Prevention of Allergic Diseases
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  • 1. Planee Vatanasurkitt,MD
  • 2.  Food allergen avoidance HDM avoidance Multiple intervention Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14
  • 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. 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.  Norecommended to avoid diet during pregnancy
  • 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.  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. EXCLUSIVE BREAST HYDROLYZED MILKFEEDING 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.  2252 newborns with atopic heredity were randomly assigned at birth to receive one of 4 blinded formulas:
  • 10.  Partially hydrolyzed whey formula Extensively hydrolyzed whey formula Extensively hydrolyzed casein formula Cow milk
  • 11.  Outcomes were physician-diagnosed allergic diseases (atopic dermatitis, food allergy, allergic urticaria, asthma, and hay fever/allergic rhinitis
  • 12. Relative riskPartially hydrolyzed whey 0.79Extensively hydrolyzed whey 0.92Extensively hydrolyzed 0.71casein
  • 13.  Result: AD significantly reduced by using extensively hydrolyzed casein compare with cow milk, some protective of partial whey hydrolyzed on AD
  • 14. number Interventio interventio Main Reduction n started n outcome in atNewborn birth Mattress Allergic 1y allergic696 cover and sensitizatio sensitizatio general n n advice 2y no effectToddler 2-4 y 1y allergic636 sensitizatioSchool 5-7 y nchildren242
  • 15.  This study provide evidence could protect at risk children against sensitization even in later childhood
  • 16. numbe Interventio intervention outcome Reductionr n started at in620 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. num Interventio interventio outcome Reductionber n started n in at810 prenatal Mattress -Total IgE HDM covers and -Specific IgE allergen general - levels advice Cough,wheez 2y: nocturnal e cough -Atopic dermatitisHDM allergen reduced but No difference in development ofatopy or asthma
  • 18. numbe Interventio intervention outcome Reduction inr n started at120 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.  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. numbe Interventi intervention outcome Reductionr on start in531 birth Diet exclusive Asthma 4y :any BF or soya AD allergy formula and Rhinitis environmental urticaria HDM and ETS avoidance
  • 21. number 545start prenatalintervention Diet : breast feeding, delayed introduction of solids and environment reduction HDM and pet exposure and ETSoutcome Allergic sensitization,Asthma,Allergic rhinitisReduction HDM allergen levelsin 1 Y: asthma and allergic rhinitis 2Y :asthma
  • 22. number 616start prenatalintervention HDM avoidance Diet : omega 3 PUFA combinedoutcome Cough,asthma,allergic sensitization,Total IgE at the age 18 monthsReduction in 1.5y :diet group;wheeze HDM group;no effect 3y diet group;cough HDMgroup sensitization to HDM
  • 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.  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.  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. Exposure to ETS Avoidance must be include in all preventive adviceMaternal avoidance of Does not work and could beallergenic food during halmfulpregnancyBF for 4-6 months protect against childhood wheeze and atopic dermatitis, no evidence of long term benefit
  • 27. Maternal avoidance of Some protective onallergenic food during reduction cow milk allergylactation and atopic dermatitisDelayed introduction of solid Lacking proof for preventivefood effectHydrolyzed milk formula Preventive effect on cow’s milk allergy and AD
  • 28. HDM avoidance Preventive effect to sensitization or respiratory allergy is not compellingCombined food and Reducing early childhoodaeroallergen avoidance wheeze and AD and later asthma