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Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled
S H Arshad1, B Bateman, S M Matthews
1The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK. sha@soton.ac.uk
Insights
Strict allergen avoidance in infancy can prevent childhood asthma and atopy. This study found reduced wheeze, cough, and allergic sensitization in infants with allergen avoidance measures.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Preventive Medicine
Background:
- Rising prevalence of childhood asthma and atopy necessitates effective primary prevention strategies.
- High-risk infants require targeted interventions to mitigate atopic disease development.
- Genetic predisposition plays a role in the development of atopy in early childhood.
Purpose of the Study:
- To evaluate the efficacy of strict allergen avoidance in preventing atopy and asthma in high-risk infants.
- To assess the long-term impact of early-life allergen exposure reduction on respiratory health.
- To determine if prophylactic measures can alter the natural course of atopic disease development.
Main Methods:
- A randomized controlled trial involving a birth cohort of genetically at-risk infants.
- Intervention group: strict allergen avoidance (low-allergen maternal diet/hydrolyzed formula, mite control).
- Control group: standard infant care advice. Assessments at age 8 included questionnaires, skin prick tests, spirometry, and bronchial challenges.
Main Results:
- Prophylactic group showed significantly lower rates of atopy (20.0% vs 46.8%, p=0.003) and nocturnal cough (13.8% vs 32.3%, p=0.02).
- Reduced risk observed for current wheeze (OR 0.26), nocturnal cough (OR 0.22), and atopy (OR 0.21) in the intervention group after adjusting for confounders.
- A trend towards reduced current wheeze (13.8% vs 27.4%, p=0.08) and significantly reduced asthma incidence (OR 0.11) was noted.
Conclusions:
- Strict infant allergen avoidance, particularly against house dust mite, effectively reduces allergic sensitization.
- These findings suggest that early-life allergen avoidance can prevent a proportion of childhood asthma cases.
- Primary prevention through allergen avoidance is a viable strategy for high-risk infants.
Background:
Recent increases in the prevalence of asthma and atopy emphasise the need for devising effective methods for primary prevention in children at high risk of atopy.
Method:
A birth cohort of genetically at risk infants was recruited in 1990 to a randomised controlled study. Allergen avoidance measures were instituted from birth in the prophylactic group (n=58). Infants were either breast fed with mother on a low allergen diet or given an extensively hydrolysed formula. Exposure to house dust mite was reduced by the use of an acaricide and mattress covers. The control group (n=62) followed standard advice as normally given by the health visitors. At age 8, all 120 children completed a questionnaire and 110 (92%) had all assessments (skin prick test, spirometry, and bronchial challenges).
Results:
In the prophylactic group eight children (13.8%) had current wheeze compared with 17 (27.4%) in the control group (p=0.08). Respective figures were eight (13.8%) and 20 (32.3%) for nocturnal cough (p=0.02) and 11 of 55 (20.0%) and 29 of 62 (46.8%) for atopy (p=0.003). After adjusting for confounding variables, the prophylactic group was found to be at a significantly reduced risk for current wheeze (odds ratio (OR) 0.26 (95% confidence interval (CI) 0.07 to 0.96)), nocturnal cough (OR 0.22 (95% CI 0.06 to 0.83)), asthma as defined by wheeze and bronchial hyperresponsiveness (OR 0.11 (95% CI 0.01 to 1.02)), and atopy (OR 0.21 (95% CI 0.07 to 0.62)).
Conclusion:
Strict allergen avoidance in infancy in high risk children reduces the development of allergic sensitisation to house dust mite. Our results suggest that this may prevent some cases of childhood asthma.