Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Human milk (HM) transforming growth factor beta (TGF-β) is critical for inflammation regulation and oral tolerance promotion. Previous reports suggested that variations in HM TGF-β levels are associated with allergic outcomes. OBJECTIVE: We undertook a systematic review (PROSPERO 2017 CRD42017069920) to reassess the evidence on the relationships between HM TGF-β and allergic outcomes in children. METHODS: Electronic bibliographic databases (MEDLINE, EMBASE, Cochrane Library) were systematically searched. Two independent reviewers screened reference lists, extracted the data and assessed risk of bias using the National Institute for Clinical Excellence methodological checklist. RESULTS: A total of 21 studies were identified. Sixteen studies assessed relationships between HM TGF-β and risk of eczema; 14, allergic sensitisation; 9, wheezing/asthma; 6, food allergy; 3, allergic rhinitis/conjunctivitis. Five cohorts (5/18, 28%) reported a protective effect of TGF-β1, while 3 (3/10, 30%) suggested increased risk of allergic outcomes development and 1 (1/10, 10%), a protective effect of TGF-β2 on eczema. Meta-analysis was not possible due to significant heterogeneity in methodology, age of outcome assessment and differing statistical approaches. 71% (15/21) of studies carried a high risk of bias. CONCLUSION AND CLINICAL RELEVANCE: In contrast with previous findings we did not find strong evidence of associations between HM TGF-β and allergic outcomes. Differences in studies' methodology and outcomes do not allow unconditional rejection or acceptance of the hypothesis that HM TGF-β influences the risk of allergy development. Future studies on diverse populations employing standardised methods, accurate phenotyping of outcomes and evaluation of the effect of TGF-β in combination with other HM immune markers, microbiome and oligosaccharides are required.
Date Issued
2019-09
Date Acceptance
2019-04-20
Citation
Clinical and Experimental Allergy, 2019, 49 (9), pp.1201-1213
ISSN
0954-7894
Publisher
Wiley
Start Page
1201
End Page
1213
Journal / Book Title
Clinical and Experimental Allergy
Volume
49
Issue
9
Copyright Statement
This article is protected by copyright. All rights reserved. This is the accepted version of the following article: Khaleva, E. , Gridneva, Z. , Geddes, D. T., Oddy, W. H., Colicino, S. , Blyuss, O. , Boyle, R. , Warner, J. and Munblit, D. (2019), Transforming growth factor beta in human milk and allergic outcomes in children: a systematic review. Clin Exp Allergy. Accepted Author Manuscript. doi:10.1111/cea.13409, which will be published in final form at https://dx.doi.org/10.1111/cea.13409
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31058363
Subjects
Human milk
TGF-β
allergic diseases
allergic outcomes
allergic sensitization
atopy
breast milk
breastfeeding
colostrum
transforming growth factor-beta
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-06-02