Food Allergy Prevention and Treatment by Targeted Nutrition
Food Allergy Prevention and Treatment by Targeted Nutrition
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DOI：
10.1159/000487380
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发表时间：
2018-01-01
影响因子：
3.9
通讯作者：
Heine, Ralf G.
中科院分区：
文献类型：
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作者：
Heine, Ralf G.
鉴于全球食物过敏患病率的急剧上升，有效的预防策略已成为公共卫生的优先事项。围绕食物过敏的病因学已经出现了几种模型，包括卫生假说，双重过敏原暴露假说和维生素D假说。这些构成了当前和潜在预防战略的基础。母乳喂养仍然是初级过敏预防的关键支柱。其他营养干预措施，包括在非母乳喂养的婴儿中使用以乳清为基础的部分水解配方奶粉，也发挥着重要作用。近年来，已经从长期避免食物过敏原转变为从4个月大开始主动引入过敏原。这种方法得到了2项关键随机临床试验的支持，这些试验表明，早期引入花生和其他食物过敏原可显著降低食物过敏的风险。然而，在人口水平上实施这一战略仍然会引起重大的后勤问题，包括患者的选择和为幼儿开发合适的食物形式。目前正在评估其他预防战略，包括补充维生素D。不建议在妊娠期和哺乳期使用消除饮食来预防过敏。食物过敏的治疗也发生了重大变化。虽然严格避免过敏原仍然是关键的治疗原则，但人们更加关注口服和表皮免疫疗法的脱敏和耐受诱导。此外，专门用于治疗牛奶过敏婴儿的低过敏性婴儿配方奶粉经过了重新配制，包括添加乳糖和益生菌，以调节肠道微生物组和早期免疫反应。需要进一步的研究来为人群水平上最有效的食物过敏预防策略提供信息。此外，更广泛地应用食物过敏原免疫疗法可以为受食物过敏影响的家庭提供更好的健康结果和改善的生活质量。(c)2018 S. Karger AG，巴塞尔
In view of the dramatic rise in the prevalence of food allergy globally, effective prevention strategies have become a public health priority. Several models have emerged around the etiology of food allergy, including the hygiene hypothesis, dual allergen exposure hypothesis, and vitamin D hypothesis. These form the basis for current and potential prevention strategies. Breastfeeding remains a key pillar of primary allergy prevention. Other nutritional interventions, including the use of whey-based, partially hydrolyzed formula in non-breastfed infants, also play an important role. In recent years, there has been a shift away from prolonged food allergen avoidance to the proactive allergen introduction from 4 months of age. This approach is supported by 2 pivotal randomized clinical trials showing that the early introduction of peanut and other food allergens significantly reduces the risk of food allergy. However, the implementation of this strategy at the population level still raises significant logistic problems, including patient selection and development of suitable food formats for young infants. Other prevention strategies, including vitamin D supplementation, are currently under evaluation. Maternal elimination diets during pregnancy and lactation are not recommended for allergy prevention. The treatment of food allergies has also seen major transformations. While strict allergen avoidance is still the key treatment principle, there is a greater focus on desensitization and tolerance induction by oral and epicutaneous immunotherapy. In addition, specialized hypoallergenic infant formulas for the treatment of infants with cow's milk allergy have undergone reformulation, including the addition of lactose and probiotics in order to modulate the gut microbiome and early immune responses. Further research is needed to inform the most effective food allergy prevention strategies at the population level. In addition, the wider application of food allergen immunotherapy may provide better health outcomes and improved quality of life for families affected by food allergies. (c) 2018 S. Karger AG, Basel