School of Paediatrics and Child Health Research, University of Western Australia, Perth, WA 6840, Australia.
Ann Nutr Metab. 2011;59 Suppl 1:28-42. doi: 10.1159/000334150. Epub 2011 Dec 21.
The need for allergy prevention strategies has never been greater. Surging rates of food allergy and eczema are now adding to the already substantial burden of asthma and respiratory allergic diseases. The parallel rise in many other immune diseases suggests that the developing immune system is highly vulnerable to modern environmental changes. These strong environmental pressures may be one reason why simple allergen avoidance strategies have not been successful. Another more recent strategy to curtail the allergy epidemic has been to identify factors associated with modern lifestyle that may be causally linked with allergic disease, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have prompted strategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventive 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. Modern environmental pollutants have also been associated with adverse effects on immune development and the risk of disease. While many of these avenues have provided some promise, they have not yet translated into specific recommendations. Current evidence-based guidelines for allergy prevention remain limited to avoidance of cigarette smoke, promotion of breastfeeding and the use of hydrolysed formula when breastfeeding is not possible. Allergen avoidance strategies have been largely removed from most guidelines. It is hoped that a number of ongoing studies will help provide clearer recommendations around the use of probiotics, prebiotics, specific dietary nutrients and the role of early introduction of allergenic foods for the promotion of tolerance. Despite the current uncertainties, prevention remains the best long-term strategy to reduce the growing burden of allergic disease.
预防过敏策略的需求从未如此之大。食物过敏和湿疹的发病率不断上升，使得哮喘和呼吸道过敏性疾病的负担已经相当沉重。与此同时，许多其他免疫性疾病的发病率也在上升，这表明发育中的免疫系统非常容易受到现代环境变化的影响。这些强烈的环境压力可能是简单的过敏原回避策略未能成功的原因之一。另一种最近的策略是确定与现代生活方式相关的因素，这些因素可能与过敏性疾病有因果关系，试图在早期发育过程中恢复更有利于免疫耐受的条件。更卫生的条件和微生物暴露的中断促使人们使用益生菌和益生元补充剂来恢复这种平衡。与过敏性疾病相关的现代饮食变化促使人们进行补充剂研究，以评估特定免疫调节饮食营养素（如多不饱和脂肪酸）的预防功效。其他营养素，如抗氧化剂、叶酸和维生素 D，也正在研究中。现代环境污染物也与免疫发育不良和疾病风险增加有关。虽然这些途径中的许多都提供了一些希望，但它们尚未转化为具体的建议。目前预防过敏的循证指南仍然仅限于避免吸烟、提倡母乳喂养以及在无法母乳喂养时使用水解配方。过敏原回避策略在大多数指南中已基本被删除。人们希望正在进行的许多研究将有助于围绕益生菌、益生元、特定饮食营养素的使用以及早期引入过敏原食物以促进耐受提供更明确的建议。尽管目前存在不确定性，但预防仍然是减轻不断增长的过敏疾病负担的最佳长期策略。
