Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: A randomized, controlled trial

Dunstan, Janet A. BAppSc, PGDip
Mori, Trevor A. BSc, PhD, CPChem
Barden, Anne BSc, PhD
Beilin, Lawrence J. MD, FRCP, FRACP
Taylor, Angie L. BAppSc(Hons)
Holt, Patrick G. DSc, FRCPath, FAA
Prescott, Susan L. MBBS, BMedSci, PhD, FRACP

Perth, Australia
From ^athe School of Paediatrics and Child Health, University of Western Australia; ^bthe School of Medicine and Pharmacology, University of Western Australia and Western Australian Institute for Medical Research; and ^cthe Division of Cell Biology, Telethon Institute for Child Health Research, Perth

Supported by grants from the National Health and Medical Research Council and Raine Medical Research Foundation, Australia.

Received for publication May 23, 2003; revised August 26, 2003; accepted for publication September 3, 2003.

Reprint requests: Prof Prescott, Department of Paediatrics, PO Box D184, Princess Margaret Hospital, Perth, WA 6001.

0091-6749/2003 $30.00 + 0

doi: 10.1016/j.jaci.2003.09.009

Journal of Allergy & Clinical Immunology 112(6):p 1178-1184, December 2003.

Background:

There is growing interest in the potential role of anti-inflammatory n-3 polyunsaturated fatty acids (n-3 PUFAs) in the prevention of allergic disease.

Objective:

We sought to determine whether maternal dietary supplementation with n-3 PUFAs during pregnancy could modify immune responses in infants.

Methods:

In a randomized, controlled trial 98 atopic, pregnant women received fish oil (3.7 g n-3 PUFAs per day) or placebo from 20 weeks' gestation until delivery. Neonatal PUFA levels and immunologic response to allergens were measured at birth.

Results:

Eighty-three women completed the study. Fish oil supplementation (n = 40) achieved significantly higher proportions of n-3 PUFAs in neonatal erythrocyte membranes (mean ± SD, 17.75% ± 1.85% as a percentage of total fatty acids) compared with the control group (n = 43, 13.69% ± 1.22%, P < .001). All neonatal cytokine (IL-5, IL-13, IL-10, and IFN-γ) responses (to all allergens) tended to be lower in the fish oil group (statistically significant only for IL-10 in response to cat). Although this study was not designed to examine clinical effects, we noted that infants in the fish oil group were 3 times less likely to have a positive skin prick test to egg at 1 year of age (odds ratio, 0.34; 95% confidence interval, 0.11 to 1.02; P = .055). Although there was no difference in the frequency of atopic dermatitis at 1 year of age, infants in the fish oil group also had significantly less severe disease (odds ratio, 0.09; 95% confidence interval, 0.01 to 0.94; P = .045).

Conclusions:

These data suggest a potential reduction in subsequent infant allergy after maternal PUFA supplementation. More detailed follow-up studies are required in larger cohorts to establish the robustness of these findings and to ascertain their significance in relation to longer-term modification of allergic disease in children. (J Allergy Clin Immunol 2003;112:1178-84.)