1. Planee Vatanasurkitt,MD

2. Foodallergen avoidance HDM avoidance Multiple interventionArshad. Primary prevention of asthma and allergyJACI2005;116:3-14 3. Maternaldiet exclude cows milk and eggduring late pregnancy does not preventallergic manifestation in geneticallypredisposed children Maternal avoidance CM egg nuts fish soyduring pregnancy and lactation ,supplementwith extensive hydrolysed and avoidance ofsolids up to 6 months reduced in foodsensitization on SPT ,food allergicmanifestation and AD at age 2 year but nolong term benefit beyond early childhood wasobservedArshad. Primary prevention of asthma and allerg JACI2005;116:3-14 4. ACochrane database meta-analysis of 4 clinical studies concluded that antigen avoidance during pregnancy is unlikely to reduce the childs risk of developing atopic disease, and dietary restrictions could adversely affect maternal or fetal nutrition. 5. Norecommended to avoid diet during pregnancy 6. Maternalavoidance dairy product ,egg,fish, peanut ,soy during lactation led toreduction in AD at 18 months in high riskinfant maternal food allergen avoidance duringlactation might be of some benet. Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14 7. Introduction solid food before 4 monthsmight increase risk of atopic dermatitis ingenetically predisposed children Could not find beneficial effect of lateintroduction of solid foods Arshad. Primary prevention of asthma and allergy JACI2005;116:3-14 8. EXCLUSIVE BREASTHYDROLYZED MILKFEEDING FORMULA Preventive effect of breast Protein hydrolyzed reducesfeeding on allergic diseaseallergic disease during theremain controversial first 2-3 years in children at risk of atopy, as supplement or alternative to breast feeding The GINI study Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14 9. 2252 newborns with atopic heredity were randomly assigned at birth to receive one of 4 blinded formulas: 10. Partiallyhydrolyzed whey formula Extensively hydrolyzed whey formula Extensively hydrolyzed casein formula Cow milk 11. Outcomeswere physician-diagnosed allergic diseases (atopic dermatitis, food allergy, allergic urticaria, asthma, and hay fever/allergic rhinitis 12. Relative riskPartially hydrolyzed whey 0.79Extensively hydrolyzed whey 0.92Extensively hydrolyzed0.71casein 13. Result: AD significantly reduced by using extensively hydrolyzed casein compare with cow milk, some protective of partial whey hydrolyzed on AD 14. number Interventio interventio Main Reduction n started n outcomein atNewbornbirth MattressAllergic 1y allergic696cover and sensitizatio sensitizatio general nn advice 2y noeffectToddler2-4 y1y allergic636 sensitizatioSchool 5-7 ynchildren242 15. This study provide evidence could protect at risk children against sensitization even in later childhood 16. numbe Interventio interventionoutcomeReductionr n started at in620prenatalExtensive-AllergicHDM HDMsensitizatio allergen avoidancenlevels -cover -Wheeze1Y: only -HEPA filter -Airwaysevere -hardwoodresistance wheeze flooring -use of Acarosan 17. num Interventio interventiooutcome Reductionber n started ninat810 prenatalMattress -Total IgEHDMcovers and -Specific IgE allergengeneral- levelsadvice Cough,wheez 2y: nocturnal e cough -Atopic dermatitisHDM allergen reduced but No difference in development ofatopy or asthma 18. numbe Interventio intervention outcome Reduction inr n started at120birthFood andAllergic HDM allergenHDM sensitizatio levelavoidance n1 y:Asthma Asthma,ADAllergic allergicrhinitis sensitizationAtopic 2Y:ADdermatitis allergicFood sensitizationallergy4Y:AD allergic sensitization 19. Strict food and aeroallergen avoidance in high risk children might reduce the development of allergic sensitization. Leading to less atopic dermatitis and asthma in later childhood 20. numbe Interventi intervention outcome Reductionr on startin531 birthDiet exclusive Asthma4y :any BF or soya ADallergy formula andRhinitis environmentalurticaria HDM and ETS avoidance 21. number545startprenatalintervention Diet : breast feeding, delayed introduction of solids and environment reduction HDM and pet exposure and ETSoutcomeAllergic sensitization,Asthma,Allergic rhinitisReductionHDM allergen levelsin 1 Y: asthma and allergic rhinitis 2Y :asthma 22. number 616startprenatalintervention HDM avoidance Diet : omega 3 PUFA combinedoutcomeCough,asthma,allergic sensitization,Total IgE at the age 18 monthsReduction in 1.5y :diet group;wheezeHDM group;no effect 3y diet group;coughHDMgroup sensitization to HDM 23. Dietarymodification of supplementationwith fish oil rich in omega-3 PUFA,might besome benefit In CAPS, reduction in wheezing at 18months but not at 3 year Prospective observation study indicateintroduction of fish in to infant diet reducesoccurrence of rhinitis but not asthma Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14 24. LactobaccilusGG given during pregnancy to mother with family history of atopy for 6 months resulted in significant reduction in AD up to age 2 yearsArshad. Primary prevention of asthma and allergJACI2005;116:3-14 25. No clinical trials have been done to assess immunomodulatory effect of vaccination in primary prevention of allergy Arshad. Primary prevention of asthma and allerg JACI2005;116:3-14 26. Exposure to ETSAvoidance must be include in all preventive adviceMaternal avoidance ofDoes not work and could beallergenic food during halmfulpregnancyBF for 4-6 monthsprotect against childhood wheeze and atopic dermatitis, no evidence of long term benefit 27. Maternal avoidance of Some protective onallergenic food duringreduction cow milk allergylactation and atopic dermatitisDelayed introduction of solid Lacking proof for preventivefoodeffectHydrolyzed milk formula Preventive effect on cowsmilk allergy and AD 28. HDM avoidancePreventive effect to sensitization or respiratory allergy is not compellingCombined food andReducing early childhoodaeroallergen avoidance wheeze and AD and later asthma