Prevention of allergic diseases

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Prevention of Allergic Diseases

Presented by Chuleeporn Kongmeesook, MD,

2013

Published in: Health & Medicine
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Prevention of allergic diseases

  1. 1. PREVENTION OF ALLERGIC DISEASE CHULEEPORN KONGMEESOOK ,MD
  2. 2. Outline Food allergen avoidance HDM avoidance Multiple intervention
  3. 3. Food allergen avoidance
  4. 4. High risk Definitions/ AAP 2008 interventions Clinical Report ‘‘High risk’’ Parent or sibling with documented allergic disease AAP 2000 recommend ations Biparental or parent plus sibling history of allergy Scott H. Sicherer et al J Allergy Clin Immunol 2008;122:29-33. 2008;122:29-33.
  5. 5. Atopic risk score Type and degree of allergy symptoms Family Total Major* Minor** Overt Father Mother Sibling Probable Absent Overt Probable Absent 2 3 2 1 2 1 0 0 0 1 1 1 0.5 0.5 0.5 0 0 0 4.5 6.5 4.5 *asthma, atopic dermatitis, allergic rhinitis, CMA. **urticaria, **urticaria, drug allergy, other food allergies except CMA, allergic conjunctivitis. J. Ngamphaiboon et al Asian Biomedicine 2009; 3:121-126. 3:121-
  6. 6. P. Bager et al Clinical and Experimental Allergy 2008;38:634–642. 2008;38:634–
  7. 7. Liem et al J Allergy Clin Immunol 2007;119:1203-9. 2007;119:1203-
  8. 8. R. E. Bergmann et al Clinical and Experimental Allergy 1997;27: 752-760. 1997;27: 752-760.
  9. 9. Allergic march www.theallergymarch.com
  10. 10. Maternal avoidance diet during pregnancy Maternal avoidance cow’s milk and egg during pregnancy not affect incidence of allergic disease No association between maternal peanut avoidance during pregnancy and incidence of peanut allergy in their children David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  11. 11. Definitions/ AAP 2008 interventions Clinical Report Pregnancy Lack of avoidance evidence AAP 2000 recommend ations Possibly peanut Scott H. Sicherer et al J Allergy Clin Immunol 2008;122:29-33. 2008;122:29-
  12. 12. Kramer MS et al Cochrane Database of Systematic Reviews 2006. 2006.
  13. 13. Maternal avoidance diet during lactation No significant benefit to children David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013; 29-36.
  14. 14. Definitions/ AAP 2008 interventions Clinical Report Maternal Some lactation evidence for avoidance of reduced allergens atopic dermatitis AAP 2000 recommend ations Peanuts, tree nuts and ‘‘consider’’ egg, milk, fish, and ‘‘perhaps other foods’’ Scott H. Sicherer et al J Allergy Clin Immunol 2008;122:29-33. 2008;122:29-
  15. 15. Kramer MS et al Cochrane Database of Systematic Reviews 2006. 2006.
  16. 16. Effect of breast-feeding on breastatopic dermatitis Exclusive breast-feeding for 3 months breastreduce incidence of atopic dermatitis in children David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  17. 17. Effect of breast-feeding on breastasthma Exclusive breast-feeding for 3-4 months breast3reduces number of early, upper respiratory infectioninfection-associated wheezing episodes before age of 4 years David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  18. 18. Effect of breast-feeding on breastfood allergy HighHigh-risk infants exclusive breast-feeding breastat least 4 months lowered risk of cow’s milk allergy (but not food allergy in general) David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013; 29-36.
  19. 19. Effect of breast-feeding on breastallergic rhinitis Not clear David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  20. 20. Infant formula for primary prevention of allergic disease 1 Cow’s milk formulas & partial whey hydrolysate formulas pHFs preventive effect on atopic disease and cow’s milk protein allergy David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013; 29-36.
  21. 21. Infant formula for primary prevention of allergic disease 2 pHFs & extensive casein or extensive whey hydrolysate formulas (ehF) (ehF) No significant difference between pHF and eHF in development of infant allergic diseases David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  22. 22. Infant formula for primary prevention of allergic disease 3 Soy formula & amino acid based formulas - Advantage of soy formula not show Amino acidebased formulas lacking studies David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013; 29-36.
  23. 23. Definitions/ AAP 2008 interventions Clinical Report AAP 2000 recommend ations Prevention formulas Compared with whole cow’s milk protein, evidence for certain extensive hydrolysates, hydrolysates, partial hydrolysates, hydrolysates, but not soy ‘‘Hypoallergenic formula’’ (extensive hydrolysate, hydrolysate, possibly partial hydrolysate); hydrolysate); not soy Scott H. Sicherer et al J Allergy Clin Immunol 2008;122:29-33. 2008;122:29-33.
  24. 24. I Brockow et al J Investig Allergol Clin Immunol 2009;19: 180-187. 2009;19: 180-187.
  25. 25. Introduction of complementary foods 1 Expert panel from European Academy of Allergology and Clinical Immunology recommends introduction of complementary foods between 4 and 6 months of age David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013;1:29-
  26. 26. Introduction of complementary foods 2 Feeding solids before 4 months of age higher incidence of atopic dermatitis No current evidence suggests that delay of introduction of solid foods beyond 4 to 6 months of age prevent allergic disease David M. Fleischer et al J Allergy Clin Immunol: In Practice 2013;1:29-36. Immunol: 2013; 29-36.
  27. 27. Definitions/ AAP 2008 interventions Clinical Report Types of Evidence to ‘‘solids’’ and wait 4 (to 6) complementary mo; lack of foods convincing evidence for avoiding specific allergenic foods AAP 2000 recommend ations Solids held to 6 mo Dairy products, age 1y Egg, age 2 y Peanuts, nuts, fish, age 3 y Scott H. Sicherer et al J Allergy Clin Immunol 2008;122:29-33. 2008;122:29-
  28. 28. HDM avoidance
  29. 29. Study on Prevention of Allergy in Children in Europe (SPACE) Number Intervention Intervention outcome started at Newborn 696 Birth Toddler 636 School children 242 2-4 y Mattress cover and general advice Reduction in Allergic 1y allergic Main sensitization sensitization 2y no effect 1y allergic sensitization 5-7 y Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116: 14.
  30. 30. Manchester Asthma and Allergy Study Number 620 Intervention Intervention started at Main outcome Prenatal Extensive Reduction in -Allergic HDM sensitization allergen HDM avoidance -Wheeze levels -Airway -cover 1Y: only -HEPA filter resistance severe -hardwood wheeze flooring -use of Acarosan Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116:3-
  31. 31. Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Number 810 Intervention Intervention started at Main outcome Prenatal Mattress covers and general advice -Total IgE -Specific IgE -Cough, wheeze -Atopic Reduction in HDM allergen levels 2y: nocturnal cough dermatitis Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116:3-
  32. 32. Multiple intervention
  33. 33. Isle of Wight prevention study Number 120 Intervention Intervention started at Birth Main outcome Food and HDM avoidance - Allergic sensitization - Asthma - Allergic rhinitis - Atopic dermatitis - Food allergy Reduction in HDM allergen level 1 y: Asthma,AD allergic sensitization 2Y:AD allergic sensitization 4Y:AD allergic sensitization 8Y:asthma, allergic sensitization Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116: 14.
  34. 34. Prevention of atopic allergy Number 531 Intervention Intervention started at Birth Main outcome Diet exclusive BF or soya formula and Reduction in - Asthma 4y :any - AD allergy - Rhinitis -Urticaria environmental HDM and ETS avoidance Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116:3-
  35. 35. Canadian Asthma Primary Prevention Study Number 545 Intervention Intervention started at Prenatal Main outcome Diet : breast feeding, delayed introduction of solids and environment reduction HDM and pet exposure and ETS - Allergic sensitization - Asthma - Allergic rhinitis Reduction in HDM allergen levels 1 Y: asthma and allergic rhinitis 2Y :asthma Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116: 14.
  36. 36. Childhood Asthma Prevention Study Number 616 Intervention Intervention started at Prenatal Main outcome - HDM avoidance - Diet : omega 3 PUFA - Combined - Cough - Asthma -Allergic sensitization -Total IgE at age 18 months Reduction in 1.5 y :diet group; wheeze HDM group no effect 3 y diet group;cough HDM group sensitization to HDM Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116: 14.
  37. 37. OmegaOmega-3 PUFAs Dietary modifications of supplementation with fish oil (rich inomega-3 PUFAs) might inomega- PUFAs) be some benefit Prospective observational study indicate introduction of fish into infant’s diet reduces occurrence of rhinitis but not asthma Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116:3-
  38. 38. Probiotics Lactobaccilus GG given during pregnancy to mothers with a family history of atopy for 6 months resulted in significant reduction in atopic dermatitis up to the age of 2 years Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116:3-
  39. 39. Vaccination No clinical trials to assess immunomodulatory effect of vaccination in primary prevention of allergy Syed Hasan Arshad J Allergy Clin Immunol 2005;116:3-14. 2005;116: 14.
  40. 40. Take Home Message 1 Maternal avoidance diets during pregnancy and lactation not recommended at this time Exclusive breast-feeding recommended breastfor at least 4 months and up to 6 months of age
  41. 41. Take Home Message 2 BreastBreast-feeding reduce incidence of atopic dermatitis, reduce early onset wheezing before age 4 years and reduce incidence of cow’s milk allergy in the first 2 years of life
  42. 42. Take Home Message 3 No conclusive evidence supports formula over breast-feeding to prevent breastatopic disease Complementary foods can be introduced between 4–6 months of age 4–
  43. 43. Take Home Message 4 Preventive effect of HDM avoidance for sensitization or respiratory allergy not compelling Combining food and aeroallergen avoidance reducing early childhood wheeze and atopic dermatitis later asthma
  44. 44. THANK YOU

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