<scp>OPINION</scp>: Primary prevention of allergy – Will it soon become a reality?

Bever, Hugo P. Van; Nagarajan, Sowmya; Lee, Bee-Wah

doi:10.1111/pai.12497

Cited by 9 publications

(8 citation statements)

References 47 publications

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“…We hypothesize that the associations we observed between antibiotic orders and allergic disease are due to changes to the gut microbiome. There is increasing evidence that changes in the gut microbiome are associated with risk of allergic disease . For example, several key bacterial phylotypes in the gut have been implicated in the development of IgE‐mediated food allergy .…”

Section: Discussionmentioning

confidence: 99%

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Early‐life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Hirsch

Pollak

Glass

et al. 2016

Clin Experimental Allergy

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Background Antibiotic use in early life has been linked to disruptions in the microbiome. Such changes can disturb immune system development. Differences have been observed in the microbiota of children with and without allergies, but there have been few studies on antibiotic use and allergic disease. Objective We evaluated associations of early-life antibiotic use with subsequent occurrence of food allergy and other allergies in childhood using electronic health record data. Methods We used longitudinal data on 30,060 children up to age 7 years from Geisinger Clinic’s electronic health record to conduct a sex and age matched case-control study to evaluate the association between antibiotic use and milk allergy, non-milk food allergies, and other allergies. For each outcome, we estimated conditional logistic regression models adjusting for race/ethnicity, history of Medical Assistance, and mode of birth delivery. Models were repeated separately for penicillins, cephalosporins, and macrolides. Results There were 484 milk allergy cases, 598 non-milk food allergy cases, and 3652 other allergy cases. Children with three or more antibiotic orders had a greater odds of milk allergy (odds ratio; 95% confidence interval) (1.78; 1.28–2.48), non-milk food allergy (1.65; 1.27–2.14), and other allergies (3.07; 2.72–3.46) compared to children with no antibiotic orders. Associations were strongest at younger ages and differed by antibiotic class. Conclusions and Clinical Relevance We observed associations between antibiotic orders and allergic diseases, providing evidence of a potentially modifiable clinical practice associated with pediatric allergic disease. Differences by antibiotic class should be further explored, as this knowledge could inform pediatric treatment decisions.

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Section: Discussionmentioning

confidence: 99%

“…Between 1997 and 2011, the prevalence of food allergies in children increased 50% and the prevalence of skin allergies increased nearly 70% . The hygiene hypothesis attributes such growth, in part, to an increasingly sanitized western lifestyle that disrupts the gut microbiota, disturbing normal immune system development .…”

Section: Introductionmentioning

confidence: 99%

Early‐life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Hirsch

Pollak

Glass

et al. 2016

Clin Experimental Allergy

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“…In fact, early exposure to peanut, egg and yogurt could reduce the risk of sensitization. 7,[50][51][52] As genetic and inflammation-driven changes of epidermal barrier function contribute to AD onset, the daily use of emollients from birth in new-borns at a high risk of developing AD could be an effective prevention strategy. 2,7,23,25,53,54 Although influencing the genetic background is not yet feasible, secondary prevention strategies based on trigger avoidance have been implemented in practical guidelines.…”

Section: Comorbiditiesmentioning

confidence: 99%

Update on Atopic Dermatitis

Torres¹,

et al. 2019

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With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was undertaken to perform this non-systematic review, which intends to provide an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and current therapies for the treatment of atopic dermatitis. In sum, this is a heterogeneous skin disorder associated with variable morphology, distribution, and disease course. Although not completely understood, its pathogenesis is complex and seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota dysbiosis, and a strong genetic influence. Diagnosis is based on specific criteria that consider patient and family history and clinical manifestations. Overall disease severity must be determined by evaluating both objective signs and subjective symptoms. Therapeutic goals require a multistep approach, focusing on reducing pruritus and establishing disease control. Patients should be advised on basic skin care and avoidance of triggers. Topical anti-inflammatory agents should be considered in disease flares or chronic/recurrent lesions. In case of inadequate response, phototherapy, systemic immunosuppressants and, more recently, dupilumab, should be added. Nevertheless, the treatment of moderate-to-severe atopic dermatitis remains challenging and novel, efficacious, safe and targeted treatments are urgently needed. In conclusion, although the last few years have seen important improvement in the understanding of the disease, future research in atopic dermatitis will continue exploring gene-environment interactions and how it affects pathophysiology, disease severity, and treatment outcomes.

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“…Strategies to prevent AD and FA have focused on limiting exposure to potential allergens, early introduction of complementary foods, supplementing diet with probiotics, and unsaturated fatty acids. 78 As dust mites may play a role in the pathophysiology of AD, avoidance strategies have been evaluated to reduce the risk of developing AD in high-risk infants compared to randomized controls. 79 However, at the moment, it is not possible to determine clear implications from the very low-quality evidence currently available and dust mite avoidance should not be recommended for this purpose.…”

Section: Prevention Strategiesmentioning

confidence: 99%

Section: Prevention Strategiesmentioning

confidence: 99%

Food allergy and atopic dermatitis: Prediction, progression, and prevention

Mastrorilli

Caffarelli

Hoffmann‐Sommergruber

2017

Pediatric Allergy Immunology

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The rising burden of allergic diseases in childhood requires a compelling need to identify individuals at risk for atopy very early in life or even predict the onset of food allergy and atopic dermatitis since pregnancy. The development and clinical phenotypes of atopic diseases in childhood depend on a complex interaction between genetic and environmental factors, such as allergen exposure, air pollution, and infections. Preventive strategies may include avoidance measures, diet supplements, and early complementary food introduction. Overall, the management of allergic diseases has been improving to date toward a patient's tailored approach. This review will cover the current understanding of risk factors, prediction, and management of food allergy and atopic dermatitis in childhood and discuss how these may contribute to the modification of the natural history of food allergy and atopic dermatitis.

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OPINION: Primary prevention of allergy – Will it soon become a reality?

Cited by 9 publications

References 47 publications

Early‐life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Early‐life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Update on Atopic Dermatitis

Food allergy and atopic dermatitis: Prediction, progression, and prevention

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