foodallergiesinchildren-allergy,nutrition：兒童過敏的食物過敏，營養(1)(編輯修改稿)

　

【文章內容簡介】 (. RANTES) ? Atopic infants do not seem to be protected from allergy by the breast milk of atopic mothers ___________________________ Snijders et al 2022 KOALA study 25 Immunological Factors in Human Milk that may be Associated with Allergy: TGF?1 ? Cytokine, transforming growth factor?1 (TGF?1) promotes tolerance to food ponents in the intestinal immune response ? TGF?1 in mother’s colostrum may influence the type and intensity of the infant’s response to food allergens ? A normal level of TGF?1 is likely to facilitate tolerance to food encountered by the infant in mother’s breast milk and later to formulae and solids ______________ Rigotti et al 2022 26 Implications of Research Data ? Exclusive breastfeeding with exclusion of mother’s and baby’s allergens will reduce signs of allergy in the first 12 years。 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 Re