Prevensi Allergy Blok 20 Maret 2013
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Primary Prevention of Allergic
Disease
SumadionoPediatric Department
Faculty of Medicine Universits Gadjah MadaYogyakarta
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THE ALLERGY ICEBERG SYMPTOMS
HYPER-
REACTIVITY
INFLAMMATION
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ATOPY
Food Allergy
Exzema
Allergic
Rhinitis
ASTHMA
Allergic March
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ATOPI
Food Allergy
Exzema
Allergic
Rhinitis
ASTHMA
Allergic March
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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
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Prediction of Allergy:
FAMILY HISTORY/atopy:
&
Cord blood IgE
Combination
Which children: Allergy risk ?
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Recommendations for Primary Prevention
in High-risk infants
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Newborn Baby (High Risk)
Partial Hypoallergenic formula
Avoid soy formulas
Probiotic, ARA/DHA
Exclusive breastfeeding
Maternal pregnancy diet Not recommended
Maternal pregnancy: Avoid Smoking
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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
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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
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Partial
Hydrolyzed Formula
Extensive
Hydrolyzed Formula
Soy Formula
Amino Acid Formula
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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
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Protein Hydrolysates: Different
Types
Allergenicity
intact protein pHF eHF Amino acids
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Longitudinal Study for 6 years: Partial Hydrolyzed Formula consistently reduce the risk of Allergic Manifestation
33
%44
%
25
%
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Longitudinal Study for 6 years: Partial Hydrolyzed Formula consistently reduce the risk of Atopic Dermatitis
46
%
42
%
38
%
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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
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Kalliomaki M, Lancet. 2001; 357:1076
Incidence of eczema at 2 years in children given probiotics from birth
50% decrease…
IgE-mediated reactions persist !
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X
Maternal Smoking
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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.
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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
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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
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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
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Thank you