Primary prevention of allergy: avoiding risk or providing protection?

Abstract

SummaryPrimary prevention strategies of allergy so far have been aimed to fight allergy causes, by avoiding risk factors and inhibiting their mechanisms of action. The results of trials testing food or airborne allergen avoidance as a prevention strategy were, however, rather disappointing. A reverse approach for primary prevention of allergies aims to facilitate exposure to protecting factors which promote the induction of immunologic tolerance against innocuous antigens. These factors are associated with farming environment and a 'traditional lifestyle', but identification of these factors is quite difficult. Major candidates include foodborne microbes, helminths or their components, which are able to stimulate mucosal immunity, particularly in the gut. Similarly, new preventive and therapeutic strategies are being tested to induce specific food-allergen oral tolerance through the ingestion of progressively increasing doses of the offending food. This shifting of allergy prevention research from avoidance to tolerance induction will hopefully allow us to reverse the epidemic trend of allergy diseases.

Cell-Based Therapy in Allergy

“…SIT is, however, associated with limited effectiveness and considerable risks, as exemplified by anaphylactic reactions or therapy-induced sensitization to additional allergens when crude extracts are used (Valenta 2002). In addition to the need for more effective allergen-specific therapeutic strategies, prevention of allergy by prophylactic induction of tolerance is a major unmet need (Hamelmann et al 2007).…”

Early Introduction of Foods for Food Allergy Prevention

“…Historically, research has primarily targeted aeroallergen sensitisation and asthma, with food allergy only recently emerging as a research focus. Avoiding exposure to inhalant allergens such as house dust mites and pets was proposed as a strategy to reduce development of sensitisation to these allergens and subsequent allergic disease; however, results of intervention studies have been conflicting and largely unsuccessful for primary prevention [19]. Similarly, the results of intervention studies of food allergen avoidance have failed to show a clear protective effect.…”

“…Allergen avoidance has long been a key focus in the primary (preventing development of disease), secondary (preventing disease progression) and tertiary (preventing symptoms in allergic individuals) prevention of allergic disease [19]. While allergen avoidance is still the mainstay for tertiary prevention of allergic disease including food allergy, its role in primary prevention is less clear.…”

Nahrungsmittelallergie bei atopischer Dermatitis

“…Die aktuellen Empfehlungen zur Allergieprävention berücksichtigen im Vergleich zu früheren diätetischen Restriktionen bei allergiegefährdeten Säuglingen mittlerweile vermehrt den Aspekt der oralen Toleranzinduktion im frühen Kindesalter [25].…”