Five times less mite allergy when vitamin D added in mid pregnancy and to infant – RCT

Created April 2016

Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitisation: a randomised controlled trial

Allergy, DOI: 10.1111/all.12909

Cameron C. Grant1,4,*, Julian Crane3, Edwin A. Mitchell1, Jan Sinclair4, Alistair Stewart2, Tania Milne1, Joshua Knight2, Catherine Gilchrist1 and Carlos A. Camargo Jr5

1Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand

2Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand

3Medicine, University of Otago, Wellington, New Zealand

4Starship Children's Hospital, Auckland, New Zealand

5Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

  • Corresponding Author: Cameron Grant, Department of Paediatrics: Child and Youth Health,

Faculty of Medical and Health Sciences, University of Auckland, cc.grant@auckland.ac.nz

Vitamin D supplementation: Woman 27 weeks till birth, Infant 0-6 months Allergen test at 18 months 1. || |Placebo| 2000 IU mother 800 IU infant Mite Der-f1|18%| 2% Mite Der-f2 |14%|2% Mite Der-p1| 19%| 3% Mite Der-p2 |12%| 3% Asthma visits (2 or more)| 5%|0%|| VitaminDWiki would expect much better success if 1) Vitamin D supplementation varied with weight of subjects (which is rarely done in an RCT) 2) Had started earlier and lasted longer 3) Dosages caried with existing vitamin D levels 4) Dosages caried with pre-existing conditions (about 20 are very important - and rarely done in an RCT) 5) Added cofactors: Magnesium, Omega-3. etc, (which is rarely done in an RCT) 6) Used a Loading dose ( mother's vitamin D levels were still rising at 36 weeks)      Loading dose would have provided good level all during pregnancy See also VitaminDWiki * Hay fever (allergic rhinitis) risk reduced 20 percent for each 100 IU of vitamin D during early pregnancy – Feb 2016 * Asthma in 3 year olds decreased somewhat with 4,000 IU during pregnancy – RCT Jan 2016 * Largest cause of infant deaths is respiratory infections, which is associated with low vitamin D – April 2011 * Wheezing reduced 35 percent if vitamin D added during pregnancy – April 2015 * 800 IU vitamin D for infant and 2000 IU for mother is good, not great – RCT Dec 2013 same cohort and authors * 2000 IU vitamin D during pregnancy and 800 IU to infant resulted in less use of antibiotics – RCT April 2014 same cohort and authors * Overview Asthma and Vitamin D * Allergy - Overview * Huge increase in food allergies in Australia may be due to low vitamin D * Immune modulation by Vitamin D, food allergy, chart of genes – July 2015 * Food allergy 12X more likely if low vitamin D and vitamin D binding gene problem – Aug 2015 * 11X more non-immigrant children allergic to peanuts if vitamin D less than 20 ng – Feb 2013 All of the studies in Breathing and Intervention (give vitamin D and see what happens) are listed here: {category} Infant-Child Intervention trials using Vitamin D: {category}

Background

Vitamin D has immune modulating effects. We determined whether vitamin D supplementation during pregnancy and infancy prevents aeroallergen sensitisation and primary care respiratory illness presentations.

Methods: A randomised, double-blind, placebo-controlled parallel-group trial. We assigned pregnant women, from 27 weeks gestation to birth, and then their infants, from birth to six months, to placebo or one of two dosages of daily oral vitamin D. Woman/infant pairs were randomised to: placebo/placebo, 1000IU/400IU, or 2000IU/800IU.

When the children were 18 months old we measured specific serum IgE antibodies and identified acute primary care visits described by the doctor to be due to a cold, otitis media, an upper respiratory infection, croup, asthma, bronchitis, bronchiolitis, a wheezy lower respiratory infection or fever and cough.

Results: Specific IgE was measured on 185/260 (71%) enrolled children.

The proportion of children sensitised differed by study group for four mite antigens: Dermatophagoides farinae (Der-f1, Der-f2) and Dermatophagoides pteronyssinus (Der-p1, Der-p2). With results presented for placebo, lower-dose, and higher-dose vitamin D, respectively (all P<0·05): Der-f1 (18%, 10%, 2%), Der-f2 (14%, 3%, 2%), Der-p1 (19%, 14%, 3%), and Der-p2 (12%, 2%, 3%).

There were study group differences in the proportion of children with primary care visits described by the doctor as being for asthma (11%, 0%, 4%, P=0·002), but not for the other respiratory diagnoses.

Conclusions: Vitamin D supplementation during pregnancy and infancy reduces the proportion of children sensitised to mites at age 18 months. Preliminary data indicate a possible effect on primary care visits where asthma is diagnosed.

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Includes a very impressive chart of the data

Tags: Breathing Infant-Child Intervention