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Allergen avoidance in infancy and allergy at 4 years of age
D W Hide1, S Matthews, S Tariq
1Clinical Allergy Research Unit, St Mary's Hospital NHS Trust, Newport, Isle of Wight, UK.
Insights
Preventing early-life sensitization to allergens through maternal diet and environmental controls significantly reduces atopic disease risk in high-risk infants. This dual approach lowers allergy, asthma, and eczema rates by age four.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Preventive Medicine
Background:
- Atopic diseases like eczema and asthma pose a significant health burden.
- Genetic predisposition plays a key role in infant atopy development.
- Early interventions are crucial for managing and preventing allergic manifestations.
Purpose of the Study:
- To evaluate the long-term efficacy of a prenatal and early-life prophylactic intervention in preventing atopic disease.
- To assess the impact of dietary modifications and environmental allergen reduction on infant allergy development.
- To determine the effectiveness of a dual approach in reducing sensitization to food and aeroallergens.
Main Methods:
- A randomized controlled study involving high-risk infants.
- Prophylactic group received maternal breastfeeding with allergen-excluded diets or extensively hydrolyzed formula, alongside house-dust mite reduction.
- Control group received conventional feeding and no environmental interventions.
Main Results:
- The prophylactic group showed significantly reduced total allergy, asthma, and eczema at 1 year.
- At 4 years, the control group had higher rates of total allergy, definite allergy, eczema, and positive skin prick tests (SPTs).
- Significantly less sensitization to dietary and aeroallergens was observed in the prophylactic group.
Conclusions:
- A dual strategy of avoiding allergen sensitization (dietary and environmental) is effective in preventing atopic disease in high-risk infants.
- This intervention significantly reduces the risk of developing allergies and related conditions.
- Close medical and dietetic supervision is recommended for infants undergoing such preventive measures.
Abstract:
In an attempt to prevent or reduce the manifestations of atopic disease, a group of infants considered to be genetically at high risk of atopy was entered in a prenatally randomized, controlled study. A prophylactic group (n = 58) was either breast-fed with their mothers excluding foods regarded as highly antigenic from their diets, or given an extensively hydrolysed formula. In addition, strenuous efforts were made to reduce exposure to the house-dust mite by application of acaricide to the bedroom and living room carpets and upholstered furniture. A control group (n = 62) was fed conventionally by breast or on formula, and no specific environmental measures were taken. The results (previously reported) after 1 year showed significantly less total allergy, asthma, and eczema in the prophylactic group. Similar results were obtained at 2 years although the reduction in asthma no longer achieved statistical significance. However, there was significantly less sensitization, as shown by a battery of skin prick tests (SPTs), to both dietary allergens and aeroallergens in the prophylactic group. All the children have now been reviewed at the age of 4 years, and SPTs to a wide range of dietary allergens and aeroallergens have been performed. The control group continues to show more total allergy (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.21-6.13, P < 0.02), definite allergy (allergic symptoms plus positive SPT) (OR 5.6, CI 1.8-17.9, P < 0.005), and eczema (OR 3.4, CI 1.2-10.1, P < 0.05). More control children have positive SPTs (OR 3.7, CI 1.3-10.0, P < 0.02). A dual approach to the prevention of allergic disease, avoiding as far as possible sensitization to food and aeroallergens, significantly reduces the risk of atopic disease. This should be reserved for infants considered at very high risk of atopy, and close medical and dietetic supervision must be available.