Allergy experts weigh in on prevention strategies

December 2, 2020
Rachael Zimlich, RN, BSN

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Guidance offers insight on allergy prevention strategies.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) has unveiled new guidelines on preventing allergies and asthma in children.1 The guidance, updated in September, reviews a number of strategies to prevent, or even delay, the development of several types of allergies.

Food Allergies

Food allergies are a big deal in children, who aren’t always able to be choosy when it comes to what they eat. Children can have a difficult time discerning the content of some foods, and parents can’t always be with them. This makes prevention key when it comes to food allergies, which can be triggered by a number of foods like peanuts, cow’s milk, eggs, and more.

Infants who have a sibling or at least 1 parent with an allergic condition are particularly at risk of developing food allergies, especially if they already show symptoms of foods allergies like atopic dermatitis, allergic rhinitis, or asthma.

There are a number of methods that help—and others that don’t—that were reviewed in the guidance.

  • FALSE—Food avoidance. Food avoidance is one method to prevent the development of food allergies. Mothers may restrict their diets during pregnancy or breastfeeding in an attempt to prevent the development of food allergies, but AAAAI says these strategies are not recommended. There are not data to support avoidance of highly allergenic foods during pregnancy or during breastfeeding to prevent allergy development, the guidance notes.
  • TRUE—Breastfeeding. Breastfeeding is seen as the best way to feed an infant, AAAAI notes, because breast milk is easy to digest and is the least likely to trigger allergic reactions. Studies show breastfeeding in the first 4 to 6 months of life can also help to reduce prevalence of early eczema, wheezing, and cow’s milk allergies, the guidance notes.
  • TRUE—Careful Introduction. Introducing solid foods gradually to monitor for any allergic reactions is a good strategy, but allergenic foods shouldn’t be avoided, either. The AAAAI supports the gradual introduction of egg, dairy, tree nuts, peanuts, fish, and shellfish in the first 4 to 6 months of solid food introduction, after other less allergenic foods have been attempted.

Environmental Allergies

There are a number of environmental factors that can trigger allergies, too. However, unlike foods, early contact with environmental allergens can make allergies worse. Research is the most robust when it comes to dust mites, according to AAAAI, which suggests working to control dust mites early to prevent allergy problems. Some solutions to control environmental allergens recommended in the guidance include:

  • using zippered covers on pillows and mattresses that are made to control allergens
  • washing bedding in hot water each week
  • keep indoor humidity below 50%
  • remove upholstered furniture and carpeting from infant bedrooms, if possible
  • avoid exposing children to secondhand tobacco smoke.

Pet are different, though, according to AAAAI, with recent research suggesting that early exposure to pets can actually help protect children from developing allergies.

When You Need Help

The AAAAI also offered guidance on when to get help and where. If possible, the organization recommends finding an allergist specifically, as they have received specialized training in allergy and immunology. Allergy testing by a specialist can give detailed information about an allergy, and the best methods for treatment, according to AAAAI. On the other hand, AAAAI recommends against massive allergy screening tests done in retail sites, applied kinesiology, or testing through muscle relaxation, cytotoxicity testing, skit titration, provocative and neutralization testing, or sublingual provocation.

Kari Christine Nadeau, MD, PhD, Naddisy Foundation Endowed Professor of Medicine and Pediatrics and director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University in Palo Alto, California says it’s important that advice be given on science and epidemiological studies. In terms of allergy prevention, research studies show that a diversification of diets with a variety of proteins from different food sources introduced all at once—rather than staged as suggested by AAAAI—can decrease the risk of allergy and asthma development.

There are a number of other tips she offers for allergy prevention, including:

  • diet diversity
  • skin emollient therapy
  • reduced detergent use
  • reducing air pollution
  • mitigating global climate change
  • maintaining healthy vitamin D levels

Nadeau also makes it clear that vaccination avoidance is not a prevention strategy for allergens, and that allergy prevention can begin at any age.

Reference

1. American Academy of Allergy, Asthma & Immunology. Prevention of allergies and asthma in children. Reviewed September 28, 2020. Accessed December 2, 2020. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/prevention-of-allergies-and-asthma-in-children.