Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.

Author:Koplin J, Allen K, Gurrin L, Osborne N, Tang ML, Dharmage S.
Title:Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.
Citation:PEDIATRIC ALLERGY AND IMMUNOLOGY 2008 Dec;19(8):682-7.
Abstract:Several studies have shown differences in the composition of the gastrointestinal
flora of children who develop sensitization to food allergens compared with
non-allergic children. It has been hypothesized that changes in the gut
microbiota resulting from caesarean section delivery could increase a child's
risk of developing food allergy; however, studies examining the relationship
between mode of delivery and food allergy have produced conflicting results. The
objective of this review was to determine whether there is sufficient evidence to
support an association between delivery by caesarean section and the development of sensitization to food allergens and immunoglobulin E (IgE) mediated food allergy. Using predefined inclusion and exclusion criteria, MEDLINE and PubMed were searched for studies investigating the relationship between caesarean section delivery and food allergy. The information on the quality of the studies and results were extracted and analysed systematically. The search identified four relevant studies as per our protocol. Symptomatic food allergy was used as the outcome in two studies and was found to occur more frequently in children born by caesarean section in one study while the second study found no association between food allergy diagnoses and mode of delivery. The other two studies measured levels of food antigen-specific IgE, with both studies showing an increase in sensitization to food allergens among children born by caesarean section. Overall, there is evidence that the risk of developing IgE-mediated sensitization to food allergens is increased among children delivered by caesarean section, however further studies using objectively diagnosed food allergy as the outcome are needed to verify whether this equates to an increase in confirmed food allergy. Future birth cohort studies should control for the effects of mode of delivery when investigating environmental modifiers of food allergy.