Challenges in the prevention of allergic disease in infancy

The prevention of atopic disease, though admirable, remains a difficult endeavor. One must overcome inherent and natural forces constantly working to sensitize humans to produce IgE antibodies. These multiple risk factors for developing allergies (Table 1) act in concert to oppose preventive efforts. IgE mediated disorders potentially could be prevented by selectively interfering with the major genetic, cellular, and environmental factors that determine the ultimate phenotypic expression of atopy. Present efforts to prevent allergic disease remain relegated to manipulating the environment by reducing the allergenic load. Unfortunately, however, there has yet to exist a definitive, prospective study that conclusively documents and defines optimal or proven effective dietary and environmental regimens that prevent allergic disease. Until such studies emerge, physicians interested in prevention should be cognizant of the data derived from the limited published reports of dietary and environmental prevention efforts in order to appreciate current espoused recommendations. In addition to developing effective and proven prevention regimens, other issues deserving scrutiny include the following: 1) recognition of those groups (individuals) most at risk, amenable, and/or responsive to preventive efforts; 2) determination of the cost-effectiveness of such endeavors; and 3) identification of interfering variables, ie, noncompliance to recommendations.