【正文】 % developed eczema by 1 year: ? Babies who were fed fish before nine months of age were 24% less likely to develop eczema by age 1 year ? Omega3 content of fish did not seem to influence the oute ? The age at which egg and milk were introduced did not affect development of eczema ? Breastfeeding did not have any significant impact on development of eczema ____________ Alm et al 2022 ____________________________ Hibbeln et al 2022 ALSPAC study 38 The Natural History of Food Allergy ? Food allergy most often begins in the first 1 to 2 years of life ? Child is sensitized to the food protein by the immune system developing allergenspecific IgE to that protein ? Sensitization does not necessarily mean that the child will develop symptoms when that food is eaten ? Over time most food allergy is lost _________ Wood 2022 39 Prognosis ? Most children outgrow early food allergy ? John’s Hopkins Children’s Center USA ? Milk allergy outgrown: ? 20% by 4 years ? 42% by 8 years ? 79% by 16 years ? Egg allergy outgrown: ? 4% by 4 years ? 37% by 10 years ? 68% by 16 years ? Allergy to some foods more often than others persists into adulthood: ? Peanut ? Tree nuts ? Seeds ? Shellfish ? Fish ______________ Skripak et al 2022 40 Induction of Oral Tolerance ? Tolerance to a specific food can be induced by oral administration of the offending food by process of “l(fā)ow dose continuous exposure” ? Designated (SOTI: specific oral tolerance induction) ? Starting with very low dosages ? Gradually increasing daily dosage up to the equivalent of the usual daily intake ? Followed by daily maintenance dose __________________ Niggemann et al 2022 _____________ Calvani et al 2022 41 Desensitization to Cow’s Milk ? 18 children with confirmed CMA 4 years of age underwent SOTI ? Starting dose ml cow’s milk ? Increased to 1 ml on first day ? Increasing dosage weekly up to a daily dose of 200250 ml ? Results: 16/18 tolerated 200250 ml milk ? Length of process median 14 weeks (range 1117 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 P