Nieto Antonio, Wahn Ulrich, Bufe Albrecht, Eigenmann Philippe, Halken Susanne, Hedlin Gunilla, Høst Arne, Hourihane Jonathan, Just Jocelyne, Lack Gideon, Lau Susanne, Matricardi Paolo Maria, Muraro Antonella, Papadopoulos Nikos, Roberts Graham, Simpson Angela, Valovirta Erkka, Weidinger Stephan, Wickman Magnus, Mazon Angel
Pediatric Pulmonology and Allergy Unit, Children's Hospital La Fe, Instituto de Investigacion La Fe, Valencia, Spain.
Pediatr Allergy Immunol. 2014 Oct;25(6):516-33. doi: 10.1111/pai.12272.
Asthma and allergic diseases have become one of the epidemics of the 21st century in developed countries. Much of the success of other areas of medicine, such as infectious diseases, lies on preventive measures. Thus, much effort is also being placed lately in the prevention of asthma and allergy. This manuscript reviews the current evidence, divided into four areas of activity. Interventions modifying environmental exposure to allergens have provided inconsistent results, with multifaceted interventions being more effective in the prevention of asthma. Regarding nutrition, the use of hydrolyzed formulas in high-risk infants reduces the incidence of atopic dermatitis, while there is for now not enough evidence to recommend other dietary modifications, prebiotics, probiotics, or other microbial products. Pharmacologic agents used until now for prevention have not proved useful, while there is hope that antiviral vaccines could be useful in the future. Allergen-specific immunotherapy is effective for the treatment of allergic patients with symptoms; the study of its value for primary and secondary prevention of asthma and allergy is in its very preliminary phases. The lack of success in the prevention of these disorders lies on their complexity, which involves many genetic, epigenetic, and environmental interactions. There is a need to identify target populations, involved mechanisms and interactions, and the best interventions. These must be effective, feasible, implementable, and affordable.
哮喘和过敏性疾病已成为21世纪发达国家的流行病之一。医学其他领域（如传染病）的许多成功都依赖于预防措施。因此，近来在哮喘和过敏的预防方面也投入了大量精力。本手稿回顾了当前的证据，分为四个活动领域。改变环境中过敏原暴露的干预措施效果不一，多方面的干预措施在预防哮喘方面更有效。在营养方面，高危婴儿使用水解配方奶粉可降低特应性皮炎的发病率，而目前尚无足够证据推荐其他饮食调整、益生元、益生菌或其他微生物产品。目前用于预防的药物尚未证明有效，而抗病毒疫苗有望在未来发挥作用。变应原特异性免疫疗法对有症状的过敏患者有效；其对哮喘和过敏一级和二级预防价值的研究尚处于非常初步的阶段。预防这些疾病缺乏成效在于其复杂性，涉及许多基因、表观遗传和环境相互作用。有必要确定目标人群、相关机制和相互作用以及最佳干预措施。这些措施必须有效、可行、可实施且经济实惠。
