Chemically Sterilized Pacifiers Tied to Increased Risk of Food Allergy

NEW YORK (Reuters Health) – Sterilizing baby pacifiers with chemical antiseptics may compromise immunity and contribute to the development of food allergies, according to a study from Australia.

The study found that babies using pacifiers cleaned with chemical sanitizers at six months of age had more than three times greater odds of developing food allergy at one year compared with no antiseptic use. There was no significant risk increase when pacifiers were boiled in water, rinsed with tap water, put in their parent’s mouth or not washed at all.

The findings are based on 787 infants from the Barwon Infant Study (BIS), a population-based birth cohort measuring food allergy outcomes.

None of the infants were born at under 32 weeks, or had serious illness, major congenital malformation, or genetic disease. Information collected via questionnaire at recruitment and infant ages 1, 6, and 12 months, included pacifier use and pacifier sanitization (defined as the joint exposure of a pacifier and cleaning methods). Challenge-proven food allergy was determined age one year.

At one year, 61 babies (8%) were diagnosed with food allergy, mostly to egg (69%), with only a few allergic to peanut, cashew, sesame and cow’s milk.

Any pacifier use at six months was associated with food allergy at 12 months (adjusted odds ratio, 1.94; 95% confidence interval: 1.04 to 3.61; P=0.037), but not pacifier use at other ages.

This overall association was driven by the joint exposure of pacifier use and antiseptic cleaning (aOR, 4.83; 95% CI: 1.10 to 21.18), compared with no pacifier use, Dr. Anne-Louise Ponsonby of the Florey Institute for Neuroscience and Mental Health in Parkville and colleagues report in the Journal of Allergy and Clinical Immunology.

Significantly higher odds of food allergy at six months were only evident for pacifier use combined with antiseptic cleaning. Using pacifiers without antiseptic at six months was not associated with food allergy.

Among the pacifier user subgroup, antiseptic compared with no antiseptic use was also associated with an increased risk of food allergy (aOR, 3.56; 95% CI: 1.18 to 10.77), “ruling out the association at six months being due to pacifier use alone,” the authors say.

“Furthermore, persistent and repeated antiseptic use over the first six months was associated with higher food allergy risk (P=0.029),” the team reports.

Other pacifier-sanitization methods (none, parent’s mouth, tape water and boiling water) were not associated to infant food allergy.

“Environmental microbial exposure plays a role in immune system development and susceptibility to food allergy,” the authors note in their paper.

“This is the first report of a pacifier-antiseptic combination being associated with a higher risk of subsequent food allergy. Future work should investigate underlying biological pathways,” they suggest.

They note that chemicals in antiseptics could alter the oral microbial flora. They cite a study that found different microbial pattern in 18-month-old infants with pacifiers cleaned by antiseptics compared with parental sucking.

The American Academy of Pediatrics (AAP) recommends offering a pacifier at nap time and bedtime once breastfeeding has been firmly established, given research showing a protective effect against sudden infant death syndrome (SIDS).

In Australia, pacifier use is not encouraged or discouraged. When pacifiers are used, maintaining appropriate sterilization of pacifiers is recommended by Raising Children’s Network in Australia until six months to protect infants from infection, but the sterilization technique is not specified.

Dr. Ponsonby and colleagues say “guidelines on pacifier use should consider the evidence on associated sterilization techniques, including the findings from this report.”

The study had no commercial funding and the authors have declared no relevant conflicts of interest. Dr. Ponsonby did not respond to a request for comment by press time.

SOURCE: Journal of Allergy and Clinical Immunology, online March 30, 2021.

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