeding and asthma was not as strong in those with a family history of allergic disease (OR 0.73, 95% CI 0.43–1.20) as in those without a family history (OR 0.58, 95% CI 0.38–0.88).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In another study in Tucson, AZ, USA, breastfeeding was inversely associated with recurrent wheeze at age two years (regardless of maternal history of atopy) but positively associated with asthma at age 6 years among children with maternal history of asthma (asthma prevalence among those with: exclusive BF<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4 months<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46%, BF<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>4 months<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23.5%, never BF 9.1%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.005).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Furthermore, data from the same cohort show that at age 16 years, children of asthmatic mothers who were exclusively BF for >4 months had lower lung function on spirometry than those who were not BF.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In contrast, the Isle of Wight prospective birth cohort showed that exclusive breastfeeding for >4 months was associated with increased lung function (higher FVC, FEV1, and peak expiratory flow rates) at age 10 years, regardless of maternal history of asthma and/or atopy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Why have there been such disparate findings across studies? What are the potential mechanisms that underlie both the protective effects of breastfeeding seen in some cohorts and the increased risk associated with breastfeeding demonstrated in others? The answers to these questions may depend on individual level factors rather than what can be assessed in large population-based observational studies. For example, data from intervention trials suggest that food allergen avoidance (including dairy, egg, nut, soy, etc.) by lactating mothers of children at high risk for atopy may reduce antigen exposure for those infants and thus be beneficial in reducing later risk of food allergy and atopic eczema.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a> In addition, Verhasselt et al. found that compared to mice breastfed by unexposed mothers, mice breastfed by mothers with exposure to airborne allergen (ovalbumin) during lactation developed antigen-specific tolerance and reduced airway hyper-reactivity and allergic inflammation in response to ovalbumin challenge.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In addition to effects of antigen exposure, investigators have looked at other aspects of breast milk composition. Studies focusing on long chain n-3 fatty acids (LCFA, which may have immunomodulatory effects) have found that maternal dietary intake has little impact on LCFA content in breast milk<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>; that there are minimal differences in LCFA content of breast milk between allergic and non-allergic mothers<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a>; and that higher LCFA levels in breast milk may actually be associated with increased rather than decreased risk of atopy in high-risk infants.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> From a methodological standpoint, some have argued that observational studies showing an increased risk of allergy among exclusively breastfed infants may be influenced by “reverse causation” (an increased tendency of mothers of high-risk children to exclusively breastfeed their children for longer duration because of well-publicised perceived protective benefits of breastfeeding).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Future studies in this field should include as detailed a prospective ascertainment of breastfeeding as possible (including information on exclusivity and duration), collection of breast milk for composition analysis (including antigens, immunological factors, and potentially toxic exposures), ascertainment of potential mediators of effects on asthma (including viral infections during early childhood and environmental tobacco smoke exposure)<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> and clearly defined outcomes based on objective diagnostic criteria (e.g., allergy markers, lung function measures) Ongoing and future clinical trials of early versus delayed introduction of foodstuff during breast feeding should help elucidate the relation between breastfeeding and asthma or allergies.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Sources of support: Grant HL079966 from the U.S. National Institutes of Health.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood ISAAC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Pearce" 1 => "N. Ait-Khaled" 2 => "R. Beasley" 3 => "J. Mallol" 4 => "U. Keil" 5 => "E. Mitchell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2006.070169" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2007" "volumen" => "62" "paginaInicial" => "758" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17504817" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged breast-feeding as prophylaxis for atopic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "U.M. Saarinen" 1 => "M. Kajosaari" 2 => "A. Backman" 3 => "M.A. Siimes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1979" "volumen" => "2" "paginaInicial" => "163" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2567933" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breastfeeding and allergies: time for a change in paradigm?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Duncan" 1 => "M.R. Sears" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACI.0b013e32830d82ed" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Allergy Clin Immunol" "fecha" => "2008" "volumen" => "8" "paginaInicial" => "398" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18769191" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does breast feeding help protect against atopic disease? Biology, methodology, and a golden jubilee of controversy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.S. Kramer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "1988" "volumen" => "112" "paginaInicial" => "181" "paginaFinal" => "190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3339499" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Bjorksten B, Ait-Khaled N, Innes Asher M, Clayton TO, Robertson C. Global analysis of breast feeding and risk of symptoms of asthma, rhinoconjunctivitis and eczema in 6-7 year old children: ISAAC Phase Three. <span class="elsevierStyleItalic">Allergol Immunopathol</span> 2011." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International study of asthma and allergies in childhood (ISAAC): rationale and methods" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.I. Asher" 1 => "U. Keil" 2 => "H.R. Anderson" 3 => "R. Beasley" 4 => "J. Crane" 5 => "F. Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "1995" "volumen" => "8" "paginaInicial" => "483" "paginaFinal" => "491" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7789502" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Translation of questions: the international study of asthma and allergies in childhood (ISAAC) experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Ellwood" 1 => "H. Williams" 2 => "N. Ait-Khaled" 3 => "B. Bjorksten" 4 => "C. Robertson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Tuberc Lung Dis" "fecha" => "2009" "volumen" => "13" "paginaInicial" => "1174" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723410" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the Spanish version of the Phase III ISAAC questionnaire on asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Mata Fernandez" 1 => "M. Fernandez-Benitez" 2 => "M. Perez Miranda" 3 => "F. Guillen Grima" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Investig Allergol Clin Immunol" "fecha" => "2005" "volumen" => "15" "paginaInicial" => "201" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16261957" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breastfeeding, maternal smoking and lower respiratory tract infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Nafstad" 1 => "J.J. Jaakkola" 2 => "J.A. Hagen" 3 => "G. Botten" 4 => "J. Kongerud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "1996" "volumen" => "9" "paginaInicial" => "2623" "paginaFinal" => "2629" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8980979" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protective effect of exclusive breastfeeding against infections during infancy: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Ladomenou" 1 => "J. Moschandreas" 2 => "A. Kafatos" 3 => "Y. Tselentis" 4 => "E. Galanakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/adc.2009.169912" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2003" "volumen" => "95" "paginaInicial" => "1004" "paginaFinal" => "1008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20876557" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effects of breastfeeding, maternal smoking during pregnancy, and recurrent lower respiratory tract infections on asthma in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Karmaus" 1 => "A.L. Dobai" 2 => "I. Ogbuanu" 3 => "S.H. Arshard" 4 => "S. Matthews" 5 => "S. Ewart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/02770900802178306" "Revista" => array:7 [ "tituloSerie" => "J Asthma" "fecha" => "2008" "volumen" => "45" "paginaInicial" => "688" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18951262" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S073510970202716X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.T. Guedes" 1 => "L.S. Souza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3038.2007.00710.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "30" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18208466" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Sears" 1 => "J.M. Greene" 2 => "A.R. Willan" 3 => "D.R. Taylor" 4 => "E.M. Flannery" 5 => "J.O. Cowan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)11025-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "360" "paginaInicial" => "901" "paginaFinal" => "907" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12354471" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.L. Wright" 1 => "C.J. Holberg" 2 => "L.M. Taussig" 3 => "F.D. Martinez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2001" "volumen" => "56" "paginaInicial" => "192" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11182011" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal asthma, infant feeding, and the risk of asthma in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.H. Oddy" 1 => "J.K. Peat" 2 => "N.H. de Klerk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2002" "volumen" => "110" "paginaInicial" => "65" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12110822" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breast-feeding reduces the risk of asthma during the first 4 years of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Kull" 1 => "C. Almqvist" 2 => "G. Lilja" 3 => "G. Pershagen" 4 => "M. Wickman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2004.07.036" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2004" "volumen" => "114" "paginaInicial" => "755" "paginaFinal" => "760" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15480312" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of breastfeeding on lung function in childhood and modulation by maternal asthma and atopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.W. Guilbert" 1 => "D.A. Stern" 2 => "W.J. Morgan" 3 => "F.D. Martinez" 4 => "A.L. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200610-1507OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2007" "volumen" => "176" "paginaInicial" => "843" "paginaFinal" => "848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17690333" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of breastfeeding duration on lung function at age 10 years: a prospective birth cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.U. Ogbuanu" 1 => "W. Karmaus" 2 => "S.H. Arshad" 3 => "R.J. Kurukulaaratchy" 4 => "S. Ewart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2008.101543" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "62" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19001004" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.H. Arshad" 1 => "B. Bateman" 2 => "S.M. Matthews" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "489" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12775858" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary prevention of allergic diseases in infants and small children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Host" 1 => "S. Halken" 2 => "A. Muraro" 3 => "S. Dreborg" 4 => "B. Niggemann" 5 => "R. Aalberse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3038.2008.00762.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "1" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18665958" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breast milk-mediated transfer of an antigen induces tolerance and protection from allergic asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Verhasselt" 1 => "V. Milcent" 2 => "J. Cazareth" 3 => "A. Kanda" 4 => "S. Fleury" 5 => "D. Dombrowicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nm1718" "Revista" => array:6 [ "tituloSerie" => "Nat Med" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "170" "paginaFinal" => "175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18223654" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low breast milk levels of long-chain n-3 fatty acids in allergic women, despite frequent fish intake" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Johansson" 1 => "A.E. Wold" 2 => "A.S. Sandberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2222.2010.03678.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Allergy" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "505" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21338426" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatty acids in breast milk of allergic and non-allergic mothers: The PIAMA birth cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Wijga" 1 => "A.C. Houwelingen" 2 => "H.A. Smit" 3 => "M. Kerkhof" 4 => "A.P. Vos" 5 => "H.J. Neijens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2003" "volumen" => "14" "paginaInicial" => "156" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12787293" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maternal breast milk long-chain n-3 fatty acids are associated with increased risk of atopy in breastfed infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.M. Stoney" 1 => "R.K. Woods" 2 => "C.S. Hosking" 3 => "D.J. Hill" 4 => "M.J. Abramson" 5 => "F.C. Thien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Allergy" "fecha" => "2004" "volumen" => "34" "paginaInicial" => "194" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14987297" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breastfeeding and the prevalence of allergic diseases in schoolchildren: does reverse causation matter?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Kusunoki" 1 => "T. Morimoto" 2 => "R. Nishikomori" 3 => "T. Yasumi" 4 => "T. Heike" 5 => "K. Mukaida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-3038.2009.00982.x" "Revista" => array:7 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2008" "volumen" => "21" "numero" => "1 Part 1" "paginaInicial" => "60" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20088862" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is reverse causation responsible for the link between duration of breastfeeding and childhood asthma?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J. Lodge" 1 => "A.J. Lowe" 2 => "S.C. Dharmage" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.178.9.994" "Revista" => array:5 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2008" "volumen" => "178" "paginaInicial" => "994" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18945873" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000003900000006/v1_201304101057/S0301054611003223/v1_201304101057/en/main.assets" "Apartado" => array:4 [ "identificador" => "5552" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000003900000006/v1_201304101057/S0301054611003223/v1_201304101057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611003223?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 13 | 1 | 14 |
| 2024 September | 8 | 6 | 14 |
| 2024 August | 17 | 5 | 22 |
| 2024 July | 19 | 4 | 23 |
| 2024 June | 10 | 7 | 17 |
| 2024 May | 11 | 12 | 23 |
| 2024 April | 12 | 6 | 18 |
| 2024 March | 30 | 7 | 37 |
| 2024 February | 19 | 12 | 31 |
| 2024 January | 33 | 8 | 41 |
| 2023 December | 14 | 5 | 19 |
| 2023 November | 12 | 4 | 16 |
| 2023 October | 10 | 6 | 16 |
| 2023 September | 12 | 1 | 13 |
| 2023 August | 13 | 6 | 19 |
| 2023 July | 28 | 14 | 42 |
| 2023 June | 12 | 3 | 15 |
| 2023 May | 11 | 4 | 15 |
| 2023 April | 16 | 1 | 17 |
| 2023 March | 15 | 4 | 19 |
| 2023 February | 10 | 6 | 16 |
| 2023 January | 13 | 13 | 26 |
| 2022 December | 16 | 5 | 21 |
| 2022 November | 17 | 10 | 27 |
| 2022 October | 15 | 7 | 22 |
| 2022 September | 15 | 5 | 20 |
| 2022 August | 15 | 13 | 28 |
| 2022 July | 11 | 5 | 16 |
| 2022 June | 8 | 8 | 16 |
| 2022 May | 19 | 8 | 27 |
| 2022 April | 9 | 5 | 14 |
| 2022 March | 13 | 3 | 16 |
| 2022 February | 16 | 10 | 26 |
| 2022 January | 18 | 7 | 25 |
| 2021 December | 6 | 9 | 15 |
| 2021 November | 12 | 12 | 24 |
| 2021 October | 11 | 9 | 20 |
| 2021 September | 11 | 6 | 17 |
| 2021 August | 6 | 7 | 13 |
| 2021 July | 10 | 12 | 22 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 16 | 9 | 25 |
| 2021 April | 27 | 10 | 37 |
| 2021 March | 15 | 9 | 24 |
| 2021 February | 19 | 14 | 33 |
| 2021 January | 12 | 10 | 22 |
| 2020 December | 1 | 1 | 2 |
| 2020 November | 0 | 1 | 1 |
| 2020 August | 0 | 1 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2020 May | 0 | 2 | 2 |
| 2020 January | 0 | 2 | 2 |
| 2019 December | 0 | 3 | 3 |
| 2019 September | 0 | 3 | 3 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 0 | 3 | 3 |
| 2019 May | 0 | 22 | 22 |
| 2019 April | 0 | 1 | 1 |
| 2018 August | 0 | 1 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 24 | 4 | 28 |
| 2018 January | 10 | 5 | 15 |
| 2017 December | 8 | 8 | 16 |
| 2017 November | 14 | 9 | 23 |
| 2017 October | 14 | 4 | 18 |
| 2017 September | 12 | 5 | 17 |
| 2017 August | 18 | 12 | 30 |
| 2017 July | 9 | 6 | 15 |
| 2017 June | 13 | 25 | 38 |
| 2017 May | 22 | 15 | 37 |
| 2017 April | 19 | 7 | 26 |
| 2017 March | 13 | 125 | 138 |
| 2017 February | 15 | 14 | 29 |
| 2017 January | 8 | 4 | 12 |
| 2016 December | 15 | 3 | 18 |
| 2016 November | 12 | 7 | 19 |
| 2016 October | 25 | 9 | 34 |
| 2016 September | 12 | 12 | 24 |
| 2016 August | 12 | 1 | 13 |
| 2016 July | 8 | 2 | 10 |
| 2016 June | 12 | 4 | 16 |
| 2016 May | 15 | 9 | 24 |
| 2016 April | 13 | 24 | 37 |
| 2016 March | 24 | 10 | 34 |
| 2016 February | 15 | 21 | 36 |
| 2016 January | 25 | 18 | 43 |
| 2015 December | 19 | 15 | 34 |
| 2015 November | 23 | 26 | 49 |
| 2015 October | 38 | 25 | 63 |
| 2015 September | 16 | 11 | 27 |
| 2015 August | 17 | 8 | 25 |
| 2015 July | 11 | 2 | 13 |
| 2015 June | 6 | 10 | 16 |
| 2015 May | 14 | 6 | 20 |
| 2015 April | 14 | 13 | 27 |
| 2015 March | 11 | 5 | 16 |
| 2015 February | 17 | 5 | 22 |
| 2015 January | 17 | 4 | 21 |
| 2014 December | 24 | 2 | 26 |
| 2014 November | 7 | 4 | 11 |
| 2014 October | 32 | 4 | 36 |
| 2014 September | 32 | 3 | 35 |
| 2014 August | 14 | 3 | 17 |
| 2014 July | 6 | 3 | 9 |
| 2014 June | 2 | 1 | 3 |
| 2014 May | 6 | 0 | 6 |
| 2014 April | 7 | 3 | 10 |
| 2014 March | 25 | 9 | 34 |
| 2014 February | 20 | 7 | 27 |
| 2014 January | 26 | 7 | 33 |
| 2013 December | 26 | 7 | 33 |
| 2013 November | 22 | 10 | 32 |
| 2013 October | 46 | 6 | 52 |
| 2013 September | 29 | 9 | 38 |
| 2013 August | 36 | 12 | 48 |
| 2013 July | 47 | 15 | 62 |
| 2013 June | 10 | 3 | 13 |
| 2013 May | 20 | 5 | 25 |
| 2013 April | 20 | 8 | 28 |
| 2013 March | 20 | 6 | 26 |
| 2013 February | 19 | 7 | 26 |
| 2013 January | 2 | 1 | 3 |
| 2012 December | 3 | 2 | 5 |
| 2012 November | 0 | 3 | 3 |
| 2012 October | 2 | 3 | 5 |
| 2011 November | 595 | 0 | 595 |
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