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Limiting Exposure to Allergens in the Home 
Prevention of Allergy and Asthma in Children
Treatment of Allergy and Asthma
Skin Testing and Allergy Injection Treatment
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Preventing asthma and allergies in children

Parental smoking

Parents should never smoke anywhere in the home or in any car in which children may be transported.  Smoking should also be prohibited in baby sitting or other day care arrangements.  There is absolute proof of a link between exposure of children to tobacco smoke and cough, wheezing and respiratory infections.   Pregnant women should not smoke at any time because of adverse effects on the foetus.

Avoidance of airborne allergens in the home

Avoidance of these allergens in infancy and early childhood will not prevent the ultimate development of allergic disease in predisposed children.   However, house dust mites, animal dander and mold exposure should be controlled to reduce symptoms caused by them in children who already have allergy and asthma.  See specific suggestions for doing this. 
There is some evidence that infants are less likely to develop allergy to common airborne allergens if two or more cats or dogs are in the house during the infant's first year of life.  The reasons for this apparent paradox may relate to beneficial effects of early exposure to endotoxin (a bacterial product).

Diet and breast feeding  

Although there is no evidence that avoidance of foods that cause allergy will prevent the eventual development of allergic diseases including asthma, avoidance of some foods combined with avoidance of tobacco smoke and control of airborne allergens in the home can delay the onset of allergic disease.  Breast feeding is preferable to formula feeding for several reasons and should be continued for as long as possible, because breast feeding helps the baby's immune system to develop properly, and reduces risk of infections in the baby.  Exclusive breast feeding without formula supplementation for at least 4 months can reduce the risk of development of wheezing in infancy, regardless of the presence of maternal allergy or asthma. 

Parental allergy and infant feeding

If the mother has allergies or asthma, and particularly if  both parents have allergies, there is an increased risk of the child developing allergies.  The first allergies developed in allergic children are to food.   There is evidence that intact food protein can be transmitted to the baby through breast milk, suggesting the possibility of sensitization of the baby to the transmitted food protein.  Although it is sometimes recommended that allergic mothers should avoid cow's milk and other dairy products, egg, peanut, and soy products during breast feeding, there is no firm evidence that would require these restrictions for all infants with a family history of allergy.  Solid food may be introduced at 4 to 6 months of age, without increasing the risk for respiratory allergy or the risk of becoming sensitized to foods later, but there is still a possibility that early introduction of solid food may increase the risk of  development of eczema.  If supplementation with formula is needed during breast feeding, only the prescribed hypoallergenic formula should be used.

New advances in prevention of asthma and allergy in children

• Respiratory infections - There may be a link, not yet firmly established, between bacterial infection in early childhood and the prevention of allergy and asthma later in childhood.  This is suggested by the finding that children growing up with limited access to antibiotics have less allergic disease.  Exposure to animals in infancy also appears to be beneficial, suggesting that certain bacterial infections or bacterial products such as endotoxin can prevent the tendency of the immune system to produce allergic responses.  This research does NOT mean that serious bacterial infection in children should go untreated!

• Fish oil -  There is some evidence that asthma occurs more often in children who rarely eat fish, possibly because of inadequate amounts of omega 3 fatty acids in the diet.

• Early allergy injection treatment - Two studies in young children who became allergic to a single allergen such as house dust mites showed that allergy shots against that allergen prevented the development of allergy to other allergens during the time frame of the study.  This suggests that allergy testing and injection treatment in children may be important to consider before the time when this is usually first done - i.e., under age 5 years.  The cost-effectiveness of doing this is unknown at present.
  

Further Reading
Falth-Magnusson K, Kjellman M:  Allergy prevention by maternal elimination diet during late pregnancy - a 5-year follow-up of a randomized study.  Journal of Allergy and Clinical Immunology  Vol 89  pp 709-713, 1992.
Peat JK, Li J:  Reversing the trend: reducing the prevalence of asthma.  Journal of Allergy and Clinical Immunology  Vol 103: pp 1-10, 1999.
Warner JO, Pohunek P, Marguet C, Roche WR, Clough JB:  Issues in understanding childhood asthma.  Journal of Allergy and Clinical Immunology  Vol 105:  pp s473-s476, 2000
von Mutius E:  The environmental predictors of allergic disease.   Journal of Allergy and Clinical Immunology  Vol 105: pp 9-19, 2000
Ownby DR, Johnson CC, Peterson EL: Exposure to cats and dogs in the first year of life and risk of subsequent sensitization at 6 to 7 years of age.  JAMA Vol 288: pp 963-972, 2002.
Oddy WH, Peat JK, de Klerk NH: Maternal asthma, infant feeding, and the risk of asthma in childhood.  Journal of  Allergy and Clinical Immunology Vol 110: pp 65-67, 2002.
Zutavern A, Brokow I, Schaaf B, et al:  Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA.  Pediatrics Vol 121: pp e44-e52, 2008.
Prevention of Allergy in Children AAAAI Tips to Remember

Disclaimer:   This site is for educational purposes only.  Any information that you have found in this web site is not intended to replace medical care or advice given to you by your own physicians. You should consider consulting your local medical library and other web sites for additional information. 

Comments and suggestions welcome!   Email: schumach@u.arizona.edu
Content Owner:  Michael J. Schumacher, MB, FRACP, The University of Arizona
Updated 3/2012