A family history of allergy and asthma identifies children at high risk of allergic disease.
Dietary restrictions in pregnancy are not recommended.
Avoiding inhalant allergens during pregnancy has not been shown to reduce allergic disease, and is not recommended.
Breastfeeding should be recommended because of other beneficial effects, but if breast feeding is not possible, a hydrolysed formula is recommended (rather than conventional cow’s milk formulas) in high-risk infants only.
Maternal dietary restrictions during breastfeeding are not recommended.
Soy formulas and other formulas (eg, goat’s milk) are not recommended for reducing food allergy risk.
Complementary foods (including normal cow’s milk formulas) should be delayed until a child is aged at least 4–6 months, but a preventive effect from this measure has only been demonstrated in high-risk infants.
There is no evidence that an elimination diet after age 4–6 months has a protective effect, although this needs additional investigation.
Further research is needed to determine the relationship between house dust mite exposure at an early age and the development of sensitisation and disease; no recommendation can yet be made about avoidance measures for preventing allergic disease.
No recommendations can be made about exposure to pets in early life and the development of allergic disease. If a family already has pets it is not necessary to remove them, unless the child develops evidence of pet allergy (as assessed by an allergy specialist).
Women should be advised not to smoke while pregnant, and parents should be advised not to smoke.
No recommendations can be made on the use of probiotic supplements (or other microbial agents) for preventing allergic disease at this time.
Immunotherapy may be considered as a treatment option for children with allergic rhinitis, and may prevent the subsequent development of asthma.
- 1. Kjellman NI. Prediction and prevention of atopic allergy. Allergy 1998; 53: 67-71.
- 2. Woodcock A, Lowe LA, Murray CS, et al. Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years. NAC Manchester Asthma and Allergy Study Group. Am J Respir Crit Care Med 2004; 170: 433-439.
- 3. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy and/or lactation for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2003; (4): CD000133.
- 4. Foucard T. Is prevention of allergy and asthma possible? Acta Paediatr Suppl 2000; 89: 71-75.
- 5. Schoetzau A, Filipiak-Pittroff B, Franke K, et al. Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. Pediatr Allergy Immunol 2002; 13: 234-242.
- 6. Oddy WH, Holt PG, Sly PD, et al. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 1999; 319: 815-819.
- 7. Gdalevich M, Mimouni D, Mimouni M. Breast-feeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies. J Pediatr 2001; 139: 261-266.
- 8. Kramer MS. Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk. Cochrane Database Syst Rev 2000; (2): CD000132.
- 9. Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev 2003; (3). Art. No.: CD003664. DOI: 10.1002/14651858.CD003664.
- 10. Ram FS, Ducharme FM, Scarlett J. Cow’s milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Cochrane Database Syst Rev 2002; (1). Art. No.: CD003795. DOI: 10.1002/14651858.CD003795.
- 11. Burr ML, Limb ES, Maguire MJ, et al. Infant feeding, wheezing, and allergy: a prospective study. Arch Dis Child 1993; 68: 724-728.
- 12. Falth-Magnusson K, Kjellman NI. Allergy prevention by maternal elimination diet during late pregnancy — a five year follow-up of a randomised trial. J Allergy Clin Immunol 1992; 89: 709-713.
- 13. Zeiger R, Heller S. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol 1995; 96: 1179-1190.
- 14. Platts-Mills TA, Rakes G, Heymann PW. The relevance of allergen exposure to the development of asthma in childhood. J Allergy Clin Immunol 2000; 105: S503-S508.
- 15. Gore C, Custovic A. Can we prevent allergy? Allergy 2004; 59: 151-161.
- 16. Koopman LP, van Strien RT, Kerkhof M, et al. Placebo-controlled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood. Am J Respir Crit Care Med 2002; 166: 307-313.
- 17. Apelberg BJ, Aoki Y, Jaakkola JJ. Systematic review: exposure to pets and risk of asthma and asthma-like symptoms. J Allergy Clin Immunol 2001; 107: 455-460.
- 18. Stick SM, Burton PR, Gurrin L, et al. Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants. Lancet 1996; 348: 1060-1064.
- 19. Martinez FD, Cline M, Burrows B. Increased incidence of asthma in children of smoking mothers. Pediatrics 1992; 89: 21-26.
- 20. Ponsonby AL, Dwyer T, Kemp A, et al. A prospective study of the association between home gas appliance use during infancy and subsequent dust mite sensitization and lung function in childhood. Clin Exp Allergy 2001; 31: 1544-1552.
- 21. Kalliomaki M, Salminen S, Poussa T, et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003; 361: 1869-1871.
- 22. Mihrshahi S, Peat JK, Marks GB, et al. Eighteen-month outcomes of house dust mite avoidance and dietary fatty acid modification in the Childhood Asthma Prevention Study (CAPS). J Allergy Clin Immunol 2003; 111: 162-168.
- 23. Peat JK, Mihrshahi S, Kemp AS, et al. Three-year outcomes of dietary fatty acid modification and house dust mite reduction in the Childhood Asthma Prevention Study. J Allergy Clin Immunol 2004; 114: 807-813.
- 24. Moller C, Dreborg S, Ferdousi HA, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol 2002; 109: 251-256.
- 25. Pajno GB, Bearberio G, De Luca F, et al. Prevention of new sensitisations in asthmatic children monosensitised to house dust mite by specific immunotherapy. A six year follow-up study. Clin Exp Allergy 2001; 31: 1392-1397.
- 26. Holt PG. A potential vaccine strategy for asthma and allied atopic diseases during early childhood. Lancet 1994; 344: 456-458.
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