【正文】 er 2 or even 3 years of age ? Research indicates that incidence of peanut allergy in children rose dramatically in the years following release of these directives ? Recent research suggests: ? Avoidance of peanuts reduced development of tolerance ? Early exposure leads to reduced incidence of peanut allergy _________________ Hourihane et al 2022 35 Introduction of Peanuts Study (n=10,786) among primary school age Jewish children in UK and Israel ? Prevalence of peanut allergy (PA): ? In UK: % ? In Israel: % ? Median monthly consumption of peanut in infants aged 8 – 14 months: ? In UK: 0 ? In Israel: g ? Difference not due to atopy, geic background, social class, or peanut allergenicity ? Israeli infants consume peanuts in high quantities during the first year of life ______________ Du Toit et al 2022 36 Introduction of Fish ? Historically, fish consumption during infancy was considered to be a risk factor for allergy ? Recent research indicates otherwise: ? Regular fish consumption during the first year of life associated with a reduced risk for allergic disease by age 4 years (n=4089)1 ? Babies of mothers who frequently consumed fish (23 times per week or more) during pregnancy had one third less food sensitivities than those whose mothers did not consume fish during pregnancy2 _____________ 1Kull et al 2022 _______________ 2Calvani et al 2022 37 Introduction of Fish Study (n= 5,000)。 Infant Food Allergies Where Are We Now? Janice Joneja ., RD 2 Food Allergy in the Past 7 Years ? Nearly 4% of North Americans have food allergies, many more than recorded in the past ? Incidence of food allergy much higher in children (8%) than adults (2%) ? Prevalence of peanut allergy doubled in American children younger than 5 years of age in the years 2022 2022 3 Food Allergy in the Past 7 Years ? Prevalence of food allergy highest in infants and toddlers ? Cow’s milk allergy incidence: % of infants ? Up to 8% of children under 3 years have allergy to a limited number of foods: ? Cow’s milk ? Wheat ? Egg ? Shellfish ? Soy ? Fish ? Peanut ? Tree nuts ? For every child who actually had a food allergy, over three more children were believed wrongly by their parents to suffer from the condition ______________ Venter et al 2022 4 Age Relationship Between Food Allergy and Atopy 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age (in years) 0 Relative Incidence Asthma Rhinitis Eczema Food Allergy Anaphylaxis Effect of Food Allergens Effect of Airborne Allergens 5 Historical Perspective ? Sensitization to food allergens was thought to be the start of the “allergic march” Food allergy Atopic dermatitis/eczema Asthma Rhinitis ? Reducing sensitization to foods was therefore considered the essential first step in allergy prevention 6 Historical Perspective ? Measures of prevention were all designed to avoid sensitization to allergens during what were considered the most vulnerable periods: ? Intrauterine life ? From birth to 23 years ? This meant reduction in exposure to highly allergenic foods: ? Mother’s diet during pregnancy and lactation ? Delay in introduction of highly allergenic foods during weaning ? In spite of these stringent measures to prevent allergy, incidence of all types of allergies have increased significantly 7 Change in Direction During the Past Five Years ? Understanding of the importance of immunological sensitization and tolerance ? Recognition that tolerance not sensitization is the critical step in allergy prevention ? Finding that exposure to the allergenic food at an optimum stage is probably a critical step in allergy prevention ? Recognition that tolerance can be induced after allergy has been established – leading to important measures for allergy management 8 Allergy is a Response of the Immune System ? Our immune systems are designed to protect the body from invasion by foreign materials ? All foods contain proteins – derived from plants and animals – all of which are foreign to the human body ? In order for food to be absorbed, metabolized, and utilized by the body, the immune system needs to be “educated” that the f