Previous recommendations for preventing allergic disease need to be critically re-examined
A marked increase in allergic disease has occurred over the past century. For example, between 1992 and 1997, the prevalence of asthma increased by 26% and skin-prick sensitivity to house dust mite (HDM) increased by 63% in Australian children.1 In determining the causes of this increase it is important to distinguish between primary and secondary causes of allergic disease. Primary causes are those considered to induce allergic disease in a non-sensitised person, while secondary causes are those that trigger symptoms in people who are already sensitised. Primary prevention strategies are aimed at reducing sensitisation. In the early 1980s it was considered that a clean environment, avoidance of pets, the provision of synthetic "allergy free" bedding (rather than feather bedding) and prolonged breastfeeding were all important in primary prevention. But recent epidemiological studies have challenged these beliefs.
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