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It is evident that a broad range of host and environmental factors interact during early development to influence patterns of immune response
Ann Nutr Metab 2011;59(suppl 1):28–42
Strategies to Prevent or Reduce Allergic Disease by Susan Prescott and Anna Nowak-Węgrzyn
Key insights Studies suggest that certain ‘western lifestyle’ factors, modern dietary changes and environmentalpressure are causally linked to many infant/childhood allergic diseases; however, guidelines remain limited. Prevention shifts to earlier introduction of antigens and supplementation to promote immune tolerance rather than the maintenance of overly hygienic conditions. Current knowledge The increasing prevalence of food allergens and differences in the disease profile require a better understandingof the triggers of immune responses, i.e. the environmental, genetic and/ or epigenetic factors, so that effective prevention strategies can be derived. Little evidence supports the benefit of allergen avoidance, thus, the focus is on immunomodulatory prevention strategies. In allergy-prone children, clear differences in the early development of the immune system exist. Restoring microbial anddietary balance as well as understanding the roles of breastfeeding and hypoallergenic infant formula is the main strategy used today to reduce allergic disease and increase tolerance to allergenic foods. Practical implications Increasing rates of food allergy and eczema, plus the already substantial burden of asthma and respiratory allergic diseases, require a concerted long-term strategy to addressthese challenges. Supplementation, complementary foods and/or the early introduction of allergenic foods may play a modulatory role in allergic disease; trials are ongoing. When available, the data should support clearer recommendations.
Risk for developing atopic disease Perinatal differences in T cell function, innate immune function; trajectory of innate development Delayed postnataldevelopment of immune competence Hygiene hypothesis Postnatal maturation kinetics of CD4 T cells highly variable Adaptive immunity High proportion of immature T cells/ low proportion of mature T cells Capacity to produce cytokines Production of IFNCapacity to express sustained responses to mitogens Innate immunity Monocyte responsiveness Dendritic cell capacity to elicit T cells Production of keyinterleukins
The key components of the developing immune system and susceptibility to allergic disease (see text for details).
Recommended reading West CE, Videky D, Prescott SL: Role of diet in the development of immune tolerance in the context of allergic disease. Curr Opin Pediatr 2010;22:635–641.
© 2011 S. Karger AG, Basel Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Accessibleonline at: www.karger.com/anm
Ann Nutr Metab 2011;59(suppl 1):28–42 DOI: 10.1159/000334150
Published online: December 21, 2011
Strategies to Prevent or Reduce Allergic Disease
Susan Prescott a Anna Nowak-Węgrzyn b
a b
School of Paediatrics and Child Health Research, University of Western Australia, Perth, W.A., Australia; Department of Pediatrics and Jaffe Food Allergy Institute,Mount Sinai School of Medicine, New York, N.Y., USA
Key Messages
• • •
•
A number of factors associated with modern (westernised) lifestyle that may be causally linked with allergic disease have been identified, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have promptedstrategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventative merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate and vitamin D are also currently under investigation. Current...
It is evident that a broad range of host and environmental factors interact during early development to influence patterns of immune response
Ann Nutr Metab 2011;59(suppl 1):28–42
Strategies to Prevent or Reduce Allergic Disease by Susan Prescott and Anna Nowak-Węgrzyn
Key insights Studies suggest that certain ‘western lifestyle’ factors, modern dietary changes and environmentalpressure are causally linked to many infant/childhood allergic diseases; however, guidelines remain limited. Prevention shifts to earlier introduction of antigens and supplementation to promote immune tolerance rather than the maintenance of overly hygienic conditions. Current knowledge The increasing prevalence of food allergens and differences in the disease profile require a better understandingof the triggers of immune responses, i.e. the environmental, genetic and/ or epigenetic factors, so that effective prevention strategies can be derived. Little evidence supports the benefit of allergen avoidance, thus, the focus is on immunomodulatory prevention strategies. In allergy-prone children, clear differences in the early development of the immune system exist. Restoring microbial anddietary balance as well as understanding the roles of breastfeeding and hypoallergenic infant formula is the main strategy used today to reduce allergic disease and increase tolerance to allergenic foods. Practical implications Increasing rates of food allergy and eczema, plus the already substantial burden of asthma and respiratory allergic diseases, require a concerted long-term strategy to addressthese challenges. Supplementation, complementary foods and/or the early introduction of allergenic foods may play a modulatory role in allergic disease; trials are ongoing. When available, the data should support clearer recommendations.
Risk for developing atopic disease Perinatal differences in T cell function, innate immune function; trajectory of innate development Delayed postnataldevelopment of immune competence Hygiene hypothesis Postnatal maturation kinetics of CD4 T cells highly variable Adaptive immunity High proportion of immature T cells/ low proportion of mature T cells Capacity to produce cytokines Production of IFNCapacity to express sustained responses to mitogens Innate immunity Monocyte responsiveness Dendritic cell capacity to elicit T cells Production of keyinterleukins
The key components of the developing immune system and susceptibility to allergic disease (see text for details).
Recommended reading West CE, Videky D, Prescott SL: Role of diet in the development of immune tolerance in the context of allergic disease. Curr Opin Pediatr 2010;22:635–641.
© 2011 S. Karger AG, Basel Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Accessibleonline at: www.karger.com/anm
Ann Nutr Metab 2011;59(suppl 1):28–42 DOI: 10.1159/000334150
Published online: December 21, 2011
Strategies to Prevent or Reduce Allergic Disease
Susan Prescott a Anna Nowak-Węgrzyn b
a b
School of Paediatrics and Child Health Research, University of Western Australia, Perth, W.A., Australia; Department of Pediatrics and Jaffe Food Allergy Institute,Mount Sinai School of Medicine, New York, N.Y., USA
Key Messages
• • •
•
A number of factors associated with modern (westernised) lifestyle that may be causally linked with allergic disease have been identified, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have promptedstrategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventative merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate and vitamin D are also currently under investigation. Current...
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