Strategies for preventing allergic disease

Prevention of allergic sensitization will probably require strategies that are operative in utero. These consist of optimisation of maternal nutrition and avoidance of tobacco smoke. Allergen avoidance should not be recommended as a primary preventive intervention. Postnatally, when allergic sensitisation has occurred but before disease is manifest, breastfeeding or using an extensively hydrolysed casein formula has been shown to be of benefit, at least in reducing food allergy and atopic eczema. The precise role of weaning in the development of allergic sensitisation is unknown and delaying the introduction of solids into the infant's diet has produced highly discrepant results. The use of microbial product including probiotics has been shown to reduce atopic eczema but not allergic sensitisation. As yet no recommendations as to their precise use can be made. Finally, immunotherapy and the use of anti-histamines in interrupting the allergic march once symptoms are apparent have shown beneficial effects, with cetirizine having been shown to be safe and effective to use, even in infancy.