Allergy Prevention Strategies Research Articles

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children.

Over the past two decades, food allergy prevention strategies have shifted from 'delayed introduction' to 'no delayed introduction' to 'early introduction' of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention. Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing. Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.

Role of skin management in the prevention of atopic dermatitis and food allergy.

Food allergy is postulated to originate from cutaneous sensitization through a disrupted skin barrier, particularly in atopic dermatitis (AD). Strategies for food allergy prevention currently centre around early allergic food introduction, but there is now increasing evidence for the role of early skin barrier restoration in the form of prophylactic emollient therapy and early aggressive, proactive treatment of established AD for food allergy prevention. Research gaps that remain to be addressed include the type of emollient or anti-inflammatory medication, which confers the greatest efficacy in preventive or proactive skin treatment, respectively, the duration of therapy, and the window of opportunity for these interventions.

Egg-sensitised infants have elevated CD4+ effector memory T regulatory cells from birth.

IgE-mediated sensitisation to egg is common in infants. In some cases, the processes leading to egg sensitisation are established in early life, even before introduction to solid foods. The underlying mechanisms remain poorly understood. We performed detailed immune cell phenotyping of peripheral blood mononuclear cells and determined invitro cytokine responses following allergen specific and non-specific immune stimulation. To determine if unique immune profiles were linked to early-life egg sensitisation, we compared 92 infants at 4-6 months of age, with (EggCAP+, n = 41) and without (EggCAP-, n = 51) early egg sensitisation. Additionally, 47 cord blood samples were analysed. For a subset of participants (n = 39), matching cord blood mononuclear cells were assessed by flow cytometry to establish the impact of IgE sensitisation on immune developmental trajectories. EggCAP+ infants were found to exhibit a unique immune phenotype characterised by increased levels of circulating CD4+ T regulatory cells (Treg), CD4+ effector memory (EM) Treg and increased expression of the IgE receptor, FcεR1, on basophils. The increased CD4+ EM Treg profiles were already present in cord blood samples from EggCAP+ infants. A general Th2-skewing of the immune system was observed based on increased IL-13 production following phytohemagglutinin stimulation and by comparing immune developmental trajectories, EggCAP+ infants displayed an expansion of basophils and reduced levels of CD4- T cells compared to EggCAP- infants. Immunological profiles associated with egg sensitisation are detectable in infant circulation at 4-6 months of age and at birth. Understanding the immune mechanisms underlying early-life sensitisation could provide important insights for future food allergy prevention strategies.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study.

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life. Recruitment and data collection started in February 2022 and is still ongoing. The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps. DERR1-10.2196/41436.

Enhanced early skin treatment for atopic dermatitis in infants reduces food allergy

Early-onset atopic dermatitis is a strong risk factor for food allergy, suggesting that early effective treatment may prevent transcutaneous sensitization. This study tested whether enhanced treatment of atopic dermatitis to clinically affected and unaffected skin is more effective in preventing hen's egg allergy than reactive treatment to clinically affected skin only. This was a multicenter, parallel-group, open-label, assessor-blind, randomized controlled trial (PACI [Prevention of Allergy via Cutaneous Intervention] study). This study enrolled infants 7-13 weeks old with atopic dermatitis and randomly assigned infants in a 1:1 ratio to enhanced early skin treatment or conventional reactive treatment using topical corticosteroids (TCSs). The primary outcome was the proportion of immediate hen's egg allergy confirmed by oral food challenge at 28 weeks of age. This study enrolled 650 infants and analyzed 640 infants (enhanced [n= 318] or conventional [n= 322] treatment). Enhanced treatment significantly reduced hen's egg allergy compared with the conventional treatment (31.4% vs 41.9%, P= .0028; risk difference: -10.5%, upper bound of a 1-sided CI: -3.0%), while it lowered body weight (mean difference: -422 g, 95% CI: -553 to -292 g) and height (mean difference: -0.8 cm, 95% CI: -1.22 to -0.33 cm) at 28 weeks of age. This study highlighted the potential of well-controlled atopic dermatitis management as a component of a hen's egg allergy prevention strategy. The enhanced treatment protocol of this trial should be modified before it can be considered as an approach to prevent hen's egg allergy in daily practice to avoid the adverse effects of TCSs. After remission induction by TCSs, maintenance therapy with lower potency TCSs or other topical therapies might be considered as alternative proactive treatments to overcome the safety concerns of TCSs.

Epicutaneous Sensitization and Food Allergy: Preventive Strategies Targeting Skin Barrier Repair-Facts and Challenges.

Food allergy represents a growing public health and socio-economic problem with an increasing prevalence over the last two decades. Despite its substantial impact on the quality of life, current treatment options for food allergy are limited to strict allergen avoidance and emergency management, creating an urgent need for effective preventive strategies. Advances in the understanding of the food allergy pathogenesis allow to develop more precise approaches targeting specific pathophysiological pathways. Recently, the skin has become an important target for food allergy prevention strategies, as it has been hypothesized that allergen exposure through the impaired skin barrier might induce an immune response resulting in subsequent development of food allergy. This review aims to discuss current evidence supporting this complex interplay between the skin barrier dysfunction and food allergy by highlighting the crucial role of epicutaneous sensitization in the causality pathway leading to food allergen sensitization and progression to clinical food allergy. We also summarize recently studied prophylactic and therapeutic interventions targeting the skin barrier repair as an emerging food allergy prevention strategy and discuss current evidence controversies and future challenges. Further studies are needed before these promising strategies can be routinely implemented as prevention advice for the general population.

Can early life interventions prevent food allergies?

The incidence of food allergies is increasing all over the world. Prevention strategies intend to reduce food sensitization risk and subsequent allergies. In this review, we will discuss the recent data concerning different geographic regions for the prevention of food allergies in children. This review provides recommendations for the prevention of food allergies based on the recent data available in the PUBMED database in English (up to December 2022). The best strategy to prevent food allergies is regarded as the early introduction of allergenic foods to an infant`s diet. A healthy and diverse diet is recommended for infants and their mothers, in accordance with the family`s eating habits and regional food culture, rather than avoiding certain foods or using supplements. Avoiding common food allergens in the maternal diet during pregnancy and/or breastfeeding is not recommended. Exclusive breastfeeding is generally recommended for all mothers for at least 6 months. There is no specific association between exclusive breastfeeding and the primary prevention of any specific food allergy. Where a breastmilk substitute is needed, the best alternative should be chosen according to the infant`s nutritional needs. There is no substantial evidence to support the use of hydrolyzed or soy formula in infancy against food allergies or sensitization. Feeding patterns in infancy play an important role in the risk of developing food allergies. Existing strategies to prevent allergies are relatively ineffective and further research is needed to figure out strategies for food allergy prevention, particularly in high-risk infants.

A pragmatic approach to infant feeding for food allergy prevention.

Early introduction of allergenic foods into an infant's diet is currently the most promising strategy to prevent food allergy, with infant guidelines around the world shifting from promoting avoidance to actively encourage the introduction of allergenic foods in the infant diet. Infant feeding guidelines vary according to regional public health priorities, and knowledge gaps remain, resulting in ongoing challenges for clinicians and families to translate guidelines into practical strategies for the introduction of complementary foods for food allergy prevention. Evidence from Australia demonstrates high community support and uptake of revised guidelines with most parents introducing allergenic foods in the first year of life, although this has not had the expected impact on substantially reducing food allergy prevalence. To uptake of guidelines from other countries is less clear, and several barriers have been noted in infant feeding RCTs, which may warrant intervention strategies. Further research is needed to understand additional strategies for food allergy prevention, particularly in infants who develop food allergy prior to when they are developmentally ready to commence solids. Several RCTs are underway investigating preventative strategies that target the window before allergen ingestion, such as vitamin D supplementation, emollient use, and immunizations that prime the immune response away from a Th2‐driven allergic phenotype. Further research is also needed to understand the role of the environment and the host environment in the development of tolerance to foods.

Current Strategies to Modulate Regulatory T Cell Activity in Allergic Inflammation

Over the past decades, atopic diseases, including allergic rhinitis, asthma, atopic dermatitis, and food allergy, increased strongly worldwide, reaching up to 50% in industrialized countries. These diseases are characterized by a dominating type 2 immune response and reduced numbers of allergen-specific regulatory T (Treg) cells. Conventional allergen-specific immunotherapy is able to tip the balance towards immunoregulation. However, in mouse models of allergy adaptive transfer of Treg cells did not always lead to convincing beneficial results, partially because of limited stability of their regulatory phenotype activity. Besides genetic predisposition, it has become evident that environmental factors like a westernized lifestyle linked to modern sanitized living, the early use of antibiotics, and the consumption of unhealthy foods leads to epithelial barrier defects and dysbiotic microbiota, thereby preventing immune tolerance and favoring the development of allergic diseases. Epigenetic modification of Treg cells has been described as one important mechanism in this context. In this review, we summarize how environmental factors affect the number and function of Treg cells in allergic inflammation and how this knowledge can be exploited in future allergy prevention strategies as well as novel therapeutic approaches.

Dissemination of atopic dermatitis and food allergy information to pregnant women in an online childbirth preparation class.

Evidence-based allergy prevention strategies have been reported, but strategies for dissemination have not been evaluated. Improving health literacy and awareness of allergies in pregnant mothers is 1 example of dissemination and implementation science that could help prevent allergic diseases and promote early detection of allergic diseases in children. We evaluated the usefulness of an online childbirth preparation class about prevention and early detection of allergic diseases in offspring. From January 2021 to August 2021, an online allergy class for pregnant mothers was provided at the hospital in Tokyo. We conducted an online survey about allergy topics before and after the online childbirth preparation class. A total of 106 pregnant women attended the online allergy class, and 92 (86.8%) responded to the online survey. Of the respondents, 90 (97.8%) were worried about the development of allergies in their children. The topic that attracted the most attention in the lecture was the prevention of atopic dermatitis by means of skin care. The percentages of correct responses regarding allergy prevention strategies increased after the class. All mothers believed that the class was useful, the information should be disseminated to the public, and the practices should be implemented. In online childbirth preparation classes, information about allergy based on dissemination and implementation science could strengthen allergy literacy among pregnant women.

Specific gut microbiome signatures and the associated pro-inflamatory functions are linked to pediatric allergy and acquisition of immune tolerance

Understanding the functional potential of the gut microbiome is of primary importance for the design of innovative strategies for allergy treatment and prevention. Here we report the gut microbiome features of 90 children affected by food (FA) or respiratory (RA) allergies and 30 age-matched, healthy controls (CT). We identify specific microbial signatures in the gut microbiome of allergic children, such as higher abundance of Ruminococcus gnavus and Faecalibacterium prausnitzii, and a depletion of Bifidobacterium longum, Bacteroides dorei, B. vulgatus and fiber-degrading taxa. The metagenome of allergic children shows a pro-inflammatory potential, with an enrichment of genes involved in the production of bacterial lipo-polysaccharides and urease. We demonstrate that specific gut microbiome signatures at baseline can be predictable of immune tolerance acquisition. Finally, a strain-level selection occurring in the gut microbiome of allergic subjects is identified. R. gnavus strains enriched in FA and RA showed lower ability to degrade fiber, and genes involved in the production of a pro-inflammatory polysaccharide. We demonstrate that a gut microbiome dysbiosis occurs in allergic children, with R. gnavus emerging as a main player in pediatric allergy. These findings may open new strategies in the development of innovative preventive and therapeutic approaches. Trial: NCT04750980.

Sistem Pakar Diagnosa Penyakit Alergi Pada Anak Dengan Menggunakan Microsoft Visual Basic Net Studi Kasus Klinik Dokter Yunita Siregar

Food allergies are health problems that arise as a result of a specific immune response to food. The prevalence of food allergy in children is 6%, while in adults it is 3 - 4%. Food allergy prevention strategies that are not yet optimal are one of the causes of the increasing incidence. Immunopathogenesis in food allergies involves reactions between allergens and antibodies that are mediated by immunoglobulin E, non-immunoglobulin E, or both. The clinical implications of food allergy in adults can affect the gastrointestinal, cutaneous, respiratory, and systemic systems. The gold standard for the diagnosis of food allergy is the oral food challenge. The most appropriate treatment is to avoid trigger factors. Specific and nonspecific therapy against allergens can be given although it is still under debate.

Effective Ways to Prevent Allergic Diseases: Where Do We Stand?

Since allergic diseases are of great public health relevance, effective primary prevention strategies are urgently needed. This chapter gives an overview of existing primary prevention programs on environmental exposures and dietary strategies based on epidemiological studies which have defined risk- and protective factors for the development of allergic diseases.The allergy protective effect mediated by growing up on a traditional farm environment is well studied. But the exact underlying mechanisms have still not been fully clarified and have not yet led to concrete prevention strategies. The beneficial effect of avoiding cigarette smoke exposure, indoor moisture and molds in pregnancy and childhood on the development of asthma is well documented. Whereas the avoidance of house dust mite exposure is not recommended to prevent eczema or allergy. Dietary supplementation with vitamins, pre- and probiotics in pregnant woman and their offspring is not harmful but evidence for the prevention of allergic diseases is still lacking. Fish oil consumption was shown to be asthma protective. The early introduction of peanuts and egg protein to prevent peanut and egg allergy in children with atopic dermatitis is promising. Further studies are needed to increase the overall evidence in allergy prevention. Most studies lack methodological standards such as randomization and blinding. More evidence is in demand on the potential beneficial impact of multifaceted interventional studies. The future of allergy prevention strategies might be based on individual risk assessment. Therefore, research in the immunological and molecular basis of allergic diseases needs to be promoted.

Early life microbial exposures and allergy risks: opportunities for prevention.

Allergies, including asthma, food allergy and atopic dermatitis, are increasing in prevalence, particularly in westernized countries. Although a detailed mechanistic explanation for this increase is lacking, recent evidence indicates that, in addition to genetic predisposition, lifestyle changes owing to modernization have an important role. Such changes include increased rates of birth by caesarean delivery, increased early use of antibiotics, a westernized diet and the associated development of obesity, and changes in indoor and outdoor lifestyle and activity patterns. Most of these factors directly and indirectly impact the formation of a diverse microbiota, which includes bacterial, viral and fungal components; the microbiota has a leading role in shaping (early) immune responses. This default programme is markedly disturbed under the influence of environmental and lifestyle risk factors. Here, we review the most important allergy risk factors associated with changes in our exposure to the microbial world and the application of this knowledge to allergy prevention strategies.

Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology.

Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancyon allergy outcomes in their offspring. We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs. We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin Dsupplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy. Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.

A comprehensive systematic review of the impact of dietary factors during pregnancy on childhood atopic outcomes

Allergic diseases are an increasing public health concern. Early life environments appear critical to immune development, and maternal dietary intake in pregnancy maysbe important influencing factors that could be modifiable as allergy prevention strategies. In this systematic review we focus on maternal diet in pregnancy alone and relate the amount of nutrients/food/food patterns studied to US dietary guidelines. Studies in allergen intake were excluded from this review. We have undertaken a systematic review on maternal diet, excluding food allergens, in pregnancy alone and its association with allergy outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis, food allergies) in offspring. We have searched 3 bibliographic databases (Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), up to February 28, 2019. The risk of bias of each study was critically appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We identified 95 papers: 17 RCTs and 78 observational. Observational studies varied in design and dietary exposures with contradicting findings. RCTs showed that vitamin D supplementation (OR: 0.73; 95% CI: 0.56 – 0.92) may prevent wheeze/asthma and omega-3 supplementation (OR; 0.74; 95% CI: 0.59 – 0.92) may prevent allergic rhinitis in offspring; meta-analysis was based on <4 outcomes . No clear recommendations regarding maternal diet in pregnancy can be made at present. Vitamin D and omega-3 supplementation needs further studies. We suggest studies should focus on diet patterns/indices on allergy outcomes in the offspring, rather than single nutrients/foods.

Current Controversies and Future Prospects for Peanut Allergy Prevention, Diagnosis and Therapies.

Peanut allergy has increased substantially in the past few decades, both in developed and developing countries. Peanut allergy has become a major public health concern, affecting up to 1 in 50 children, with repercussions for school and airline policies. Recent research findings have shown that, contrary to the long-standing teaching of “delayed” introduction of allergens, early introduction of peanut protein is of benefit as an allergy prevention strategy, especially in high-risk cases. Ideal dose, frequency and duration of “proactive” peanut therapy for maximum protection remain to be determined in order for it to become acceptable and practical on a large scale. Logistics around widespread screening of high-risk patients remain complex. The correct diagnosis of peanut allergy is crucial and diagnostic tests have been fine-tuned in the past 2 decades in order to help differentiate true allergy from false-positive sensitization through cross-reactivity. Component-resolved diagnostics have become routinely available, and the use of basophil activation tests has increased, although standardization and availability remain issues. Future tests, including epitope testing and histamine-release assays, promise to be even more specific in ruling out false positives and reducing the need for incremental food challenges. Stringent peanut avoidance and prompt treatment of reactions remain the cornerstone of treatment. The concept of exposing the allergic body to small amounts of peanut protein in a cautious, orderly, escalating fashion in the form of desensitization has been widely applied in the past 10–15 years, mainly in the research domain, but of late spilling over into every-day practice. However, desensitization does not equate to a cure, and has significant safety concerns and practical ramifications; probably requiring lifelong-controlled peanut ingestion for ongoing protection. Further strategies to enhance the safety and efficacy of immunotherapy are under exploration, many with a non-specific immune-modifying effect. Despite recent advances in peanut allergy, we still need to go back to basics with accurate diagnosis, nutritional counselling, well-organized allergy action plans and accessible emergency kits.

Direct Infant UV Light Exposure Is Associated With Eczema and Immune Development

To determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development.This study included 197 healthy, term, singleton infants with family history of atopy. Ninety-seven participants were randomly assigned to the intervention vitamin D group, and 98 were randomly assigned to the placebo group. Ninety-two percent of infants attended their appointment at 3 months of age, and 89% of infants attended their appointment at 6 months of age.This study was a double-blind randomized controlled trial of infants born in Australia between October 2012 and January 2017. Newborn infants were randomly assigned to receive vitamin D supplementation (400 IU/day) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age. Eczema was defined by clinical features and graded on the basis of the Scoring Atopic Dermatitis score.At both 3 and 6 months of age, vitamin D levels were greater for the vitamin D group compared with the placebo group; however, there was no difference in eczema incidence between groups. The secondary outcome investigating direct UV light exposure found infants with eczema to have had less UV light exposure compared with those without eczema. Additionally, UV light exposure was also inversely correlated with interleukin-2, granulocyte-macrophage colony-stimulating factor, and eotaxin production to Toll-like receptor ligands.Researchers in this study found that UV light exposure in early infancy was associated with lower incidence of eczema and proinflammatory immune markers by 6 months of age. These findings suggest that UV light exposure may be more beneficial than vitamin D supplementation as an allergy prevention strategy in early life.Although the initial intent of this study was focused on vitamin D, the more remarkable finding related to the demonstrated association between greater direct UV light exposure in early infancy with lower incidence of eczema and proinflammatory immune markers. The lack of effect of vitamin D supplementation is consistent with previous studies in which researchers have reviewed vitamin D supplementation during pregnancy and infancy. Future studies would be ideal, powered for effect of direct UV exposure on the incidence of eczema and involving mechanistic studies. Additionally, future studies are required to determine how much sunlight exposure in infancy is both safe and effective.

Prenatal visits for allergy prevention

Allergic diseases, such as atopic dermatitis, food allergy, asthma, and allergic rhinitis, are common; according to a national birth cohort study in Japan, almost half of pregnant women reported a history of allergic disease.1 Given that genetic factors, including family history, are predictors of allergic diseases in offspring, we expect the birth of many infants with a high risk of developing allergies. Among allergy prevention strategies, the effectiveness of primary prevention of eczema in high-risk infants by the topical application of emollient during the neonatal period has been demonstrated in 2 randomized controlled trials (RCTs).

P358 DEVELOPMENT OF EDUCATION PROGRAM FOR OFFSPRING ALLERGY DURING PREGNANCY -PILOT STUDY-

Almost half of pregnant women had past history of allergic disease in Japan from a nationwide birth cohort study. A lot of babies are born with genetically high risk of allergy. Evidence-based allergy prevention strategies were reported. The aim of this study was to develop allergy education program for parents during pregnancy.