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 in her child 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, asthma, allergic rhinitis, 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.
Types of prevention — There are three types of allergy prevention :
●Primary prevention, which blocks the initial immunologic sensitization (ie, the development of IgE specific to an allergen).
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