 was found in 28.2% of children, of whom 32.4% with and 23.9% without family history of AD. Children exclusively breastfed exhibited a reduced risk of atopy (5.8% v 35.3%, OR=0.11, 95%CI= 0.03;0.34, P<0.001). The difference of atopy was strongly significant between children who had exclusive breastfeeding and those without exclusive breastfeeding whether or not the subjects had family history of AD (P<0.001). There was a highly significant risk reduction for atopy related to prolonged breastfeeding (=6 months) (OR=0.37, 95%CI = 0.19 to 0.72, P=0.001). The difference of atopy was strongly significant between children who had prolonged breastfeeding and short breastfeeding duration whether or not the subjects had family history of AD (P<0.001) Conclusions Exclusive and prolonged breastfeeding decrease atopy in children with as well as without family history of AD.(Paediatr Indones 2007;47:179-184).

The association between duration of breastfeeding and atopy in children with or without family history of atopic disease Riana Novy, Budi Setiabudiawan, Cissy B. Kartasasmita A topic diseases (AD) are the commonest chronic diseases in childhood, posing serious problems in the world. 1,2 Their incidence tends to increase recently and their prevalence varies worldwide. 1,3,4 The prevalence of symptoms of asthma varies from 28% to 36% in the industrial countries. 5 Tendency to get atopy or AD can be triggered by many factors acquired in the early stage of life. These include low birth weight, maternal smoking, and possibly, early cessation of exclusive breastfeeding. 6 When do environmental factors exert their major effects? There may be a "window of opportunity" in the first few years of life when the developing immune system is particularly susceptible to being directed along an atopic pathway. 2,7 The maturation of the immune system has been proposed to continue up to 5-7 years of age. [8][9][10][11] Time of exclusive breastfeeding cessation or early exposure to cows' milk and other foreign food proteins which were introduced in the first months of life can increase atopy. 12 Some studies indicated that prolonged breastfeeding significantly decreased the risk of asthma and other allergic

Abstract
Background Atopic diseases (AD) are the most common chronic diseases in childhood, and their incidence has a tendency to increase recently. Tendency to have atopy could be triggered by many factors originated in early life, including time of breastfeeding cessation. Objective To determine the association between exclusive and duration of breastfeeding and atopy in children with or without family history of atopic disease. Methods This was an observational clinical epidemiology study performed at Babakansari, Padasuka, Garuda Primary Health Care Center in Bandung from January to March 2006. One hundred fifty of 749 children were randomized from group with and without family history of AD. They underwent skin prick tests and total serum IgE level analysis. Atopy was defined as a positive skin prick test to any of the eight allergens tested. History of exclusive and duration of breastfeeding was obtained from their parents. Significance tests for contingency tables were on the basis of x 2 test for association odds ratio with 95% confidence interval. Results Atopy was found in 28.2% of children, of whom 32.4% with and 23.9% without family history of AD. Children exclusively breastfed exhibited a reduced risk of atopy (5.8% v 35.3%, OR=0.11, 95%CI= 0.03;0.34, P<0.001). The difference of atopy was strongly significant between children who had exclusive breastfeeding and those without exclusive breastfeeding whether or not the subjects had family history of AD (P<0.001). There was a highly significant risk reduction for atopy related to prolonged breastfeeding (=6 months) (OR=0.37, 95%CI = 0.19 to 0.72, P=0.001). The difference of atopy was strongly significant between children who had prolonged breastfeeding and short breastfeeding duration whether or not the subjects had family history of AD (P<0.001) Conclusions Exclusive and prolonged breastfeeding decrease atopy in children with as well as without family history of AD. Keywords: Atopy, atopic disease, total serum IgE, breastfeeding diseases among children. 6,[12][13][14][15][16] However, other studies have failed to confirm it. 17,18 Since the scientific evidence about the effect of breastfeeding on the development of allergic disease is inconclusive, especially in Indonesia, a study of this matter is needed. The aim of this study was to determine the association between duration of breastfeeding and atopy in children with or without family history of AD.

Methods
We performed an observational clinical epidemiology study on groups with and without family history of AD as a part of "Prevalence of allergic and identification of risk factors in the first two years of life" study at Babakansari, Padasuka, and Garuda Primary Health Care Center in Bandung. The first phase study was a community survey that was done from May to August 2004. The second phase was from January to March 2006. Inclusion criteria were children who had completed phase I study and physically healthy. Those who changed address or consumed first generation antihistamine within three days, non-sedative antihistamine within seven days, or systemic or topical steroids within three weeks before skin prick test procedure were excluded.
From 800 children joining the first phase, only 749 were eligible for the next phase, of whom 204 children had family history of AD. Subjects from those with and without family history of AD were randomly chosen. Subjects who fulfilled the inclusion criteria were brought to Hasan Sadikin Hospital Bandung. In the hospital, the study procedure was re-explained and written informed consent was obtained. Afterward, history, physical examination, skin prick test, and blood sampling were performed.
Exclusive breastfeeding denoted that the infants were only breastfed and no infant formulas, cow's milk, or solid foods had been introduced except for drugs, vitamin, or oral rehidration solution within six months of life. Duration of breastfeeding was defined as duration during which a child was breastfed (in months), with or without infant formulas, cow's milk, or solid foods, in which was grouped into two categories, i.e., breastfed <6 months and breastfed >6 months.
Skin prick test was performed in the volar area of the forearms with allergens i.e Dermatophagoides pteronyssinus, Blomia tropicalis, cat hair, cockroach, cow's milk, egg white, peanut, and soyabean. Histamine was used for a positive control and saline for negative control. A test was considered positive if the diameter of skin wheal was 3 mm or more compared to the negative control at least to one allergen 15 minutes after testing. Atopy was defined as a positive skin prick test to any of the eight allergens tested.
Total serum IgE was measured using electrochemiluminescence immunoassay (ECLIA) methods for quantitative determination of immunoglobulin E in human serum and plasma, with <60 IU/mL as a normal value from reagent package insert for children 1-5 years of age.
SPSS software version 11.5 for windows and EpiInfo Version 6.0 were used to analyze the data. Significance tests for contingency tables were on the basis of χ 2 test for association odds ratio with 95% confidence interval.
This study was approved by the Health Study Ethical Committee at Medical School, Padjadjaran University/Hasan Sadikin General Hospital Bandung.

Results
From 300 subjects, nine children had already moved from the address and the parents of seven children refused to be involved in the study, therefore there were only 284 subjects in this study, with 142 children for each group. The subjects characteristics based on family history of AD is seen in Table 1.
Atopy was found in 80 (28.2%) children. Prevalence of atopy in group with history of AD was 52% greater than the other group, however the difference was not statistically significant (OR=1.52, 95%CI = 0.87-2.65, P=0.113). The atopy prevalence based on family history of AD is described in Table 2.
Total serum IgE values were obtained from 271 (95.4%) blood samples. Median total serum IgE of children with family history of atopic disease (131.7 with range 12.12 to >2,500 IU/mL) was higher than those without family history of AD (105.9 with range 5.22->2,500 IU/mL). Children who had normal and high total serum IgE level were 79 (29.2%) and 192 (70.8%), respectively.
Atopy was found in 61 of 192 (31.8%) children with high total serum IgE level and in 17 of 79 (21.5%) children with normal total serum IgE level. There was no significant difference of atopy between children with high total serum IgE level compared to those with normal total serum IgE level (P=0.09) ;OR (95% CI) = 1.70 (0.88-3.30).
Exclusive breastfeeding and non exclusive breastfeeding children percentage were 24.3% and 75.7%, respectively. There were 76 (35.3%) atopy found in non exclusive breastfeeding, on the other hand only four (5.8%) children who exclusively breastfed experienced atopy. There was a high reduction of atopy related to exclusive breastfeeding (OR=0.11, 95%CI =0.03-0.34, P<0.001). Exclusive breastfeeding was