【正文】 7 weeks) ? Tolerance has been maintained for 1 year _______________ Zapatero et al 2022 42 Oral Tolerance Induction to Milk, Egg, and Peanut ? 36% of children with IgEmediated allergy to cow’s milk and hen’s egg developed permanent tolerance of the foods after a median 21 months specific oral tolerance induction (SOTI)1 ? 4 peanutallergic children underwent SOTI: ? Daily doses of peanut flour starting at 5 mg peanut protein ? 2weekly dosage increase up to 800 mg protein ? All subjects tolerated at least 10 whole peanuts ( g protein) on postintervention challenge2 ______________ 1Staden et al 2022 ______________ 2Clark et al 2022 43 Progression of Peanut Allergy ? Peanut allergy, like many early food allergies, can be outgrown ? In 2022 pediatric allergists in the . reported that about per cent of children will eventually outgrow their peanut allergy1 ? Those with a mild peanut allergy, as determined by the level of peanutspecific IgE in their blood, have a 50% chance of outgrowing the allergy2 ? Only about 9% of patients are reported to outgrow their allergy to tree nuts3 __________________ 1Skolnick et al 2022 2Fleischer et al 2022 3Fleischer et al 2022 44 Maintaining Tolerance of Peanut ? When there is no longer any evidence of symptoms developing after a child has consumed peanuts, it is preferable for that child to eat peanuts regularly, rather than avoid them, in order to maintain tolerance to the peanut ? Children who outgrow peanut allergy are at risk for recurrence, but the risk has been shown to be significantly higher for those who continue to avoid peanuts after resolution of their symptoms _________________ Fleischer et al 2022 45 Probiotics and Allergy Prevention ? Probiotics and prebiotics may change the colonic microflora of the neonate ? Theory: ? Change from Th2 to Th1 response in the neonatal period is required to reduce potential for allergy ? This change is mediated by contact with microanisms ? Nonallergic children have a predominance of lactobacilli and bifidobacteria ? Atopic children tend to have more clostridia and lower levels of bifidobacteria ? Probiotics could be used to change the “atopic” to a more “nonatopic flora” ____________ Ozdemir 2022 46 Studies on Probiotics in Allergy Prevention ? Some studies indicate a positive oute in reducing the incidence of allergy: ? Lactobacillus F19 in cereals fed to infants from 4 to 13 months of age reduced the incidence of eczema1 ? Other studies showed no effect: ? Bifidobacterium + Lactobacillus rhamnosus daily for the first 6 months in at risk infants had no effect pared to placebo2 ____________________ 1 West et al 2022 ___________________ 2 Soh et al 2022 47 Current Status of Probiotics in Allergy Prevention ? Beneficial effects of probiotic therapy depends on: ? Type of bacteria selected ? Dosage of the bacteria delivered to the digestive tract ? Method of delivery of the bacteria to the GI tract (in formulae。 in cereals) ? Age of the individual ? Length of duration of delivery ? Conclusion at the current state of research: ? Probiotics cannot be remended generally for primary prevention of atopic disease _____________ Ozdemir 2022a 48 Take Home Message ? Allergy prevention emphasizes inducing tolerance rather than avoiding sensitization ? Beginning of tolerance to foods may occur in utero or during breastfeeding ? Restriction of maternal diet to avoid highly allergenic foods during pregnancy or lactation is contraindicated ? Unless either mother or baby is allergic to them 49 Take Home Message ? Management of established food allergy includes: ? Accurate identification of the allergenic food(s) ? Careful avoidance of the food allergens – especially if there is any risk of anaphylaxis ? Avoidance of unnecessary food restrictions 50 Take Home Message ?Provision of plete balanced nutrition by substituting foods of equal nutritional value ?Monitoring the child’s response at intervals to determine when the food allergy has been outgrown ?Maintenance of tolerance by feeding tolerated foods regularly 51 Invitation to Further Information Joneja, Dealing with Food Allergies in Babies and Children Bull Publishing Company, Boulder, Colorado. October 2022