Allergy Prevention

Dr. Roger Lauener

Allergology, University Children's Hospital, Zurich

May 12, 2021

PREVENTION: WHAT IS IT ALL ABOUT?

Allergies have increased in frequency in recent decades and are now one of the most common childhood diseases. Some success has been achieved in the treatment of allergic diseases. However, most treatments are only able to prevent the negative consequences of an allergy and suppress symptoms. Causative treatments, such as desensitisation therapy, are costly and only possible for certain allergies. Preventive measures to prevent allergies are therefore particularly important. Many aspects of prevention are currently being intensively researched, some things are still unclear. However, a lot can be achieved with simple measures.

Experience has shown that some allergens are particularly likely to cause allergic diseases in infants. Some of these allergens can at least be reduced by simple measures. In addition, early childhood, especially the first year of life, is formative for the development of allergies. Thus, it makes particular sense to introduce certain foods with a delay, because most allergies to foods in childhood also develop in the first year of life; older children rarely develop new food allergies.

WHAT PREVENTIVE MEASURES PROTECT AGAINST ALLERGIES?

Food

All children should be breastfed for as long as possible. However, some recent studies have shown only a limited effect of breastfeeding on the prevention of allergies, but since breast milk is the optimal nutrition for the newborn for many other reasons, breastfeeding is still strongly recommended.

If breastfeeding is not possible or not possible enough, breast milk substitutes can be given. For children with an increased risk of allergies (i.e. the child has one or two first-degree relatives with allergies), special infant milk preparations (so-called HA milk preparations; HA = hypoallergenic) should be used, especially during the first 4 to 5 months. Additional foods (complementary foods) should be introduced from 5 to 6 months. Only one new food should be introduced into the child’s diet per week. If a child still reacts allergically, you know which food it is allergic to and can avoid it.

For children with an increased risk of allergies, it is also advisable to avoid foods that are known to trigger allergies particularly frequently during the first year of life. These are primarily dairy products, hen’s eggs and fish. Foods containing nuts and peanuts should even be avoided during the first three years of life. If the family history of allergies is particularly strong, individual counselling can be helpful: depending on the situation, it may make sense to avoid other foods during the first year of life and to take further measures. If no allergies have occurred, the above-mentioned foods can be given after the first year of life: by then, the immune system and intestines have matured to such an extent that, as a rule, no new allergies to foods arise in the digestive system.

If, on the other hand, allergies occur during the first year of life despite the preventive measures, it makes sense to consult a specialist in order to determine the further course of action.

House dust mites

House dust mites are particularly important allergens. They can not only lead to respiratory allergies such as asthma and hay fever, but can also aggravate neurodermatitis (atopic dermatitis). House dust mites thrive best in warm, humid climates. The following simple measures help to reduce house dust mites.

Even apart from allergies, these measures contribute to a healthy living environment for babies:

– Ventilate 2-3 times a day. Vacuum 2 -3 times a week

– Do not overheat rooms; especially in bedrooms, a room temperature of 18 degrees is sufficient

– Wash bed linen at 60 degrees – Only one or two stuffed animals in the child’s bed (there are stuffed animals that can be washed at 60 degrees)

Smoking

Not only active smoking, but also passive smoking damages the respiratory tract. Children who have to grow up in an environment where people smoke suffer more often from diseases of the respiratory tract. The irritation of the respiratory tract by tobacco smoke contributes decisively to the suffering of children with allergies. Therefore, for the sake of your children: stop smoking or at least do not smoke in the home.

Environment, Pets and Allergies

Recently, studies have appeared showing that farm children have fewer allergies than children who did not grow up on a farm; in addition, reports have appeared showing that children who grew up with two or more cats or dogs in the first years of life had fewer allergies at school age than those who did not have pets. This has led to much confusion: should we recommend keeping pets?

Until recently, the categorical recommendation for allergy sufferers was to avoid pets. This remains true if someone is already allergic to cats, for example. It is less clear whether it makes sense to avoid pets as a preventive measure if you are expecting offspring. Should you get a new pet if there is a baby in the house? We still advise against this.

Whether a pet that has been in the family for many years should be given away to prevent the development of an allergy when a family has a new baby must be discussed individually. The exact factors that cause farm children to suffer less from allergies than their companions are still being researched. It is hoped that it will be possible to learn from this how children who do not grow up on a farm can also be protected from allergies.

Vaccination and allergies

The assumption is often made that vaccinations promote the development of allergies. Various large studies have shown that this is not true. In Finland, for example, it was found that adults who were vaccinated against measles as children had fewer allergies than those who were not vaccinated and had to go through the measles disease. Vaccinations against childhood diseases do not increase the risk of allergies!

Further measures

The measures mentioned above are simple and effective. They are primarily aimed at healthy infants who have an increased risk of developing allergies in the course of their lives. It does not hurt to apply them even if no one in the family has allergies. However, it may make sense to take further measures if family members suffer from particularly severe allergies. It is even more important to clarify whether additional measures are necessary if the child already suffers from an allergic disease, e.g. neurodermatitis, in infancy. In this case, allergological examinations and a specific consultation with a doctor who has experience with children and allergies are often useful.

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