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

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