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Primary Prevention of Allergic
Disease

Sumadiono
Pediatric Department
Faculty of Medicine Universits Gadjah Mada
Yogyakarta
THE ALLERGY ICEBERG SYMPTOMS

HYPER-
REACTIVITY

INFLAMMATION
Allergic March

ATOPY

Food Allergy

Exzema

ASTHMA

Allergic
Rhinitis
Allergic March

ATOPI

Food Allergy

Exzema

ASTHMA

Allergic
Rhinitis
Prevention of allergy

1. Primary Prevention
Before any IgE mediated disease
has occurred

2. Secondary Prevention
Further sensitivities once IgE mediated
disease has developed

3. Tertiary Prevention
Prevention manifestation of allergic
disease
Which children: Allergy risk ?
Prediction of Allergy:
FAMILY HISTORY/atopy:
&

Cord blood IgE

Combination
8
Recommendations for Primary Prevention

in High-risk infants

9
Newborn Baby (High Risk)

Maternal pregnancy diet Not recommended

Exclusive breastfeeding
Maternal pregnancy: Avoid Smoking

Partial Hypoallergenic formula

Probiotic, ARA/DHA

Avoid soy formulas 10

 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

 Exclusive
breastfeeding
for at least 4-6 months

reducing allergic disease

in early childhood

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

 Partial
Hydrolyzed Formula

Extensive
Hydrolyzed Formula

Soy Formula

Amino Acid Formula

 Technologies to Reduce the Allergenicity of a Protein

Heating

Enzymatic
hydrolysis

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

intact protein pHF eHF Amino acids

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

33 25
44 % %
%
Longitudinal Study for 6 years: Partial Hydrolyzed Formula 
consistently reduce the risk of Atopic Dermatitis

46 42 38
% % %
Probiotic & allergy
Intestinal
microflora
Probiotics

Epithelium

AP-Cell

Th0
IL-2
IL-4
IL-12 Th2
Th1 IL-10
TNF-α IL-2
IFN- γ Il-6
IFN-α
IFN-β
B B
TNF-β Allergy
IgA Ig
Virus Tumor E
s
Incidence of eczema at 2 years in children given
probiotics from birth

IgE-mediated reactions persist !

50% decrease…

Kalliomaki M, Lancet. 2001; 357:1076

1 cell membrane.flv
Maternal Smoking

X
 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 Wandita

Department of Child Health, Sardjito Hospital, Medical School, Gadjah Mada University Yogyakarta

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

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.
 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 Kusuma
Department of Child Health, Medical School, University of Brawijaya, Saiful Anwar Hospital, Malang

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

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.
Thank you

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