Professional Documents
Culture Documents
Primary Prevention
of Allergic Disease
Learning objective
Environment
trigger:
Cold air
passive smoke
Environment
Enhancer:
DEP, PAH,
Fluorene, Viruses
Which children
are at risk for having
allergy?
Moderate risk
1 family history
of allergy
High risk
2 or more family
history of
allergy
Family history
Newborn (100
population)
% risk of infant
having allergy
No. of newborn
with allergy risk
= population x
% allergy risk
Number of newborn
at risk
Number of newborn
at risk
Prenatal sensitization
Amniocentesis: Lymphocyte specific activation
at gestational age 20-24 weeks
House dust and egg allergen detected in
amniotic fluid
Warner JO.
Kamemura N. JACI
Allergy Mechanism
SENSITIZATION
ENHANCEMENT
TRIGGERING
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Allergy prevention
Is an important part in the management of
allergy, since allergy can be fatal, OR,
experienced throughout life
Primary prevention: is the most effective
Before sensitization to occur
Period: prenatal first 6 month of life
Target: all population with allergy risk
Tool for detection: Allergy trace card
should be done before the pregnancy ended
12
13
Diagnos Suspect No
ed
ed
history
Score
Mother
Father
Sibling
Total
score
Givie Score
2 if diagnosed by physician
1 if suspected by family
0 if no history of allergy
14
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Management of infant at
risk
Breastfeeding exclusively for 4-6
month
16
Management of infant at
risk
Recommendation AAP-IDAI
During
pregnancy
Probiotics
Avoid
smoke
No diet
restriction
Vaginal
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Exclusive Breastfeeding
Exclusive BF for 4-6 month reducing the rate of allergic
disease in early childhood
Kemp.AS. MJA 2003 www.mja.com.au
Sarinen,
Halkens
18
Maternal avoidance
Maternal food antigen avoidance (cows
milk, egg, HDM) infant IgE, SPT, allergic
ds : no difference
Faith-Magnusson JACI 1992
20
23
Intact Protein
Partial
Hidrolysed
Extensively
Hidrolysed
Allergenicity
24 12/29/16
24
24 12/29/16
Amino acid
25
Probiotics
L rhamnosus GG : 4 weeks prior to delivery
infant high risk for allergy: in first 6 month of
life
Atopic eczema diagnosed in 46 of 132 (35%)
of aged 2 years. The frequency in probiotic
vs placebo group was 23% vs 46%, RR 0.55
(95%CI 0.32-0.85)
Kaliomaki M et al. The Lancet
2001;357-61
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Incidence of eczema at 2
years in children given
probiotics from birth
Prevention:effect
sizes of 0.69 (0.57,
0.83) and 0.66
(0.49, 0.89)
The treatment trial:
SCORAD score
reduction by -6.64
points (-9.78, -3.49)
and -8.56 (-18.39,
1.28)
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29
Cigarette-smoke exposure
EBM
Breastfeeding
A
Maternal nutrition during pregnancy and/or A and B
breastfeeding
Feeding of children at risk with mothers milk A
substitutes
Introduction of solid food and child nutrition A and B
in the first year
Nutrition after the first year
A
Pets
B
Housedust mites
B
Mold and damp
B
Exposure to tobacco smoke
A
Indoor air pollutants
B
Vaccinations
A
Body weight
A
Motor vehicle emissions
B
32
Effect of Muche-Boroswki,
probioticset al, 2009. Dtsch Arztebl Int. 106(39): 625631.
and sibling
Not recommended with
possible exception of
peanut
6mo
or sibling
Not recommended
Not recommended
46 mo
Not discussed
Yes
Yes: use formula
with confirmed
reduced
allergenicity 33
Thank
you
34