Specific Recommendations Allergy prevention in children
Clinical and Editor in Chief :
DR WIDODO JUDARWANTO
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- The epidemic rise of allergic disease which is most apparent in “westernised” countries has occurred in parallel with many societal and lifestyle changes. It is self-evident that these environmental changes must be responsible for the increasing propensity for allergic disease.
- There is an ongoing search for causal associations that will facilitate identification of strategies to reverse this trend . At this stage, most allergy prevention strategies are relatively crude with small or unconfirmed effects, and newer strategies are still in experimental stages
- It has long been known that allergies and asthma tend to run in families. In other words, children in families where one or both parents have allergies or asthma are more likely to develop allergies or asthma. That is why many prevention efforts have been targeted to these children. This pamphlet describes steps that may be taken to delay or, possibly, prevent the onset of allergies and asthma in children.
- A great deal of research is taking place to determine which children are most likely to develop allergies and asthma and to learn how to prevent the development of these diseases. The measures, described above, may be very helpful to children who are at risk to develop allergies and asthma and much more information and treatment options will be available in coming years.
- Recently published data has made the relationship between early life exposure to animals and the eventual development of allergies and asthma much more confusing. For example, some evidence seems to show that early life exposure to animals may make children more likely to develop allergies and asthma whereas more recent evidence seems to show that early life exposure to animals (dogs and cats, in particular) may protect children from later developing these diseases.
- The major strategy for preventing food allergies is to delay exposure to potentially allergenic foods and liquids, since newborn infants may be more likely to become allergic to foods than older infants. Mothers should breast feed their infants for at least four to six months if possible, since breast milk is much less likely to produce an allergic reaction and can strengthen the child’s immune system. Infants not being breast fed or fed with breast milk should be fed partially pre-digested, protein hydrolysate formulas such as Alimentum or Nutramigen rather than milk- or soy-based formulas.
|Identifying infants at risk of allergic disease||A family history of allergy and asthma can be used to identify children at increased risk of allergic disease|
|Allergen avoidance in pregnancy||Dietary restrictions in pregnancy are not recommended.Aeroallergen avoidance in pregnancy has not been shown to reduce allergic disease, and is not recommended.|
|Breastfeeding||Breastfeeding should be recommended because of other beneficial effects.Maternal dietary restrictions during breastfeeding are not recommended.|
|Infant formulae||In high risk infants only, If breast feeding is not possible a hydrolysed formulae is recommended (rather than conventional cows milk based formulae). Partially hydrolysed formula is available in Australia without prescription. Extensively hydrolyzed formula is more expensive, only available on prescription, and only subsidised for treatment of combined cow’s milk and soy allergic infants. Soy formulae and other formulae (eg. Goat’s milk) are not recommended for the reduction of food allergy risk.|
|Infant diet||Complementary foods (including normal cows milk formulae) should be delayed for at least 4-6 monthsThis preventive effect has only been demonstrated in high-risk infantsThere is no evidence that an elimination diet after the age of 4-6 months provides a protective effect, though this needs additional investigation
Avoidance of peanut, tree nuts, and shellfish may be recommended in high risk children during the first years of life pending further study as this is unlikely to cause harm, however it must be emphasised that there is no evidence to support this recommendation.
House dust mite exposure
|Before definitive recommendations can be made, further research is needed to determine the relationship between early HDM exposure and the development of sensitisation and disease.No recommendation can be made at this time regarding the implementation of HDM avoidance measures for prevention of allergic disease.|
|No recommendations can be made at this time regarding exposure to pets in early life and the development of allergic disease. If a family already has pets it is not necessary to remove them, unless the child develops evidence of pet allergy (as assessed by an allergy specialist). However, at this stage we do not recommend getting new pets to reduce allergy.|
|Smoking and other irritants||Pregnant women should be advised not to smoke in pregnancy.Parents should be advised not to smoke.|
The role of microbial agents
|No recommendations can be made at this time regarding the use of probiotic supplements for the prevention of allergic disease|
Secondary prevention strategies
|Immunotherapy may be considered as a treatment option for children with allergic rhinitis, and may prevent the subsequent development of asthma.|
source : ascia
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