Primary Prevention Of Atopic Disease Research Articles

Does antioxidant-rich diet during pregnancy protect against atopic multimorbidity in children?

BackgroundGenetics and prenatal environmental exposures are indicated in the complex etiopathogenesis and clinical expression of atopic diseases. This study examined the clinical features of infantile-onset atopic dermatitis (AD) in relation to maternal diet during pregnancy. MethodsMaternal dietary habits were evaluated in terms of the frequency of intake of six different food categories rich in antioxidants or omega-3 fatty acids. ResultsOne hundred mother–child pairs were recruited, 47 infants (<12 months) and 53 children aged 12–36 months. Forty-six of the children had mild, 41 moderate and 13 severe AD. The other atopic manifestations (alone or associated) included: asthma in 9 cases, allergic rhinitis in 22 cases and food allergy in 33 cases. The presence of asthma in children was significantly associated with a lower level of maternal dietary intake of fruits and vegetables as well as chocolate confectionery, while associations with whole grain breakfast cereals, nuts and seeds, non-alcoholic beverages (coffee, tea, fruit juices) and fish and fish products, were not statistically significant. The age of onset and severity of infantile-onset AD were not linked to any of the food categories considered for analyses. ConclusionsHealthy diet in pregnant women that is rich especially in antioxidants may provide protection against atopic comorbidities of AD. Further prospective reasearch on the role of maternal diet in primary prevention of atopic diseases is warranted.

Immunomodulation: Basic Concepts and Clinical Application

The third Encuentro Latinoamericano de Infecciones Respiratorias Recurrentes (ELAIR) took place in Mexico City, Mexico, on 11th−12th May 2017. ELAIR brought together experts from across Latin America and further afield, continuing an extraordinary didactic exercise on the cutting-edge advances of respiratory medicine. Impressive progress has been made in the past 15 years, with new treatments available to manage and prevent airway infections. It remains to be seen how this might affect the related conditions of wheezing and asthma in predisposed and sensitised subjects. However, early data suggest that lower respiratory infection rates may reduce the development of the above conditions which are closely related to viral infections. Immunomodulators that both prime the immune system to fight infection and reduce inflammation are likely to play a major role in secondary and even potentially primary prevention of atopic diseases.

Facing the Worldwide Threat of Antimicrobial Resistance

The third Encuentro Latinoamericano de Infecciones Respiratorias Recurrentes (ELAIR) took place in Mexico City, Mexico, on 11th−12th May 2017. ELAIR brought together experts from across Latin America and further afield, continuing an extraordinary didactic exercise on the cutting-edge advances of respiratory medicine. Impressive progress has been made in the past 15 years, with new treatments available to manage and prevent airway infections. It remains to be seen how this might affect the related conditions of wheezing and asthma in predisposed and sensitised subjects. However, early data suggest that lower respiratory infection rates may reduce the development of the above conditions which are closely related to viral infections. Immunomodulators that both prime the immune system to fight infection and reduce inflammation are likely to play a major role in secondary and even potentially primary prevention of atopic diseases.

Upper Respiratory Tract Infections in Children and Adults: Burden and Management

The third Encuentro Latinoamericano de Infecciones Respiratorias Recurrentes (ELAIR) took place in Mexico City, Mexico, on 11th–12th May 2017. ELAIR brought together experts from across Latin America and further afield, continuing an extraordinary didactic exercise on the cutting-edge advances of respiratory medicine. Impressive progress has been made in the past 15 years, with new treatments available to manage and prevent airway infections. It remains to be seen how this might affect the related conditions of wheezing and asthma in predisposed and sensitised subjects. However, early data suggest that lower respiratory infection rates may reduce the development of the above conditions which are closely related to viral infections. Immunomodulators that both prime the immune system to fight infection and reduce inflammation are likely to play a major role in secondary and even potentially primary prevention of atopic diseases.

Wheezing and Infection-Triggered Asthma Exacerbation: Is Prevention in Early Childhood Possible?

The third Encuentro Latinoamericano de Infecciones Respiratorias Recurrentes (ELAIR) took place in Mexico City, Mexico, on 11th−12th May 2017. ELAIR brought together experts from across Latin America and further afield, continuing an extraordinary didactic exercise on the cutting-edge advances of respiratory medicine. Impressive progress has been made in the past 15 years, with new treatments available to manage and prevent airway infections. It remains to be seen how this might affect the related conditions of wheezing and asthma in predisposed and sensitised subjects. However, early data suggest that lower respiratory infection rates may reduce the development of the above conditions which are closely related to viral infections. Immunomodulators that both prime the immune system to fight infection and reduce inflammation are likely to play a major role in secondary and even potentially primary prevention of atopic diseases.

The microbiome and development of allergic disease.

First, to review how the global rise in prevalence of asthma prompted studies of the relationships between microbial exposure in early infancy, the rate and pattern of development of immune function, and the development of allergic sensitization and of wheezing in childhood. And, second, to review how those studies laid the groundwork for a possible strategy for primary prevention of asthma through manipulation of the microbiome of the gastrointestinal and/or respiratory tracts. Atopy and asthma are complex diseases thought to result from a 'gene-by-environment' interaction; the rapidity of their rise in prevalence points to a change in environment as most likely causal. Epidemiologic studies noting associations between events in infancy and later development of atopic diseases have suggested that their rise in prevalence is related to a deficiency in microbial exposure in early life. The findings from birth cohort studies of humans and from interventional studies of mice converge in suggesting that a deficiency in microbial colonization of the respiratory or gastrointestinal tract by certain commensal microbes results in skewed development of systemic and/or local immune function that increases susceptibility to allergic sensitization and to viral lower respiratory infection. Recent studies are now honing in on identifying the microbes, or collection of microbes, whose collective functions are necessary for induction of immune tolerance, and thus of reduced susceptibility. Atopy and asthma appear to have their roots in an insufficiency of early-life exposure to the diverse environmental microbiota necessary to ensure colonization of the gastrointestinal and/or respiratory tracts with the commensal microbes necessary for induction of balanced, toleragenic immune function. Identification of the commensal bacteria necessary, now ever closer at hand, will lay the groundwork for the development of strategies for primary prevention of atopic disease, especially of childhood asthma.

A clinical reading on “World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics”

To the Editor Since the immunomodulatory properties of probiotics have been described, the effect of probiotic supplementation has been investigated in several trials and it has been also proposed as a preventive intervention for the development of allergic diseases. Recently two important evidence-based recommendations about the use of probiotics in the prevention of allergy were published [1, 2] with conflicting conclusions, in particular the most recent guideline [1] seems to be partially in contradiction with the previous statements about prevention of eczema. For these reasons, we tried to analyze the evidences leading to these recommendations [1] to highlight the aspects that can be more directly related or correlated with clinical practice. This clinical reading was addressed to offer some reflections about the methods used to formulate such recommendations, and the possibility to adopt in the clinical practice the proposed conclusions. We tried to retraces the path proposed by the Authors to analyse three important questions about the efficacy of probiotics in preventing allergic diseases if administrated to pregnant women (first question), to breastfeeding mothers (second question) and in healthy infants (third question). These questions have been investigated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [3], to perform a systematic review of randomized controlled trials and formulate recommendations. In summary, the GRADE method aims to define a rigorous and explicit method for the production of clinical recommendations. According to this method, the knowledge of advantages and disadvantages, benefits and risks of an intervention is necessary to make decisions in the health field. The GRADE approach also provides a three-phases decisional framework: a) formulation of a clinical question, with the choice and the formal evaluation of its related outcomes, and systematic evaluation of the scientific literature and the quality of the evidence; b) evaluation of the benefits and risks associated to the intervention, taking also in consideration its feasibility, the necessary resources and the patients’ preferences; c) formal definition of the strength of the recommendation. From a methodological point of view, it should be noted that the recommendations are directed to patients, clinicians and other health care professionals with different objectives, as clearly explained in the guidelines introduction. Each recommendation can have different levels of strength: strong recommendation indicates that patients would like to receive the intervention and that clinicians should actuate it. Conditional or weak recommendation indicates that the majority of patients would like to receive the intervention, but many other not, as well as they hope that clinicians would recognize that different choices may be appropriate for different patients, by taking advantage of decision-making tools to help patients to make consistent choices. In the results section of the guidelines we can read that “Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing * Correspondence: giampaolo.ricci@unibo.it Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy Full list of author information is available at the end of the article

The Editor takes a closer look at some of this month's articles

Clinical & Experimental AllergyVolume 45, Issue 9 p. 1373-1373 Editor's ChoiceFree Access The Editor takes a closer look at some of this month's articles First published: 24 August 2015 https://doi.org/10.1111/cea.12602AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The gut microbiome: a key to the development of allergic disease? A fascinating story is emerging that a general lack of diversity of the gut microbiome and a reduced presence of those gut commensals which induce a tolerant immune environment is associated with the development of allergic disease in early childhood 1. Moreover, a tolerance inducing gut microbiome is a feature of infants brought up in a farming environment which has been clearly shown to be associated with a greatly reduced risk of developing allergic disease 2. This story is given further support by West and colleagues who have found a relationship between eczema and an infant gut microbiome which contains low levels of tolerance associated gut bacteria such as Ruminococcaceae and Proteobacteria. Reduced amounts of these bacterial types in the gut are in turn associated with enhanced innate immune responses with increased production of inflammatory mediators such as TNF-alpha. This increasingly persuasive explanation for the allergy epidemic is in tune with the idea that probiotics are the solution to childhood allergies, a topic which has long been popular with our authors 3. Christina West Microbiota composition at the phylum level and α-diversity at 1 week, 1 month and 1 year in vaginally delivered infants (n = 7, n = 5, n = 11) and their mothers (n = 11), and Caesarean-delivered infants (n = 7, n = 6, n = 9) and their mothers (n = 8) in pregnancy. [See figure 1a in C. E. West et al. (pp. 1419–1429)]. Harbingers of asthma: infant cough as well as wheeze Both wheeze and cough are characteristic symptoms of asthma. However, while infant wheeze has been exhaustively explored as a marker for the subsequent development of asthma, cough as a sentinel symptom has been relatively ignored. In a novel and deceptively simple paper, Oren et al. have taken advantage of a non-selected birth cohort to determine whether a persistent cough in infancy predicts the later onset of asthma between the ages of 2 and 9. They found a greater than threefold increase in the likelihood of a later diagnosis of asthma in infants who had a persistent cough in the first year of life which was independent of wheeze. The association was particularly strong in those children whose mothers had asthma. It will be interesting to know whether the same heterogeneity is seen in infant coughers as has been demonstrated for infant wheezers. Eyal Oren The prevalence of asthma by cough duration, stratified by the presence of maternal asthma. [See figure 3 in E. Oren et al. (pp. 1439–1446)]. References 1Abrahamsson TR, Jakobsson HE, Andersson AF, Bjorksten B, Engstrand L, Jenmalm MC. Low gut microbiota diversity in early infancy precedes asthma at school age. Clin Exp Allergy 2014; 44: 842– 50. 2Braun-Fahrlander C, von Mutius E. Can farm milk consumption prevent allergic diseases? Clin Exp Allergy 2011; 41: 29– 35. 3Campbell DE. Probiotics and primary prevention of atopic disease: are we closer to a firm evidence base for clinical use? Clin Exp Allergy 2013; 43: 978– 80. Caption to cover illustration: An example of vocal cord dysfunction (Image courtesy of S. J. Fowler). This logo highlights the Editor's choice articles on the cover and the first page of each of the articles. Volume45, Issue9September 2015Pages 1373-1373 ReferencesRelatedInformation

Probiotics and primary prevention of atopic disease: Are we closer to a firm evidence base for clinical use?

Probiotics and primary prevention of atopic disease: Are we closer to a firm evidence base for clinical use?

Adherence to recommendations for primary prevention of atopic disease in neonatology clinical practice

The prevalence and severity of atopic manifestations in children are increasing in western countries in the last decades. Specific nutritional intervention may prevent or delay the onset of atopic diseases in infants at high risk of developing allergy. These nutritional interventions should be applied early in the perinatal period to have a chance of success. Thus, we assessed adherence to the dietary management recommendations of the Committee on Nutrition and Section on Allergy and Immunology of the American Academy of Pediatrics (AAP) for the prevention of atopic diseases in neonatal age through an audit study. Questionnaire was administered to the chiefs of 30 maternity units (MU) with more than 1500 live births/yr to report the policy applied in their MU. Twenty-two MU returned the questionnaire. Identification of high-risk newborns was routinely performed only in 7/22 MU (31.8%). High-risk newborns were identified by the presence of at least two or one first-degree relative (parent or sibling) with documented allergic disease by 18.2% and 45.5% of MU, respectively. Specific maternal dietary restrictions during lactation were adopted in 7/22 MU (31.8%). Extensively or partially hydrolyzed formula was prescribed for bottle-fed high-risk infants in 22.7% of MU. Only 2/22 MU have a policy in complete agreement with the nutritional intervention proposed by the AAP. Our study suggest a poor adherence to dietary recommendations for primary prevention of atopic disease in neonatology clinical practice. Further efforts should be planned to improve the knowledge and the application of these preventive strategies.

Any benefits of probiotics in allergic disorders?

Development of the child's immune system tends to be directed toward a T-helper 2 (Th2) phenotype in infants. To prevent development of childhood allergic/atopic diseases, immature Th2-dominant neonatal responses must undergo environment-driven maturation via microbial contact in the early postnatal period. Lactic acid bacteria and bifidobacteria are found more commonly in the composition of the intestinal flora of nonallergic children. Epidemiological data also showed that atopic children have a different intestinal flora from healthy children. Probiotics are ingested live health-promoting microbes that can modify intestinal microbial populations in a way that benefits the host; and enhanced presence of probiotic bacteria in the intestinal microbiota is found to correlate with protection against atopy. There is insufficient but very promising evidence to recommend the addition of probiotics to foods for prevention and treatment of allergic diseases, especially atopic dermatitis. Clinical improvement especially in allergic rhinitis and IgE-sensitized (atopic) eczema has been reported too. Literature data for food allergy/hypersensitivity and asthma are not adequate for this guaranteed conclusion; however, clinical benefit of probiotic therapy depends on numerous factors, such as type of bacterium, dosing regimen, delivery method, and other underlying host factors, e.g., the age and diet of the host. The selection of the most beneficial probiotic strain, the dose, and the timing of supplementation still need to be determined. Accordingly, probiotics can not be recommended generally for primary prevention of atopic disease; and if probiotics are used in atopic infants/children for any reason, such as therapy or prevention, cautionary approach ought to be taken.

Probiotics and prevention of allergic disease

Over the past few decades, public reports have shown increasing enthusiasm for the potential health effects of probiotics. Therefore, the purpose of this review is to focus on studies, which have addressed the use of probiotics for primary prevention of atopic diseases. The Finnish study of Kalliomaki was the first report to describe that the frequency of atopic dermatitis in neonates treated with Lactobacillus rhamnosus GG (LGG) was half that of the placebo. Recently, these results have been questioned by two trials, which reported no difference in the development of atopic dermatitis in neonates supplemented with LGG and L. acidophilus, respectively. In contrast, an unexpected increase in respiratory side-effects was observed in some studies in children who received the probiotics. Up to now no data have been released which report a positive effect of probiotics for the prevention of allergic rhinitis or asthma. Moreover, an allergen-preventive effect of probiotics for the development of atopic dermatitis could not be consistently established. In conclusion, probiotics cannot be generally recommended for primary prevention of atopic disease. Further studies should clarify if any susceptible subgroups exist and how these subgroups benefit from supplementation with certain probiotic strains. Moreover, the selection of the most beneficial probiotic strain or the composition of different probiotics and/or prebiotics, the dose and the timing of supplementation still need to be determined.

Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights

Recent insights into the relevance of the epidermal barrier function and its interaction with components of the innate and adaptive immune responses in patients with atopic dermatitis (AD) give rise to a number of novel potential treatment options. In particular, the identification of loss-of-function mutations in the barrier protein filaggrin and of a diminished expression of certain antimicrobial peptides in AD skin stimulates new concepts to think beyond the T(H)1/T(H)2 paradigm. This review will focus on these most recent discoveries and will discuss new and corresponding proof-of-concept trials in patients with AD. It will further speculate on novel ways to restore the homeostasis among the 3 major components in AD skin suspected to be clinically relevant.

Strategies for primary prevention of atopy in children

In recent decades, the prevalence of atopic diseases such as asthma, hayfever, food allergy, and atopic dermatitis has been steadily increasing. Unfortunately, more advances have been made in secondary prevention of symptoms and exacerbations than in primary prevention. One barrier to adopting prevention strategies is uncertainty regarding the cause of atopy. A genetic predisposition has been well documented. However, other factors, including diet, environment, infections, medications, and gastrointestinal flora, all play a role in the development of atopic disease. Modifying these factors holds promise for stopping the atopic march in the future. This paper reviews advances that have been made in the primary prevention of atopic disease.

Allergieprävention in Schwangerschaft und Stillzeit

Das Auftreten von Krankheitsbildern des allergischen Formenkreises wie Neurodermitis, Heuschnupfen und Asthma kann präventiv beeinflusst werden. Meiden des verantwortlichen Allergens und die spezifische Immuntherapie (SIT) sind Verfahren der tertiären und sekundären Allergieprävention.

EVS1-1 Early intervention strategies for primary prevention of atopic disease

EVS1-1 Early intervention strategies for primary prevention of atopic disease

Probiotics: a complementary approach in the treatment and prevention of pediatric atopic disease

The goal of this article is to review recent primary research and developments in the area of probiotics and pediatric atopic disease. Research developments in probiotics summarized in this article include the following: (1) the role of probiotics in primary prevention of atopic disease, (2) the effect of probiotics on cytokines involved in the allergic immune response, (3) the long-term effects of peri-natal probiotic use and (4) the relationship between the gut microflora and atopic dermatitis. Probiotics continue to be an area of active investigation as our understanding evolves of the gut microbiota's role in the altered immune response of atopic patients. Physicians should be aware of these developments as probiotics may be an important complementary approach in the treatment and the natural and long-term course of various pediatric diseases. This article summarizes the research conducted over the past 10 years with a primary focus on the literature published since January 2003.

BCG (bacille Calmette-Guerin) vaccination may play a role in the primary prevention of atopic diseases among Japanese children aged 3 years

BCG (bacille Calmette-Guerin) vaccination may play a role in the primary prevention of atopic diseases among Japanese children aged 3 years

Probiotics in primary prevention of atopic disease

Probiotics in primary prevention of atopic disease

Is intestinal microflora in new-borns of significance for immunological maturation and development of atopic disease?

In the past 20-30 years, an increasing incidence of atopic diseases has been reported, particularly amongst children in the Western world. It has been hypothesised that Western lifestyle has changed the exposure to microbial stimulation early in life, which implies a reduced stimulation of TH1 immunity, a skewed cytokine balance and an increased risk of allergic disease. The composition of intestinal microflora in new-borns has been studied, but a controlled prospective study has been called for. The objective is to study the relationship between gut flora composition in new-borns, the development of the immune response and the incidence of atopic disease. Within the frame of a large, controlled, prospective study of primary prevention of atopic diseases in Trondheim (PACT), blood, stools, and exposure information will be collected from mothers and their new-borns. End-points will be collected after 2 years Some 760 pregnant women are included and blood, stools and vaginal bacterial specimen are collected at delivery. Stool samples from children are collected at age 2, 4, 7, 10 days, and 4, 12 and 24 months. Faeces are stored at −80 C, and later 16S rRNA hybridisation technique will be used to specify and quantify the microbial composition. Likewise, samples of cord blood, and venous blood are collected at age 10 days, 4, 12 and 24 months. PBMC are separated, and stored in liquid nitrogen for later analysis of cytokine profile at different ages, related to microbial stimulation. Atopic children will be identified by questionnaire at 1 and 2 years of age, and the diagnosis confirmed by clinical examination, including skin tests at 2 years The inclusion of 760 pregnant women will be concluded in March 2002, and results presented in 2004. The protocol will be given in detail.