ALLERGEN AVOIDANCE IN INFANCY AND ALLERGY AT 4 YEARS OF AGE

In an attempt to prevent or reduce the manifestations of atopic diseas e, a group of infants considered to be genetically at high risk of ato py was entered in a prenatally randomized, controlled study. A prophyl actic group (n=58) was either breast-fed with their mothers excluding foods regarded as highly antigenic from their diets, or given an exten sively hydrolysed formula. In addition, strenuous efforts were made to reduce exposure to the house-dust mite by application of acaricide to the bedroom and living room carpets and upholstered furniture. A cont rol group (n=62) was fed conventionally by breast or on formula, and n o specific environmental measures were taken. The results (previously reported) after 1 year showed significantly less total allergy, asthma , and eczema in the prophylactic group. Similar results were obtained at 2 years although the reduction in asthma no longer achieved statist ical significance. However, there was significantly less sensitization , as shown by a battery of skin prick tests (SPTs), to both dietary al lergens and aeroallergens in the prophylactic group. All the children have now been reviewed at the age of 4 years, and SPTs to a wide range of dietary allergens and aeroallergens have been performed. The contr ol group continues to show more total allergy (odds ratio [OR] 2.73, 9 5% confidence interval [CI] 1.21-6.13, P<0.02), definite allergy (alle rgic symptoms plus positive SPT) (OR 5.6, CI 1.8-17.9, P<0.005), and e czema (OR 3.4, CI 1.2-10.1, P<0.05). More control children have positi ve SPTs (OR 3.7, CI 1.3-10.0, P<0.02). A dual approach to the preventi on of allergic disease, avoiding as far as possible sensitization to f ood and aeroallergens, significantly reduces the risk of atopic diseas e. This should be reserved for infants considered at very high risk of atopy, and close medical and dietetic supervision must be available. (C) Munksgaard 1996.