Ng Pauline Poh-Lin Chan, Tham Elizabeth Huiwen, Lee Bee-Wah
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.
Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore.
Allergy Asthma Immunol Res. 2023 Jul;15(4):419-436. doi: 10.4168/aair.2023.15.4.419.
The allergy epidemic has been attributed to environmental influences related to urbanization and the modern lifestyle. In this regard, various theories exploring the role of microbes (hygiene, old friends, microbiota, and biodiversity hypotheses), and the epithelial barrier (epithelial, dual allergen exposure and vitamin D hypotheses) have been proposed. These hypotheses have guided clinical studies that led to the formulation of intervention strategies during the proposed window of opportunity dubbed as the "first thousand days." The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. Other strategies with less robust clinical evidence include: encouraging a healthy balanced diet, rich in fish, during pregnancy; continuing allergenic food intake during pregnancy and lactation; vitamin D supplementation in pregnant women with asthma; discouraging social indications for caesarean section delivery; judicious use of antibiotics in early childhood; daily emollient use from birth in high risk babies; and avoiding cow's milk formula use in the first week of life. However, if early supplementation with cow's milk formula is required, continuing at least 10 mL of formula daily until age 2 months may be considered. Translating these strategies to public health and clinical practice is still a work in progress. Long-term population studies are crucial to assess the feasibility of these measures on allergy prevention.
过敏症的流行被认为与城市化和现代生活方式相关的环境影响有关。在这方面，人们提出了各种理论来探讨微生物的作用（卫生假说、老朋友假说、微生物群假说和生物多样性假说）以及上皮屏障的作用（上皮假说、双重过敏原暴露假说和维生素D假说）。这些假说指导了临床研究，从而在被称为“生命最初一千天”的建议机会窗口期间制定了干预策略。最显著的干预措施是一种范式转变，即从避免接触过敏原转变为在大约6个月大时尽早引入致敏食物，特别是鸡蛋和花生，以预防食物过敏。这一建议已在全球范围内被采纳，并被纳入过敏预防指南。其他临床证据不太充分的策略包括：鼓励孕妇在孕期保持健康的均衡饮食，多吃鱼；在孕期和哺乳期持续摄入致敏食物；对患有哮喘的孕妇补充维生素D；不鼓励因社会因素进行剖宫产；在幼儿期谨慎使用抗生素；对高危婴儿从出生起每天使用润肤剂；以及在出生后第一周避免使用牛奶配方奶。然而，如果需要早期补充牛奶配方奶，可以考虑持续每天至少摄入10毫升配方奶直至2个月大。将这些策略转化为公共卫生和临床实践仍在进行中。长期的人群研究对于评估这些预防过敏措施的可行性至关重要。
