The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies
The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies
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DOI：
10.1111/j.1399-3038.2008.00718.x
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发表时间：
2008-08-01
影响因子：
4.4
通讯作者：
Makrides, Maria
中科院分区：
文献类型：
--
作者：
Prescott, Susan L.;Smith, Peter;Makrides, Maria
儿童早期食物过敏率的上升反映了早期免疫耐受机制的失败。越来越多的人担心，目前推荐的将辅食推迟到6个月大的做法可能会增加而不是减少免疫系统疾病的风险。对食物过敏原的耐受性似乎是由在发育的“关键早期窗口”期间定期早期暴露于这些蛋白质驱动的。虽然这个窗口的时间在人类中并不清楚，但目前的证据表明，这最有可能是在生命的4至6个月之间，并且超过这一时期的延迟暴露可能会增加食物过敏，腹腔疾病和胰岛细胞自身免疫的风险。还有证据表明，其他因素，如有利的殖民化和持续的母乳喂养，促进了容忍，并在开始补充喂养的这段时间内具有保护作用。这篇讨论论文探讨了对目前建议推迟补充食品作为预防过敏性疾病的一种方法的关注的基础。它还将审查越来越多的情况，从大约4个月大开始引入补充食品，并在这一早期喂养期间保持母乳喂养，如果可能的话，至少6个月。
Rising rates of food allergies in early childhood reflect increasing failure of early immune tolerance mechanisms. There is mounting concern that the current recommended practice of delaying complementary foods until 6 months of age may increase, rather than decrease, the risk of immune disorders. Tolerance to food allergens appears to be driven by regular, early exposure to these proteins during a 'critical early window' of development. Although the timing of this window is not clear in humans, current evidence suggests that this is most likely to be between 4 and 6 months of life and that delayed exposure beyond this period may increase the risk of food allergy, coeliac disease and islet cell autoimmunity. There is also evidence that other factors such as favourable colonization and continued breastfeeding promote tolerance and have protective effects during this period when complementary feeding is initiated. This discussion paper explores the basis for concern over the current recommendation to delay complementary foods as an approach to preventing allergic disease. It will also examine the growing case for introducing complementary foods from around 4 months of age and maintaining breastfeeding during this early feeding period, for at least 6 months if possible.