Primary prevention of allergic disease: Maternal diet in pregnancy and lactation
- David M Fleischer, MD
David M Fleischer, MD
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- University of Colorado Denver School of Medicine
The term "allergy" refers to a hypersensitivity reaction initiated by immunologic mechanisms. The available literature concerning manipulation of a woman's diet in pregnancy or lactation (or both) in an attempt to achieve primary prevention of allergic disease will be reviewed here. The fetus can make immunologic responses to foods and other allergens . It is unclear if these responses represent normal immunologic phenomena, are related to the subsequent development of allergy, or both. The impact of breastfeeding and probiotics on the development of allergic disease and general issues related to food allergen avoidance are presented separately. (See "Management of food allergy: Avoidance" and "The impact of breastfeeding on the development of allergic disease" and "Prebiotics and probiotics for prevention of allergic disease".)
The most prevalent allergic or atopic disorders include atopic dermatitis (AD), asthma, allergic rhinitis (AR), and food allergies. These conditions afflict 20 percent of the population of the United States, and their prevalence is rising in developed nations. The increase in atopic diseases has been recognized as a pandemic, thus emphasizing the need for effective allergy prevention .
Early interventions — Three factors are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s), and environmental factors. Convincing studies support the existence of a critical time early in infancy and possibly even in prenatal life, in which the genetically predisposed atopic infant is at higher risk for becoming sensitized (ie, developing specific immunoglobulin E [IgE] to an allergen) . Therefore, dietary interventions instituted during pregnancy, lactation, and the first year of life have been proposed. These include maternal avoidance of allergenic foods and the addition of certain supplements to the maternal diet.
High-risk infants — Most of the studies examining the effects of maternal avoidance diets during pregnancy and lactation have been performed in "high-risk" populations. An infant's risk for developing allergic disease is based upon the family's atopic history. An infant is defined as "high risk" if there is at least one first-degree relative (parent or sibling) with documented allergic disease. This definition is based upon a consensus among several committees representing the American Academy of Pediatrics (AAP), the joint guidelines of the European Society of Pediatric Allergy and Clinical Immunology (ESPACI), and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) [3,4].
This definition of "high risk" is relatively inclusive. As an example, an infant may be at high risk because the father has AR or because multiple siblings have severe asthma and life-threatening food allergy. These two circumstances are clearly not equivalent. The general nature of this definition ensures that the findings of studies can be applied to significant portions of the general population, although it also introduces some uncertainty about how such findings should be applied to specific individuals.
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