【正文】 specifically: ? Cow’s milk allergy ? Eczema ? Reduction or prevention of early food allergy by breastfeeding does not seem to have longterm effects on the development of asthma and allergic rhinitis ? Other benefits of breastfeeding far outweigh any possible negative effects on allergy: exclusive breastfeeding for 46 months is strongly encouraged 27 Summary of 2022 AAP Guidelines for Allergy Management [Greer et al 2022] ? There is no convincing evidence that women who avoid highly allergenic foods, or other foods during pregnancy and breastfeeding lower their child’s risk of allergies ? For highrisk for allergy infants (one firstdegree relative with established allergy), exclusive breastfeeding for at least 4 months prevents or delays the occurrence of atopic dermatitis (eczema), cow’s milk allergy, and wheezing in early childhood _____________ Greer et al 2022 ____________________ Sicherer and Burks 2022 28 Preventive Effect of Breastfeeding: KOALA Study ? Longer duration of breastfeeding is associated with lower risk for eczema in nonatopic mothers ? Slightly lower risk for mothers with allergy but no asthma ? Longer duration of breastfeeding reduced risk for wheezing in infants: possibly due to reduction in respiratory infections ? There is a lack of evidence that exclusive or prolonged breastfeeding has any positive effect on the development of asthma in older children ___________________________ Snijders et al 2022 KOALA study 29 Summary of 2022 AAP Guidelines continued ? In infants at high risk for allergy who are not exclusively breastfed for 46 months there is modest evidence that the onset of atopic disease (allergy), especially eczema, may be delayed or prevented by the use of hydrolyzed formulas ? There is no good evidence that soybased infant formulas have any preventive effect on the development of allergy 30 Preventive Effect of Hydrolyzed Infant Formulae ? No evidence of any reduction in allergy with hydrolyzed formula pared to breastfeeding ? Limited evidence that prolonged feeding with hydrolyzed formula pared to cow’s milk reduces incidence of CMA and eczema ? No evidence that hydrolyzed formulas have any effect on the development of rhinitis and asthma later ? Extensively hydrolyzed cow’s milk (Ehf) formulas marginally better than partially hydrolyzed whey (Phf) in prevention _________________________________ Osborn and Sinn 2022 Cochrane Review __________________________ Von Berg et al GINI Study 2022 31 Infant Formulae for the Allergic Baby Current Remendations ? Cow’s milk based formula if there are no signs of milk allergy ? Partially hydrolysed (phf) wheybased formula if there are no signs of milk allergy in high risk for allergy group ? Extensively hydrolysed (ehf) casein based formula if milk allergy is proven _________________ Greer et al AAP 2022 Von Berg et al 2022 32 Remendations for Introduction of Solids to High Risk for Allergy Infants ? Little evidence that delaying the introduction of plementary foods beyond 46 months of age prevents allergy ? Introduction of solid foods should be individualized ? Foods should be introduced one at a time in small amounts ? Mixed foods containing various potential food allergens should not be given unless tolerance to each ingredient has been assessed ____________________ Greer et al AAP 2022 _____________________ Thygaran and Burks 2022 33 Introduction of Solid Foods in Relationship to Celiac Disease ? Results suggest that in high risk for celiac disease infants introduction of glutencontaining grains before 3 months or after 7 months increases incidences of development of CD1 ? Introduction of gluten while breastfeeding offers protection or delays onset of celiac disease in atrisk infants2 ? Remendations: ? Introduce gluten grains in small amounts between 4 and 6 months while infant is breastfed ? Continue breastfeeding for a further 23 months ? Similar results for wheat allergy3 _______________ 1Norris et al 2022 ______________ 2Guandalini 2022 ____________ 3Poole et al 2022 34 Introduction of Peanuts ? Directives from pediatric societies (1998 2022) remended avoidance of peanuts by mothers during pregnancy and lactation, and delaying introduction of peanuts until aft