Allergies in children: primary prevention through the determination of at-risk populations

In the case of primary prevention of childhood allergies, before adopting measures at the environmental level, it is important to identify populations at risk, warned Dr. Jocelyne Just (Armand Trousseau Hospital, Paris).

"The increase in the prevalence of asthma and allergies is related to a complex phenomenon involving amplifiers and the disappearance of protective factors, for which, however, must not lead to the against-messages," the Dr. Just.

According to her, it is important to determine the populations of children at risk by tracing the history of the disease in one or both parents, allergic (food allergy, eczema, rhinitis or asthma) and establishing a concept of atopy family.

"Primary prevention is then passed through the absolute rejection of passive smoking. Should, however, continue to vaccinate children (no vaccination does not protect against allergy, contrary to popular belief)," observes the specialist.

The decrease in allergen load is not obvious, she says, whether the sometimes controversial eviction of mites, as the attitude to adopt vis-à-vis the dogs and cats, while it will be resolved in secondary prevention. "For dust mites, a study has shown, in fact, that we were more exposed to it during the first 6 months of life, the less danger of developing allergies," she says.

About exposure to cats and dogs, primary prevention is more difficult to implement. "High exposure (presence of several pets in the same household) or, conversely, low, cause a potentially protective effect, while an average exposure promote the development of allergies, knowing that everything depends on the number animals present in a house and vent it, as well as genetic polymorphism. In this case, it is impossible to decide at least to establish a genetic map of each child ", noted the Dr. Just.

In terms of childcare in the community, she says, "an early entry into kindergarten before the age of one year to protect allergen sensitization but not hay fever, or asthma, knowing, moreover, that respiratory syncytial virus (RSV) causes epidemics of bronchiolitis, reveals itself no protector among predisposed patients. "

Finally, the contribution of probiotics in the diet could have, again, a protective effect against allergic sensitization, primary prevention, as well as the ouster of certain foods (eggs, peanuts), in the case of family atopy .

It is often a combination of different measures provides meaningful results. Such is the case of the reduction of the burden of mites combined with dietary intervention that has, in a population of children aged 18 months to reduce the hiss (but not asthma, however), illustrates the allergist based on the results of a study. Another showed a reduction of allergen sensitization, wheezing and asthma in older children (8 years) through a combination of several measures such as breastfeeding and the use of acaricides and dust mite covers.