Prevention of Allergic Diseases Presented by Planee Vatanasurkitt, MD.

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

10. 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

11.  2252 newborns with atopic heredity were
randomly assigned at birth to receive one
of 4 blinded formulas:

12.  Partially
hydrolyzed whey formula
 Extensively hydrolyzed whey formula
 Extensively hydrolyzed casein formula
 Cow milk

13.  Outcomes were physician-diagnosed
allergic diseases (atopic dermatitis, food
allergy, allergic urticaria, asthma, and hay
fever/allergic rhinitis

14. Relative risk
Partially hydrolyzed whey 0.79
Extensively hydrolyzed whey 0.92
Extensively hydrolyzed 0.71
casein

15.  Result: AD significantly reduced by using
extensively hydrolyzed casein compare
with cow milk, some protective of partial
whey hydrolyzed on AD

17. 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

18.  This study provide evidence could protect
at risk children against sensitization even
in later childhood

19. 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

20. 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

22. 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

23.  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

24. 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

25. 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

26. 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

28.  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

29.  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

30.  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

32. 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

33. 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

34. 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