MONDAY, Jan. 7 (HealthDay News) -- Atopic disease -- which includes eczema, asthma and food allergies -- may be delayed or even prevented in high-risk infants if they are exclusively breast-fed for at least four months or fed infant formula without cow milk protein.

That's the conclusion of a new clinical report from the American Academy of Pediatrics (AAP) that's published in the January issue of Pediatrics. The report replaces an earlier policy statement from the AAP.

"Basically, it probably does not matter what pregnant or lactating women eat," said Dr. Frank Greer, an author of the report, professor of pediatrics at the University of Wisconsin and chairman of the AAP Committee on Nutrition.

"The best prevention for atopic [allergic] disease is exclusive breast-feeding for four months," he added. "And if your infant comes from a family with significant atopic disease, then weaning from breast milk to a partially or extensively hydrolyzed [hypoallergenic] formula [without cow milk protein] may delay or prevent the onset of atopic disease, especially atopic dermatitis [eczema]."

Greer added that this recommendation would also apply to formula-fed infants who are at risk for atopic disease.

The timing and introduction of solid foods has no protective effect on the prevention of atopic disease, according to the new report.

"With the increase in asthma and food allergies that we've seen recently, we had hoped that maternal diet, breast-feeding and early childhood diet might all have some factor in decreasing incidence," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "Unfortunately, it doesn't seem to significantly impact, according to studies already done. The only one that seems to be impacted is the atopic dermatitis, which is decreased by about one third by breast-feeding. But the studies that have been done so far have not proven that breast-feeding will significantly impact childhood asthma or food allergies."

The incidence of allergic diseases such as asthma, food allergies and various skin conditions has exploded during the past few decades. In children 4 years of age and younger, the incidence of asthma has risen 160 percent, while the incidence of atopic dermatitis has almost tripled. And the incidence of peanut allergy has doubled just during the past decade, according to the report.

While genetics certainly plays a role in the development of these diseases, environmental factors such as diet are also strongly related.

The new report reviewed different evidence on nutrition during pregnancy, breast-feeding and the first year of life that might affect the development of allergic disease. Its major findings are as follows:

• Currently, there is no evidence that what a mother eats during pregnancy or breast-feeding plays a major role in preventing atopic disease in infants. There is some evidence, however, that avoiding certain foods during breast-feeding may help prevent atopic eczema.
• Exclusive breast-feeding for at least four months for infants at high-risk of developing atopic disease decreases the risk of developing eczema and cow milk allergy during the first two years of life.
• In high-risk infants who aren't breast-fed exclusively for four to six months, the use of hydrolyzed infant formula (as opposed to formula containing cow milk) may delay or prevent the onset of atopic dermatitis.
• Exclusive breast-feeding for at least three months protects an infant against wheezing in early life.
• There is no good evidence to support the use of soy-based infant formula to prevent allergies.
• There is no evidence to suggest that delaying the introduction of solid foods before the recommended 4 to 6 months of age will have an effect on the development of atopic disease.
• There is no convincing evidence to suggest that any dietary intervention will prevent atopic disease after 4 to 6 months of age.

"It's a mixed picture," Wu said. "We don't have proven efficacy for breast-feeding. It may mean that we need more robust studies and a longer-term follow-up for kids."

The new report is titled "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas."

More information

There's more on infant nutrition at the National Institutes of Health.

TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work no better than a placebo in combating sinus infections, a new British study shows.

"Antibiotics are probably not as effective as have been previously believed, particularly for the majority of cases of acute sinusitis," said study author Dr. Ian Williamson, a senior lecturer in primary medical care at the University of Southampton. "Patients should turn more to symptomatic remedies like analgesics while the body heals itself, usually over a period of three days to three weeks. Topical steroids have little overall effect, but may be beneficial, particularly in milder cases of acute sinusitis."

"For sinusitis, however it is being diagnosed in the primary-care setting, many of these cases do not require treatment, and a more cautious and conservative approach would seem to be warranted," added Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center College of Medicine and director of the division of otolaryngology at Scott & White, in Temple, Texas.

But other experts say the study, published in the Dec. 5 issue of the Journal of the American Medical Association, is no reason to scrap antibiotics altogether in this scenario.

"This is a helpful and useful study, and we shouldn't condemn antibiotics in those people who need them," said Dr. Michael Stewart, chairman of the department of otolaryngology at New York Presbyterian-Weill Cornell Medical Center, in New York City.

But, he added, only a minority of sinus infections are bacterial and will respond to antibiotics. The majority are viral infections, which won't respond to antibiotics.

According to an accompanying editorial, sinus problems account for 25 million doctor's office visits in the United States each year. Antibiotics are used to treat sinus infections 85 percent to 98 percent of the time in the United States.

Overuse of antibiotics not only won't help a patient with a viral infection get better, it will contribute to the growing problem of antibiotic resistance, experts have noted.

"Antibiotic resistance is rising dramatically, and there is no question about that," Baugh said.

For this study, 240 adults with sinus infections were randomized to one of four treatment groups: 500 milligrams of the antibiotic amoxicillin three times a day for seven days plus 200 micrograms of the nasal steroid budesonide once a day for 10 days; a placebo in place of the antibiotic plus budesonide; amoxicillin plus a placebo in place of budesonide; or two placebos.

In the amoxicillin group, 29 percent of patients had symptoms lasting at least 10 days, and 33.6 percent of those not receiving amoxicillin had the same symptom length of time.

In both the budesonide and no-budesonide groups, exactly 31.4 percent of patients had symptoms lasting at least 10 days.

The nasal steroids seemed to be more effective in individuals who had less severe symptoms.

As the editorial pointed out, most patients with acute sinusitis will get better on their own. Unfortunately, there's no good way to determine who has viral sinusitis and who has bacterial sinusitis.

"It's difficult to make a distinction in a primary-care setting," Baugh said.

If the symptoms are worse, treatment might be warranted, he added. "But for the bulk, I would assume it would be more of a wait-and-see approach. The bugs are winning," he said.

While researchers investigate possible new treatments, sinus infections sufferers might look to analgesics or brief use of steam inhalations, Williamson said.

Dr. William Morris, chairman and director of the department of osteopathic manipulative medicine at Touro College of Osteopathic Medicine in New York City, recommends an alternative approach: manual pressure to the bottom of the head and beginning of the neck, to allow better drainage from the head.

"One of the problems with sinusitis is that the sinuses tend to get closed up," he said. "If you don't drain properly, bacteria is just happy as a clam. If you can increase drainage and improve flow through the sinuses, you're going to be facilitating the process."

More information

For more on sinus infections, head to the U.S. Centers for Disease Control and Prevention.

FRIDAY, Nov. 30 (HealthDay News) -- The common pain reliever and anti-inflammatory ibuprofen significantly slows the decline in lung function seen in children with cystic fibrosis, U.S. researchers report.

A team at Case Western Reserve University School of Medicine, in Cleveland, found that children with cystic fibrosis who took high doses of ibuprofen twice a day had a 29 percent reduction in loss of lung function compared with children who did not take the drug.

"In cystic fibrosis the lungs are destroyed by chronic infection and inflammation. One of the treatments for that would be anti-inflammatory therapy," explained lead researcher Dr. Michael W. Konstan, director of the Cystic Fibrosis Center at Rainbow Babies and Children's Hospital.

One expert agreed that ibuprofen should be more widely used in treating the illness.

"This study confirms the benefit of ibuprofen in children with cystic fibrosis," said Dr. Bruce Marshall, vice president of clinical affairs at the Cystic Fibrosis Foundation.

In fact, the foundation currently recommends ibuprofen therapy. "This paper is in alignment with Cystic Fibrosis Pulmonary Guideline Committee recommendations," Marshall said.

CF is a genetic disease that affects the lungs and other organs. It's characterized by thick, sticky mucus that makes it almost impossible for CF patients to fight off germs and infections. The disease is always fatal, and lung disease accounts for 85 percent of deaths among CF patients. However, advances in treatment in the last 60 years have increased life expectancy from just a few years to about 36 years.

A decade ago, Konstan had shown that daily use of ibuprofen could slow the progression of the disease. "Our hope was that that would translate into increased years of survival," he said.

Since that time ibuprofen therapy has not been used very much, Konstan noted. "Only about 5 percent of patients who are eligible for this therapy are actually treated with ibuprofen," he said.

Part of the reluctance to use ibuprofen is the fear on the part of doctors of increased gastrointestinal bleeding, a common side effect with ibuprofen and other anti-inflammatory drugs, Konstan explained.

But he added that this problem "happens in about one in 500 treated patients. That's an awfully small risk considering the strong benefit."

In the new study, which appears in the December issue of American Journal of Respiratory and Critical Care Medicine, Konstan's team was able to show that the risk of gastrointestinal bleeding was small while the benefit was significant.

Konstan's group looked at 1,365 children who took ibuprofen and 8,960 who did not. Patients ranged from 6 to 17 years of age. Doses ranged from 20 milligrams to 30 milligrams per kilogram of the patient's weight. Some patients took up to 1,600 milligrams per dose -- typical, over-the-counter doses of ibuprofen recommend a maximum dose of 1,200 milligrams for people over 12 years of age.

The researchers found that for patients taking ibuprofen, the progression of the disease was cut by almost one-third compared with those not taking the drug. Moreover, gastrointestinal bleeding was rare, with an incidence of 0.37 percent in children taking ibuprofen, compared with 0.14 percent in those not taking the drug.

"Based on these findings, we should reconsider the use of ibuprofen as a treatment option," Konstan said. Whether ibuprofen actually increases survival isn't known, but based on the slowing of the disease, Konstan thinks that it probably does.

The researcher noted that his team has been looking for an anti-inflammatory alternative to ibuprofen for 10 years, but they have yet to find one that is as effective and safe as the common drug. "We continue to search for alternatives to ibuprofen," Konstan said.

More information

For more information on cystic fibrosis, visit the Cystic Fibrosis Foundation  .