Allergy prevention

General information
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Allergies are a significant health and socio-economic problem. In addition to drug treatment, prevention plays an even more decisive role. Both primary prevention and secondary prevention are essential (see Prevention). The German Society for Allergology and Clinical Immunology (DGAI) developed an "evidence-based" guideline for this (see table 1).

The risk of developing an allergy is influenced by the time at which potentially allergenic foods are consumed. A meta-analysis with large collectives showed that early exposure (between 4 and 11 months of age) induces oral tolerance for both eggs and peanuts; this relationship is not clear for fish (Lerodiakonou 2016). This is not true for celiac disease.

Literature
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Ierodiakonou D et al. (2016) Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or
Autoimmune Disease: A Systematic Review and Meta-analysis. JAMA 316:1181-1192.
Guideline of the German Society of Allergology and Clinical Immunology (DGAI) in collaboration with the German Dermatological Society (DDG), Aktionsbündnis Allergieprävention. AWMF Guideline Register No. 061/016.
Worm M et al. (2016) Guideline on the management of IgE-mediated food allergy. Allergology 39: 302-344
https://www.dha-allergien-vorbeugen.de/pdf/leitlinie_allergiepraevention.pdf
https://www.dha-allergien.de/ernaehrung.html

Tables
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Prevention measures	Familial predisposition: secondary prevention	No family history: Primary prevention
Exclusive breastfeeding for at least 4 months, if not possible partially or extensively hydrolyzed infant formula until completed 4th month of life, no soy-based infant formula	yes	no
Balanced and nutrient-dense diet, no evidence for avoidance of potent food allergens in maternal diet during breastfeeding (effect on atopic eczema possible) ,fish in maternal diet during pregnancy or breastfeeding shows a protective effect on the development of atopic diseases in the child	yes	yes
No complementary food before 4 months of age	yes	yes
No general diet for allergy prevention in the 1st year of life	yes	yes
No acquisition of fur bearing animals, dog ownership probably no increased allergy risk	yes	no
Avoidance of cat keeping	yes	no
Reduction of house dust mite allergen exposure	no	no
Avoidance of a mold-promoting climate	yes	yes
Avoidance of active and passive smoke exposure	yes	yes
Indoor pollutant exposure	yes	yes
Vaccination according to STIKO recommendations	yes	yes
Avoidance of cesarean delivery	yes	yes