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Title

CAN ALLERGIC DISORDERS BE PREVENTED BY ALLERGEN AVOIDANCE DURING INFANCY?

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Abstract

 Introduction: Early life environmental factors, including exposure to allergens, are known to increase the risk of childhood allergy. However, it is not known if avoidance of allergens in early life can prevent allergic disease.Methods: A birth cohort of genetically at-risk infants was recruited in 1990 in a randomised, controlled study. Allergen avoidance measures were instituted, from birth, in the prophylactic (P) group (n=58). Infants were either breast fed with mother on a low allergen diet or given an extensively hydrolysed formula. Exposure to house dust mite was reduced by the use of an acaricide and mattress covers. Control (C) group (n=62) followed standard advice as normally given by the health visitors. Development of allergic diseases (asthma, atopic dermatitis, rhinitis, food allergy) and atopy (positive skin test) was assessed blindly at ages one, two, four and eight years in all 120 children (except 4 children missing skin test at 8 years).Results: Period prevalence of one or more allergic disease was significantly reduced in the prophylactic group at all ages. At one year; P: 13.8% vs. C: 38.7%, at two years; P: 25.9% vs. C: 50.0%, at four years; P: 32.8% vs. C: 53.2%, at eight years; P: 51.7% vs. C: 69.4%. There was a 2 to 5 fold reduction in the number of children with atopy at all follow-ups. When adjusted for confounding variables in a logistic regression model, the P group was confirmed to have significantly reduced risk at all ages. At one year; odds ratio (OR): 0.26, 95% confidence interval (CI): 0.08, 0.85; p=0.03, at two years; OR 0.17, CI 0.05, 0.53, p=0.002, at four years; OR 0.30, CI 0.11, 0.80, p=0.02, at eight years; OR 0.32, CI 0.12, 0.86, p=0.02.Conclusion: This study demonstrates that childhood allergic manifestations can be reduced by combined food and aero-allergen avoidance in infancy.

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