E-Commerce Presentation System v1.0

SlideSelection

http://pptheaven.mvps.org

About

Reset

Quit

Now Playing…Lurking by calpomatt

1

2

3

45

678

9

10

11 12

Primary Prevention of Allergic

Disease

SumadionoPediatric Department

Faculty of Medicine Universits Gadjah MadaYogyakarta

THE ALLERGY ICEBERG SYMPTOMS

HYPER-

REACTIVITY

INFLAMMATION

ATOPY

Food Allergy

Exzema

Allergic

Rhinitis

ASTHMA

Allergic March

ATOPI

Food Allergy

Exzema

Allergic

Rhinitis

ASTHMA

Allergic March

1. Primary Prevention

2. Secondary Prevention

3. Tertiary Prevention

Before any IgE mediated disease

has occurred

Further sensitivities once IgE mediated

disease has developed

Prevention manifestation of allergic

disease

Prevention of allergy

Prediction of Allergy:

FAMILY HISTORY/atopy:

&

Cord blood IgE

Combination

Which children: Allergy risk ?

8

9

Recommendations for Primary Prevention

in High-risk infants

10

Newborn Baby (High Risk)

Partial Hypoallergenic formula

Avoid soy formulas

Probiotic, ARA/DHA

Exclusive breastfeeding

Maternal pregnancy diet Not recommended

Maternal pregnancy: Avoid Smoking

Maternal Antigen Avoidance During Pregnancy

Evidence from 4 trials (451 subjects)

does not support protection

maternal food antigen avoidance

(cow’s milk, peanuts, egg and chocolates)

Kramer MS, Kakuma R. The Cochrane Library 2004

A. S. Kemp. The Medical Journal of Australia 2003

www.mja.com.au

Exclusive

breastfeeding

for at least 4-6 months

reducing allergic disease

in early childhood

Partial

Hydrolyzed Formula

Extensive

Hydrolyzed Formula

Soy Formula

Amino Acid Formula

Technologies to Reduce the Allergenicity of a Protein

Enzymatic hydrolysis

Heating

Ultrafiltration

The lower the chain length and the smaller the molecular mass, the lower is the residual allergenicity of a protein / peptide

Protein Hydrolysates: Different

Types

Allergenicity

intact protein pHF eHF Amino acids

Longitudinal Study for 6 years: Partial Hydrolyzed Formula consistently reduce the risk of Allergic Manifestation

33

%44

%

25

%

Longitudinal Study for 6 years: Partial Hydrolyzed Formula consistently reduce the risk of Atopic Dermatitis

46

%

42

%

38

%

IgA

IL-2

IFN-α

IFN-β

TNF-β

Virus Tumor

s

B

Th0

Th1Th2

Ig

E

IL-4

IL-10

Il-6

Intestinal

microflora

AP-Cell

B

IL-2

IL-12

TNF-α

IFN- γ

Allergy

Epithelium

Probiotics

Probiotic & allergy

Kalliomaki M, Lancet. 2001; 357:1076

Incidence of eczema at 2 years in children given probiotics from birth

50% decrease…

IgE-mediated reactions persist !

1 cell membrane.flv

X

Maternal Smoking

Cigarette-smoke exposure

• Risk of asthma and poor lung function

• Associated with higher levels of IgE specific for house dust mite in children

• Risk factor for allergic disease in children

JAMA. 2010;303(18):1848-56. J Allergy Clin Immunol. 2009;123: 1012–21.

Correlation between total immunoglobulin E (IgE) of newborn cord blood and cigarette smoke exposure during pregnant mother

Lely Hasanah, Sumadiono, Setya WanditaDepartment of Child Health, Sardjito Hospital, Medical School, Gadjah Mada University Yogyakarta

Abstract

• Background Allergic disease is one of common disease in childhood. The key pathogenetic factor is the ability to produce IgE. Measurement of total IgE in newborn cord blood is important for early detection of newborns at risk of allergy disease. Cigarette smoke is the environmental factors, which has been demonstrated to influence the immunologic system by inducing increase of IgE production.Objective To determine the correlation between total immuno-globulin E (IgE) of newborn cord blood and cigarette smoke exposure during pregnant mother.Methods A cross sectional study was conducted on babies born at Maternal-Perinatal Installation of Dr. Sardjito Hospital. Subjects were grouped into baby born from passive smoker mother and no smoke exposure mother. We measured total IgE of the newborn cord blood using enzyme linked fluorescent assay (ELFA) method. Questionnaire was given to the mother to get information of cigarette smoke exposure during pregnancy.Results Level of newborn cord blood IgE in passive smoker mother group was 0,77 + 0,4 KIU/L, whether. in no smoke exposure group was 0,63 + 0,5 KIU/L (mean + SD). Student t test analysis showed no significant difference between two groups (p=0,19). Study is still on going.

Conclusion Level of newborn cord blood IgE in passive smoker mother group is higher compared to that in no smoke exposure group.

Paediatrica Indonesiana Vol 50 No.2 (Supplement) March 2010

Delayed Introduction to Solid Food??

• Systematic review (2006):

– Early solid feeding may increase the risk of eczema.

– However, there are little data supporting an association between early solid feeding and other allergic conditions.

Arch Pediatr Adolesc Med 2006;160:502–7

Timing of solid food introduction and the development of cow milk allergy

in Saiful Anwar General Hospital, Malang

Ratna Mustika Sari, Ni Luh Putu HM, Dicky Faturrahman, Wisnu Barlianto, HMS Chandra KusumaDepartment of Child Health, Medical School, University of Brawijaya, Saiful Anwar Hospital, Malang

Abstract

• Background The age when infants are introduced to solid foods varies greatly. Currently, guidelines recommend avoidance of solid feeding for at least the first 4 months of life, citing studies that have suggested increased risk of

allergies associated with earlier introduction of solids.Objective This study investigated whether the delayed timing of solid food introduction protects against the

development of cow milk allergy.Methods Data from allergies and immunology out patients from May 2008 to April 2009 were analyzed to find any

relationship between the timing of solid food introduction with sensitization to milk on skin prick tests and the age of development of allergic manifestations. Patients were divided into 3 groups based on time of solid food introduction; <4 months, 4-6 months, and >6 months. Data was analyzed with Chi-square test and considered significant if p value

was <0.05.Results There were 158 patients divided into 3 groups; <4 months (n=27), 4-6 months (n=117), and > 6 months (n=14). There was no significant difference in age of allergic manifestation development in all three groups. But there was an

increased trend in the incidence of cow milk sensitization in the group receiving solid food at the age of <4 months and >6 months.

•

Conclusion This study found no evidence supporting the assumption that delayed introduction of solids until after 6 months prevents the onset of cow milk allergy.

Paediatrica Indonesiana Vol 50 No.2 (Supplement) March 2010

27

Thank you