Effects of maternal dietary egg intake during early lactation on human milk ovalbumin concentration: a randomized controlled trial

Abstract

Background

There is limited understanding of how maternal diet affects breast milk food allergen concentrations, and whether exposure to allergens through this route influences the development of infant oral tolerance or sensitization.

Objective

To investigate how maternal dietary egg ingestion during early lactation influences egg protein (ovalbumin) levels detected in human breast milk.

Methods

In a randomized controlled trial, women were allocated to a dietary group for the first six weeks of lactation: high-egg diet (> 4 eggs per week), low-egg diet (1-3 eggs per week) or an egg-free diet. Breast milk samples were collected at two, four and six weeks of lactation for the measurement of ovalbumin. The permeability of the mammary epithelium was assessed by measuring the breast milk sodium: potassium ratio. Egg-specific IgE and IgG4 were measured in infant plasma at six weeks, and prior to the introduction of egg in solids at 16 weeks.

Results

Average maternal egg ingestion was associated with breast milk ovalbumin concentration. Specifically, for each additional egg ingested per week there was an average 25% increase in ovalbumin concentration (95% CI 5%–48%, p=0.01). Breast milk ovalbumin concentrations were significantly higher in the 'high-egg' group (> 4 eggs per week) compared with the 'egg-free' group (p=0.04). However one third of women had no breast milk ovalbumin detected. No detectable associations were found between mammary epithelium permeability and breast milk ovalbumin concentrations. Infant plasma egg-specific IgG4 levels were also positively associated with maternal egg ingestion, with an average 22% (95% CI 3%-45%) increase in infant egg-specific IgG4 levels per additional egg consumed per week (P=0.02).

Conclusions & Clinical Relevance

Increased maternal egg ingestion is associated with increased breast milk ovalbumin, and markers of immune tolerance in infants. These results highlight the potential for maternal diet to benefit infant oral tolerance development during lactation.

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