Can Vitamin D Supplementation in the First Year of Life Prevent Food Allergy in Infants? The VITALITY Trial: Parts 1&2 (VITALITY)

Can Vitamin D Supplementation Prevent Food Allergy in Infants? The VITALITY Trial

We report that Australia has the highest prevalence of Immunoglobulin(Ig)E-mediated food allergy in the world, with 10% of infants having challenge-proven food allergy in Melbourne. There has been a 5-fold increase in hospital admissions for life-threatening anaphylaxis. These changes are most pronounced in children less than 5 years, suggesting a causal role for early life determinants. We have primary data to inform hypotheses for the rise in food allergy, which appears to result from potentially modifiable factors related to the modern lifestyle, particularly Vitamin D insufficiency (VDI). We propose an intervention study to assess if infant Vitamin D supplementation during the first year of life significantly decreases the risk of early-onset food allergy and other allergic disease at 12 months (part 1) and 6 years of age (part 2). Australia is ideally placed to answer this important question since, unlike the USA, Canada and Europe, there are no population recommendations for routine infant supplementation with Vitamin D and we are one of the few developed countries that do not supplement the food chain supply with Vitamin D.

Study Overview

• Status: Active, not recruiting
• Conditions: Food Allergy
• Intervention / Treatment: Drug: Vitamin D; Drug: placebo

Detailed Description

There is an urgent need to prevent the onset and progression of food allergy in our population. Evidence demonstrates that food allergy and atopic eczema represent the earliest manifestations of the atopic march with 50% of infants with food allergy predicted to develop respiratory allergic diseases later in life. We report that Australia has the highest prevalence of Immunoglobulin(Ig)E-mediated food allergy in the world, with 10% of infants having challenge-proven food allergy in Melbourne. There has been a 5-fold increase in hospital admissions for life-threatening anaphylaxis. These changes are most pronounced in children less than 5 years, suggesting a causal role for early life determinants. We have primary data to inform hypotheses for the rise in food allergy, which appears to result from potentially modifiable factors related to the modern lifestyle, particularly Vitamin D insufficiency (VDI), and have demonstrated an association between VDI and increased risk of challenge-proven food allergy in 12-month old infants, which supports numerous ecological studies showing an increased risk of food allergy the further a child resides from the equator (associated with decreased UV exposure and Vitamin D levels). Despite Australia's sunny climate, population rates of VDI have steadily increased in infants and pregnant women in parallel to the apparent rise in food allergic disease. This association is biologically plausible, as there is evidence Vitamin D is critical to the healthy development of the immune system in early life. We propose an intervention study to assess if infant Vitamin D supplementation during the first year of life significantly decreases the risk of early-onset food allergy and other allergic disease at 12 months (part 1) and 6 years of age (part 2). Australia is ideally placed to answer this important question since, unlike the USA, Canada and Europe, there are no population recommendations for routine infant supplementation with Vitamin D and we are one of the few developed countries that do not supplement the food chain supply with Vitamin D.

• Study Type: Interventional
• Enrollment (Actual): 2739
• Phase: Phase 4

Contacts and Locations

Study Locations

• Australia
  • Victoria
    • Melbourne, Victoria, Australia, 3052
      • Murdoch Childrens Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 month to 2 months (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Each participant must meet the following criteria to be included in this study:

• Healthy, term (born no earlier than 2 weeks before estimated date of delivery), predominantly breastfeeding infants aged 6 to 12 weeks (inclusive) who are expected to be predominantly breastfed for at least 6-months. This will be determined by answering yes/no to question 'do you intend/wish to breastfeed until your infant is at least 6 months of age.' Up to one bottle (approx. 120mL) of formula per 24 hours at the time of screening is acceptable, as this will contain <100 IU vitamin D.
• Has a parent/legally acceptable representative (LAR) capable of understanding the informed consent document and providing consent on the subject's behalf,
• The parent must expect to be able to complete 4 online questionnaires over the infant's first 12 months of life and for the infant to be available for skin prick testing (+/- food challenge) at The Royal Children's Hospital at 12 months of age.

Exclusion Criteria:

Participants meeting any of the following criteria will be excluded from the study:

• Infants who are currently receiving vitamin D supplementation
• Infants on medication that interferes with vitamin D metabolism
• Poor health due to a current or past significant disease state or congenital abnormality.
• Prematurity <37 weeks/low birth weight <2500 g/Small for gestational age (SGA)
• Unable to provide consent without the aid of an interpreter.
• Women at high risk of vitamin D deficiency with infants on vitamin D supplementation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: vitamin D; 400 IU /daily cholecalciferol/vitamin D	Drug: Vitamin D; 400 IU/daily until age 12 months; Other Names: cholecalciferol
Placebo Comparator: placebo; carrier formulation minus vitamin D	Drug: placebo; identical placebo daily; Other Names: placebo is identical carrier minus vitamin D

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The prevalence of challenge-proven food allergy at 12 months of age	The prevalence of challenge-proven food allergy at 12 months of age determined by a positive SPT and a positive oral food challenge	At 12 months of age
The occurrence of definite food allergy or tolerance at 6 years of age	The occurrence of definite food allergy or tolerance at 6 years of age can only be determined by combining data from an oral food challenge, a skin prick test (SPT) and/or serum specific IgE test, and/or parent/self-reported ingestion history and reactions to the index food.	At 6 years of age

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The prevalence of food sensitisation at 12 months of age determined by SPT positive	The prevalence of food sensitisation at 12 months of age determined by SPT positive	At 12 months of age
The prevalence of doctor diagnosed eczema during the first postnatal year	The prevalence of doctor diagnosed eczema during the first postnatal year	During the first postnatal year
The prevalence of vitamin D insufficiency (serum concentration of 25(OH)D <50 nmol/L ) at age 12 months determined by measuring blood taken at the 12 month clinic visit	The prevalence of vitamin D insufficiency (serum concentration of 25(OH)D <50 nmol/L ) at age 12 months determined by measuring blood taken at the 12 month clinic visit	At 12 months of age
Allergy-related healthcare utilisation within the first 12 months of life	Allergy-related healthcare utilisation within the first 12 months of life	Within the first 12 months of life
Infection episodes within the first 12 months of life	Infection episodes within the first 12 months of life	Within the first 12 months of life
Measure of height at 12 months of age	Measure of height at 12 months of age	At 12 months of age
Measure of weight at 12months of age	Measure of weight at 12months of age	At 12 months of age
Wheeze episodes within the first 12 months of life	Wheeze episodes within the first 12 months of life	Within the first 12 months of life
The occurrence of food sensitisation at 6 years of age determined by SPT positive	The occurrence of food sensitisation at 6 years of age determined by SPT positive	At 6 years of age
The occurrence of asthma in the first 6 years of life	The occurrence of asthma at 6 years of age	At 6 years of age
The occurrence of eczema in the first 6 years of life	The occurrence of eczema in the first 6 years of life	Within first 6 years of life
The prevalence of vitamin D insufficiency (serum concentration of 25(OH)D <50 nmol/L ) at age 6 years determined by measuring blood taken at the 6 year clinic visit	The prevalence of vitamin D insufficiency (serum concentration of 25(OH)D <50 nmol/L ) at age 6 years determined by measuring blood taken at the 6 year clinic visit	At 6 years of age
Allergy-related healthcare utilisation in the first 6 years of life	Allergy-related healthcare utilisation in the first 6 years of life by data linkage from MBS and PBS	Within first 6 years of life
Measure of height at 6 years of age	Measure of height at 6 years of age	At 6 years of age
Measure of Waist circumference at 6 years of age	Measure of Waist circumference at 6 years of age	At 6 years of age
Measure of Hip circumference at 6 years of age	Measure of Hip circumference at 6 years of age	At 6 years of age
Lung function at 6 years of age	Lung function: bronchial responsiveness is measured using the percent change from baseline and absolute changes in forced expiratory volume (FEV) in 1 second and/or forced vital capacity (FVC) at 6 years of age	At 6 years of age
The occurrence of rhinitis in the first 6 years of life	The occurrence of rhinitis in the first 6 years of life	Within first 6 years of life
Psychosocial Distress at 6 years of age	Psychosocial health at 6 years of age by Kessler Psychological Distress Scale-10 (K-10) for parents The K10 scale involves 10 questions about emotional states each with a five-level response scale. Each item is scored from one 'none of the time' to five 'all of the time'. Scores of the 10 items are then summed, yielding a minimum score of 10 and a maximum score of 50. Low scores indicate low levels of psychological distress and high scores indicate high levels of psychological distress.	At 6 years of age
Psychosocial health at 6 years of age	Psychosocial health at 6 years of age by Strengths and Difficulties Questionnaire (SDQ) for child SDQ ask about 25 attributes, some positive and others negative.bThese 25 items are divided between 5 scales: emotional symptoms (5 items) } 1) to 4) added together to generate a total difficulties score (based on 20 items); conduct problems (5 items); hyperactivity/inattention (5 items); peer relationship problems (5 items); prosocial behaviour (5 items)	At 6 years of age
Quality of life at 6 years of age	Quality of life (QL) at 6 years of age by Child Health Utility 9D (CHU9D, parent proxy version; PedsQL Parent Report for Young Children ages 5-7) The questionnaire has 9 questions with 5 response levels per question. The CHU9D allows the analyst to obtain quality adjusted life years (QALYs) directly for use in cost utility analysis.	At 6 years of age
Quality of life regarding Food Allergy at 6 years of age	Quality of life (QL) at 6 years of age by Food Allergy Quality of Life Questionnaires-Parent Form (FAQLQ-PF) All items are scored on a 7-point Likert scale from 0 (not at all troubled) to 6 (extremely troubled) [22]. The total scores are divided by the number of items answered, giving a range of scores from 0 to 6, with higher values indicating a poorer quality of life	At 6 years of age
Cardiovascular health (vascular function) at 6 years of age	Cardiovascular health at 6 years of age determined by assessing vascular function through a pulse doppler recording of the blood flow	At 6 years of age
Cardiovascular health (Carotid and aortic Intima-Media Thickness) at 6 years of age	Cardiovascular health (Carotid and aortic Intima-Media Thickness) at 6 years of age by acquiring images with simultaneous ECG gating	At 6 years of age
Cardiovascular health (Blood pressure) at 6 years of age	Cardiovascular health (Brachial and central blood pressure ) at 6 years of age will be measured using the SphygmoCor® XCEL system.	At 6 years of age
Cardiovascular health (Arterial stiffness) at 6 years of age	Cardiovascular health (Arterial stiffness ) at 6 years of age will be assessed by central and peripheral pulse wave velocity (PWV) and pressure waveform analysis (PWA) using a cuff for the femoral artery and tonometer pressure sensor for the carotid artery.	At 6 years of age
Dental health at 6 years of age	Dental health at 6 years of age: A registered oral health professional will examine the participant's mouth and teeth, checking for cavities/dental decay as well as developmental mark on the teeth. In addition, a 3D scan and/or photographs of the participant's teeth will be taken to document findings.	At 6 years of age
Hearing health at 6 years of age	Hearing health at 6 years of age by using SHOEBOX® Audiometry Professional Edition to measure hearing threshold	At 6 years of age

Collaborators and Investigators

• Sponsor: Murdoch Childrens Research Institute
• Investigators: Principal Investigator: Kirsten Perrett, MD PhD, Murdoch Children's Research Institute

Publications and helpful links

General Publications

• Allen KJ, Koplin JJ, Ponsonby AL, Gurrin LC, Wake M, Vuillermin P, Martin P, Matheson M, Lowe A, Robinson M, Tey D, Osborne NJ, Dang T, Tina Tan HT, Thiele L, Anderson D, Czech H, Sanjeevan J, Zurzolo G, Dwyer T, Tang ML, Hill D, Dharmage SC. Vitamin D insufficiency is associated with challenge-proven food allergy in infants. J Allergy Clin Immunol. 2013 Apr;131(4):1109-16, 1116.e1-6. doi: 10.1016/j.jaci.2013.01.017. Epub 2013 Feb 27.
• Allen KJ, Panjari M, Koplin JJ, Ponsonby AL, Vuillermin P, Gurrin LC, Greaves R, Carvalho N, Dalziel K, Tang ML, Lee KJ, Wake M, Curtis N, Dharmage SC. VITALITY trial: protocol for a randomised controlled trial to establish the role of postnatal vitamin D supplementation in infant immune health. BMJ Open. 2015 Dec 16;5(12):e009377. doi: 10.1136/bmjopen-2015-009377.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2014
• Primary Completion (Estimated): April 1, 2028
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: April 10, 2014
• First Submitted That Met QC Criteria: April 10, 2014
• First Posted (Estimated): April 14, 2014

Study Record Updates

• Last Update Posted (Actual): November 21, 2023
• Last Update Submitted That Met QC Criteria: November 19, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: eczema; vitamin D; food allergy
• Additional Relevant MeSH Terms: Immune System Diseases; Hypersensitivity, Immediate; Hypersensitivity; Food Hypersensitivity; Physiological Effects of Drugs; Micronutrients; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol; Vitamins; Ergocalciferols
• Other Study ID Numbers: HREC # 34168 A