Paediatric Allergology, Kidsallergy Paediatric and Allergy Centre, Cape Town, South Africa.
Yale J Biol Med. 2020 Dec 29;93(5):689-698. eCollection 2020 Dec.
: There has been a rapid rise in allergic disorders across the globe. This has increased research into the determinants of allergy development, to identify factors that may be manipulated to mitigate risk. An opportune window in immunological development appears to exist in early life whereby certain exposures may promote or prevent the development of an allergic disposition. Furthermore, factors that affect the composition and diversity of the microbiome in early life have been explored. In this review, we discuss current literature and recommendations relating to exposures that may prevent allergy development or promote tolerance. : Delivery by caesarean section, omission of breastfeeding, vitamin D insufficiency, and environmental exposures, such as cigarette smoke exposure, all increase the risk of an allergic predisposition. Dietary diversity during pregnancy, lactation, and in infancy is protective. Breastfeeding for at least 4 months reduces the risk of eczema. Recommendations for food-allergen exposure has shifted from delayed introduction to early introduction as a tolerance-inducing strategy. Supplements such as probiotics and vitamins during pregnancy and infancy have yet to produce conclusive results for allergy prevention. Emollient use in infancy has not been shown to be protective against eczema or food allergy.
: 全球范围内过敏疾病的发病率迅速上升。这促使人们对过敏发展的决定因素进行了更多的研究,以确定可能被操纵的因素来降低风险。在生命早期的免疫发育过程中,似乎存在一个适宜的窗口期,某些暴露可能促进或预防过敏倾向的发展。此外,还探索了影响生命早期微生物组组成和多样性的因素。在这篇综述中,我们讨论了与可能预防过敏发展或促进耐受的暴露相关的当前文献和建议。 : 剖宫产、母乳喂养中断、维生素 D 不足以及环境暴露(如吸烟)都会增加过敏易感性的风险。妊娠、哺乳期和婴儿期的饮食多样化具有保护作用。至少母乳喂养 4 个月可降低特应性皮炎的风险。食物过敏原暴露的建议已经从延迟引入转变为早期引入作为诱导耐受的策略。在妊娠和婴儿期补充益生菌和维生素等补充剂对预防过敏尚未产生明确的结果。在婴儿期使用保湿剂并没有显示出对特应性皮炎或食物过敏的保护作用。