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LIM SL Zerlina,LEE Bee Wah,SHEK PC Lynette,LIM L Dawn,VAN BEVER Hugo 대한 소아알레르기 호흡기학회 2008 Allergy Asthma & Respiratory Disease Vol.18 No.1
Food allergies and atopic diseases are on the rise worldwide. There have been several published practice guidelines on the primary prevention of these diseases. One aspect of these guidelines is the recommendations on infant nutrition, as food allergen exposure and other nutritional factors may influence allergen sensitization. This article aims to review the current international recommendations on infant diet and weaning practices in the primary allergy prevention of infants. The conclusions drawn are as follows: (1) Breastfeeding is considered the gold standard for infant nutrition, especially since exclusive breastfeeding confers some protection against the development of allergic diseases. However, large cohort studies have not been carried out in Asian populations. (2) Maternal avoidance of allergenic food substances during pregnancy and lactation has not been proven to reduce the risk of allergies and is not recommended as a primary prevention strategy. (3) Hydrolyzed formulas have not been shown to have an advantage over breastfeeding, although they have some protective value against atopic eczema in at risk infants when compared to regular cows milk based infant formula. (4) Soy formula is also not recommended for prevention of atopic diseases. (5) Weaning to semisolids should be undertaken between the ages of 4 to 6 months as weaning before the age of 4 months is associated with increased of allergy symptoms. (6) The age for introduction of certain highly allergenic foods have been arrived at empirically and included in some guidelines. These comprise the initiation of dairy products at 12 months, eggs at 24 months, and peanuts, nuts and fish at 36 months.
Shellfish and House Dust Mite Allergies: Is the Link Tropomyosin?
Lydia Wong,Chiung Hui Huang,Bee Wah Lee 대한천식알레르기학회 2016 Allergy, Asthma & Immunology Research Vol.8 No.2
Crustacean shellfish allergy is an important cause of food allergy and anaphylaxis in Asia. The major allergen in shellfish allergy is tropomyosin, a pan-allergen that is also found in house dust mites and cockroaches. Tropomyosins from house dust mites (HDMs) have a high sequence homology to shellfish tropomyosins, and cross-reactivity between HDM and shrimp tropomyosins has been demonstrated. Exposure to inhaled tropomyosins from house dust mites has been postulated to be the primary sensitizer for shellfish allergy, in a reaction analogous to the oral allergy (inhalant-food) syndrome. This notion is supported by indirect data from the effects of HDM immunotherapy on shellfish allergy, and strong correlations of shellfish and HDM sensitization. HDM immunotherapy has been reported to induce both shrimp allergy in non-allergic patients and shrimp tolerance in shrimp-allergic patients. Epidemiological surveys have also demonstrated a strong correlation between shellfish and HDM sensitization in both hospital-based and community-based studies. Unexposed populations have also been shown to develop sensitization–shellfish sensitization in orthodox Jews with no history of shellfish consumption was associated with HDM sensitization. Reciprocally, HDM sensitization in an Icelandic population living in a HDM-free environment was associated with shrimp sensitization. In vitro IgE inhibition studies on sera in shrimp-allergic Spanish patients indicate that mites are the primary sensitizer in shrimp-allergic patients living in humid and warm climates. Current data supports the hypothesis that tropomyosin is the link between HDM and shellfish allergies. The role of tropomyosin in HDM and shellfish allergies is a fertile field for investigation as it may provide novel immunotherapeutic strategies for shellfish allergy.
Primary Prevention of Allergy – Is It Feasible?
Ng Pauline Poh-Lin Chan,Tham Elizabeth Huiwen,LEE Bee Wah 대한천식알레르기학회 2023 Allergy, Asthma & Immunology Research Vol.15 No.4
The allergy epidemic has been attributed to environmental influences related to urbanization and the modern lifestyle. In this regard, various theories exploring the role of microbes (hygiene, old friends, microbiota, and biodiversity hypotheses), and the epithelial barrier (epithelial, dual allergen exposure and vitamin D hypotheses) have been proposed. These hypotheses have guided clinical studies that led to the formulation of intervention strategies during the proposed window of opportunity dubbed as the “first thousand days.” The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. Other strategies with less robust clinical evidence include: encouraging a healthy balanced diet, rich in fish, during pregnancy; continuing allergenic food intake during pregnancy and lactation; vitamin D supplementation in pregnant women with asthma; discouraging social indications for caesarean section delivery; judicious use of antibiotics in early childhood; daily emollient use from birth in high risk babies; and avoiding cow’s milk formula use in the first week of life. However, if early supplementation with cow’s milk formula is required, continuing at least 10 mL of formula daily until age 2 months may be considered. Translating these strategies to public health and clinical practice is still a work in progress. Long-term population studies are crucial to assess the feasibility of these measures on allergy prevention.