Prevention of allergic diseases

PREVENTION OF ALLERGIC
DISEASE
CHULEEPORN KONGMEESOOK ,MD

Outline
Food allergen avoidance
HDM avoidance
Multiple intervention

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.

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-

P. Bager et al Clinical and Experimental Allergy 2008;38:634–642.
2008;38:634–

Liem et al J Allergy Clin Immunol 2007;119:1203-9.
2007;119:1203-

R. E. Bergmann et al Clinical and Experimental Allergy 1997;27: 752-760.
1997;27: 752-760.

Allergic march

www.theallergymarch.com

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-

interventions
Clinical
Report
Pregnancy
Lack of
avoidance
evidence

AAP 2000
recommend
ations
Possibly
peanut

2008;122:29-

Kramer MS et al Cochrane Database of Systematic Reviews 2006.
2006.

Maternal avoidance diet during
lactation
No significant benefit to children

Immunol:
2013; 29-36.

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’’

2008;122:29-

Effect of breast-feeding on
breastatopic dermatitis
Exclusive breast-feeding for 3 months
breastreduce incidence of atopic dermatitis in
children

Immunol:
2013;1:29-

breastasthma
Exclusive breast-feeding for 3-4 months
breast3reduces number of early, upper respiratory
infectioninfection-associated wheezing
episodes before age of 4 years

Immunol:
2013;1:29-

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)

Immunol:
2013; 29-36.

breastallergic rhinitis
Not clear

Immunol:
2013;1:29-

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

Immunol:
2013; 29-36.

pHFs & extensive casein or extensive
whey hydrolysate formulas (ehF)
(ehF)
No significant difference between pHF and
eHF in development of infant allergic
diseases

Immunol:
2013;1:29-

Soy formula & amino acid based
formulas
-

Advantage of soy formula not show
Amino acidebased formulas lacking
studies

Immunol:
2013; 29-36.

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

2008;122:29-33.

I Brockow et al J Investig Allergol Clin Immunol 2009;19: 180-187.
2009;19: 180-187.

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

Immunol:
2013;1:29-

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

Immunol:
2013; 29-36.

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

2008;122:29-

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.

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

2005;116:3-

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
2005;116:3-

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

2005;116: 14.

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

2005;116:3-

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

2005;116: 14.

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

2005;116: 14.

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
2005;116:3-

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

2005;116:3-

Vaccination
No clinical trials to assess
immunomodulatory effect of
vaccination in primary prevention of allergy

2005;116: 14.

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

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

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–

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

Prevention of allergic diseases

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