Alamo Asthma & Allergy Associates
Drs. Michael and Adrianne Vaughn

115 Gallery Circle
Suite 200
San Antonio, TX 78258
(Stone Oak MRI/Urgent Care Bldg.)
Tel: 210.499.0033
Fax: 210.404.0926

Prevention of Allergies and Asthma in Children

It has long been known that allergies and asthma tend to run in families. In other words, children in families where one or both parents have allergies or asthma are more likely themselves to develop allergies or asthma. That is why many prevention efforts have been targeted to these children. This information, derived from available scientific studies, may help to delay or, possibly, prevent the onset of allergies and asthma in "at risk" children.

Preventing food allergies

Food allergies in children can cause a variety of problems that range from eczema to lifethreatening allergic reactions. The major strategy for preventing food allergies is to delay exposure to potentially allergenic foods until the gastrointestinal tract has matured. If possible, mothers should breast feed their infants for at least four to six months since newborn infants are more likely to become allergic to foods than older children. Breast milk is much less likely to produce allergic reactions than formula and can strengthen the child's immune system. Food allergens can pass through breast milk and it is recommended that highly allergic foods such as egg, peanut and tree nuts,(and possibly milk products) be avoided while nursing. Infants not being fed with breast milk should be fed partially pre-digested, protein hydrolysate formulas such as Alimentum or Nutramigen rather than milk or soy-based formulas. Infants should not be fed solid foods until they are six months old. When infants are six to 12 months old, vegetables, rice, meat, and fruit can be introduced to their diets. Each food should be introduced one at a time so parents or caregivers can identify and eliminate any foods that cause a reaction. After the child is one year old, milk, wheat, corn, citrus, and soy may be added. At two years of age, the child may have egg. Finally, at age three, fish and peanuts may be introduced.

Preventing environmental allergies and asthma

Since some airborne substances may trigger allergy or asthma symptoms, reducing contact with these substances early in life may delay or prevent the onset of allergy or asthma symptoms. The evidence for this relationship is clearest in the case of dust mites, which are microscopic creatures related to spiders that are found in large quantities inside the home. Therefore, taking steps to aggressively control dust mites in the homes of high risk children may reduce the occurrence of dust mite allergy in these children. These steps include using zippered clust mite proof covers on pillows and mattresses and washing all bedding in hot water every seven to ten days. Indoor relative humidity should be kept below 50 percent and, optimally, carpets, upholstered furniture, or objects that collect dust (stuffed animals) should be removed from the infant's bedroom.

Recently published data has made the relationship between early life exposure to animals and the eventual development of allergies and asthma much more confusing. For example, some evidence seems to show that early life exposure to animals may make children more likely to develop allergies and asthma whereas other evidence seems to show that early life exposure to animals (dogs and cats, in particular) may protect children from later developing these diseases. Adding an indoor pet to the home of a child "at risk" for allergies is generally a bad idea.

Other considerations in preventing asthma

Maternal smoking during pregnancy is associated with increased wheezing during infancy. Exposing children to secondhand smoke in the home has also been shown to increase the development of asthma and other chronic respiratory illnesses (such as recurrent ear and sinus infections). Therefore, it is extremely important that infants not be exposed to tobacco smoke before or after they are born. Finally, respiratory infections are a common trigger of asthma. Breast feeding for the recommended time period of at least six months strengthens children's immune systems, which can be helpful in avoiding respiratory infections. Although day care for your child may increase the chance for him/her to develop wheezing from viral infections, recent evidence suggests that frequent infections early in life may actually protect against the long term development of asthma and allergies.

It has long been noted that most allergies begin in infants as food allergies often causing childhood eczema or atopic dermatitis (AD). One theory suggests that modern society has become so sterile that the normal intestinal flora (bacterium) have become delayed in their introduction into the infant GI tract. As a result, the GI tract fails to mature normally making it more likely to foster allergic reactions when exposed to certain foods. C-section delivered infants have also been reported to be at high risk for developing food allergy and atopic dermatitis. The addition of probiotics or "normal bacterium" into the intestinal tract has also been shown to lower the risk of developing atopic dermatitis in children with parents or siblings with a history of atopic dermatitis. Lactobacillus rhamnosus is the most commonly reported bacteria strains shown to be beneficial.

Since Pro-biotics are known to be safe in children as well as adults, we recommend their use in all children with AD and in all children who have parents or siblings with a history of AD, nasal allergies or asthma. Not all Probiotics contain the same bacterial species. In one recently reported study, which examined the effects of Probiotics in infants with allergy to cow's milk formula, it was found that a mixture of various bacteria did not perform as well as a Probiotic containing a pure culture of Lactobacillus rhamnosus - strain GG (previously known as Lactobacillus casei). This strain of bacteria has an unusual property in that it can survive stomach acids after it is eaten and readily colonizes the gastrointestinal tract. Lactobacillus rhamnosus - strain GG is available in the USA only in a product called Culturelle-DS. It can be purchased over the internet at www.culturelle.com or at HEB (located in the natural products refrigerated area near the vitamin and health supplements). It is also carried by many Walgreen's stores.

*For infants and children give 1/2 to 1 capsule per day for one month. Capsules can be opened and mixed into food, drink or formula. Dosing should be repeated following any course of antibiotics.

Conclusion

A great deal of research is taking place to determine which children are most likely to develop allergies and asthma and to learn how to prevent the development of these diseases. The measures, described above, may be very helpful to children who are "at risk" for developing allergies and asthma, and it is likely that much more information and treatment options will be available in coming years.




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Asthma & Allergy Associates
115 Gallery Circle
Suite 200
San Antonio, TX 78258
(Stone Oak MRI/Urgent Care Bldg.)
Tel: 210.499.0033
Fax: 210.404.0926
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