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Prevention of Allergic Diseases

  1. 1. Planee Vatanasurkitt,MD
  2. 2.  Food allergen avoidance  HDM avoidance  Multiple intervention Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14
  3. 3.  Maternal diet exclude cow’s milk and egg during late pregnancy does not prevent allergic manifestation in genetically predisposed children  Maternal avoidance CM egg nuts fish soy during pregnancy and lactation ,supplement with extensive hydrolysed and avoidance of solids up to 6 months reduced in food sensitization on SPT ,food allergic manifestation and AD at age 2 year but no long term benefit beyond early childhood was observed Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14
  4. 4. A Cochrane database meta-analysis of 4 clinical studies concluded that antigen avoidance during pregnancy is unlikely to reduce the child’s risk of developing atopic disease, and dietary restrictions could adversely affect maternal or fetal nutrition.
  5. 5.  Norecommended to avoid diet during pregnancy
  6. 6.  Maternal avoidance dairy product ,egg, fish, peanut ,soy during lactation led to reduction in AD at 18 months in high risk infant  maternal food allergen avoidance during lactation might be of some benefit. Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14
  7. 7.  Introduction solid food before 4 months might increase risk of atopic dermatitis in genetically predisposed children  Could not find beneficial effect of late introduction of solid foods Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14
  8. 8. EXCLUSIVE BREAST HYDROLYZED MILK FEEDING FORMULA  Preventive effect of breast  Protein hydrolyzed reduces feeding on allergic disease allergic disease during the remain controversial first 2-3 years in children at risk of atopy, as supplement or alternative to breast feeding  The GINI study Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14
  9. 9.  2252 newborns with atopic heredity were randomly assigned at birth to receive one of 4 blinded formulas:
  10. 10.  Partially hydrolyzed whey formula  Extensively hydrolyzed whey formula  Extensively hydrolyzed casein formula  Cow milk
  11. 11.  Outcomes were physician-diagnosed allergic diseases (atopic dermatitis, food allergy, allergic urticaria, asthma, and hay fever/allergic rhinitis
  12. 12. Relative risk Partially hydrolyzed whey 0.79 Extensively hydrolyzed whey 0.92 Extensively hydrolyzed 0.71 casein
  13. 13.  Result: AD significantly reduced by using extensively hydrolyzed casein compare with cow milk, some protective of partial whey hydrolyzed on AD
  14. 14. number Interventio interventio Main Reduction n started n outcome in at Newborn birth Mattress Allergic 1y allergic 696 cover and sensitizatio sensitizatio general n n advice 2y no effect Toddler 2-4 y 1y allergic 636 sensitizatio School 5-7 y n children 242
  15. 15.  This study provide evidence could protect at risk children against sensitization even in later childhood
  16. 16. numbe Interventio intervention outcome Reduction r n started at in 620 prenatal Extensive -Allergic HDM HDM sensitizatio allergen avoidance n levels -cover -Wheeze 1Y: only -HEPA filter -Airway severe -hardwood resistance wheeze flooring -use of Acarosan
  17. 17. num Interventio interventio outcome Reduction ber n started n in at 810 prenatal Mattress -Total IgE HDM covers and -Specific IgE allergen general - levels advice Cough,wheez 2y: nocturnal e cough -Atopic dermatitis HDM allergen reduced but No difference in development of atopy or asthma
  18. 18. numbe Interventio intervention outcome Reduction in r n started at 120 birth Food and Allergic HDM allergen HDM sensitizatio level avoidance n 1 y: Asthma Asthma,AD Allergic allergic rhinitis sensitization Atopic 2Y:AD dermatitis allergic Food sensitization allergy 4Y:AD allergic sensitization
  19. 19.  Strict food and aeroallergen avoidance in high risk children might reduce the development of allergic sensitization. Leading to less atopic dermatitis and asthma in later childhood
  20. 20. numbe Interventi intervention outcome Reduction r on start in 531 birth Diet exclusive Asthma 4y :any BF or soya AD allergy formula and Rhinitis environmental urticaria HDM and ETS avoidance
  21. 21. number 545 start prenatal intervention Diet : breast feeding, delayed introduction of solids and environment reduction HDM and pet exposure and ETS outcome Allergic sensitization,Asthma,Allergic rhinitis Reduction HDM allergen levels in 1 Y: asthma and allergic rhinitis 2Y :asthma
  22. 22. number 616 start prenatal intervention HDM avoidance Diet : omega 3 PUFA combined outcome Cough,asthma,allergic sensitization,Total IgE at the age 18 months Reduction in 1.5y :diet group;wheeze HDM group;no effect 3y diet group;cough HDMgroup sensitization to HDM
  23. 23.  Dietary modification of supplementation with fish oil rich in omega-3 PUFA,might be some benefit  In CAPS, reduction in wheezing at 18 months but not at 3 year  Prospective observation study indicate introduction of fish in to infant diet reduces occurrence of rhinitis but not asthma Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14
  24. 24.  LactobaccilusGG given during pregnancy to mother with family history of atopy for 6 months resulted in significant reduction in AD up to age 2 years Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14
  25. 25.  No clinical trials have been done to assess immunomodulatory effect of vaccination in primary prevention of allergy Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14
  26. 26. Exposure to ETS Avoidance must be include in all preventive advice Maternal avoidance of Does not work and could be allergenic food during halmful pregnancy BF for 4-6 months protect against childhood wheeze and atopic dermatitis, no evidence of long term benefit
  27. 27. Maternal avoidance of Some protective on allergenic food during reduction cow milk allergy lactation and atopic dermatitis Delayed introduction of solid Lacking proof for preventive food effect Hydrolyzed milk formula Preventive effect on cow’s milk allergy and AD
  28. 28. HDM avoidance Preventive effect to sensitization or respiratory allergy is not compelling Combined food and Reducing early childhood aeroallergen avoidance wheeze and AD and later asthma