On Thu, 15 Feb 2001 13:42:15 +0000, heather <[log in to unmask]> wrote: >I can't tell, therefore, if any mechanism is suggested for this >phenomenon, or, indeed if the researchers controlled for other >factors. One possibility is that both bf and asthma are markers for >ultra-clean homes! Ultra-clean mothers have already been considered >by asthma experts as being responsible for reducing immunity. >Any ideas, or further info?> Saw this letter and response on Pediatrics website at http://archpedi.ama-assn.org/issues/v155n2/ffull/plt0201-7.html. Could this be referring to the same study? Julia in dreary Eden, NC Asthma, Breastfeeding, and Hypoallergenic Formula It was encouraging to read about the ambitious program undertaken by Chan-Yeung and colleagues1 to reduce the incidence of asthma through early intervention. However, I have 2 major concerns about the methods employed regarding "dietary avoidance." First, partial breastfeeding is never defined. The interested reader cannot determine whether the infants were breastfed once per day or 5 times per day. Since the benefits of breastfeeding tend to be dose-related, the amount of breast milk a baby actually ingests becomes an important clinical question. The failure to accurately define partial (vs token vs almost exclusive) breastfeeding makes the results of this study less reliable and less useful. It is imperative that researchers use consistent and valid definitions of breastfeeding to increase the comparability of data collected from different sites.2 My second concern is that when full breastfeeding was not possible, Good Start (Nestle Canada Inc, North York, Ontario), the partially hydrolyzed whey formula, was used. When Good Start was first marketed in this country, its manufacturers labeled it "hypoallergenic." They were compelled to stop making this claim, however, when the Food and Drug Administration Rockville, Md)determined that the formula did not meet the criteria to be considered hypoallergenic. If the researchers were seeking to minimize the load of ingested allergens, they should have utilized a truly hypoallergenic formula such as Nutramigen (Mead Johnson & Co, Evansville, Ind) or Alimentum (Ross Products Division/Abbott Laboratories, Columbus, Ohio). The use of a partially hypoallergenic formula and a nebulous definition of partial breastfeeding dilutes the message and lessens the usefulness of this investigation. Brian W. Donnelly, MD Pediatric Alliance-North Hills Division Passavant Professional Bldg 9104 Babcock Blvd, Suite 2111 Pittsburgh, PA 15237 1. Chan-Yeung M, Manfreda J, Dimich-Ward H, Ferguson A, Watson W, Becker A. A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants. Arch Pediatr Adolesc Med. 2000;154:657-663. 2. Labbok M, Belsey M, Coffin CJ. A call for consistency in defining breast-feeding. Am J Public Health. 1997;87:1060-1061. MEDLINE In reply Dr Donnelly brought up 2 important issues related to "dietary avoidance." He is right in that partial breastfeeding should have been defined. In our study, we considered infants to be partially breastfed from the time any formula supplement was added. However, we have records of the percentage of time the infants were breastfed (Table 1). Very few infants (2.8%) were breastfed less than 20% of the time. We apologize for not defining this in our paper. When we started the study in 1994, our preference was to use an extensively hydrolyzed casein formula. Funding for this study was insufficient to support purchase of this type of formula, however, and the manufacturers that we approached declined involement in our study. We are very appreciative that Nestle agreed to donate their whey hydrolysate for this study. (At that time the Food and Drug Administration had not yet determined that the formula did not meet the criteria for a hypoallergenic product.) We thank Dr Donnelly very much for bringing up these points for discussion. Moira Chan-Yeung, MB Helen Dimich-Ward Alexander Ferguson Jure Manfreda Wade Watson Allen Becker University of Hong Kong Department of Medicine, 4/F Professional Block Queen Mary Hospital Pokfulam Road Hong Kong *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html