Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma

Abstract

The available evidence suggests that the reduction of exposure to multiple allergens compared to usual care reduces the likelihood of a current diagnosis of asthma in children (at ages < 5 years and 5 years and older). Mono-intervention studies have not produced effects which are statistically significant compared with control. In children who are at risk of developing childhood asthma, multifaceted interventions, characterised by dietary allergen reduction and environmental remediation, reduce the odds of a physician diagnosis of asthma later in childhood by half. This translates to a number needed to treat (NNT) of 17. The effect of multi-faceted interventions on parent reported wheeze was inconsistent and had no significant impact on nocturnal coughing or dyspnoea. Data from monofaceted intervention exposed children studies were not significantly different from those of control groups for all outcomes. There remains uncertainty as to whether multiple interventions are more effective than mono-component interventions. The comparisons made were indirect, making the conclusions drawn uncertain. To our knowledge there are no ongoing studies in which both intervention strategies are randomly compared. The findings, however, warrant further direct comparison between multiple- and monofaceted interventions aimed at reducing the prevalence of asthma in children.

Rhinovirus and the developing lung

“…If allergy alone was so crucial to the development of asthma, avoidance of aeroallergen exposure could conceivably prevent childhood asthma developing. A recent Cochrane review concluded that uncertainty remains as to benefits of aeroallergen avoidance in preventing asthma [78].…”

Developing Primary Intervention Strategies to Prevent Allergic Disease

“…Intervention studies based on reduced exposure to cigarette smoke and/or aeroallergens suggest that modification of these factors as part of multi-faceted interventions are more effective than individual exposure reduction measures, but the preventative effect on allergies is inconsistent and not necessarily maintained long term [66,[91][92][93][94]. Avoidance of cigarette smoke during pregnancy and throughout life has multiple, well-established health benefits for both mothers and their offspring, including reduced risk of allergic disease, and is strongly recommended.…”

Allergieprävention bei Asthma bronchiale

“…Eine Zusammenführung der Daten, die den Effekt der Präventionsmaßnahmen im Alter von 5 Jahren beschrieben, ergab eine Notwendigkeit der Behandlung von 17 Kindern, um die Erkrankung von einem Kind an Asthma bronchiale zu verhindern [12]. Zwischenzeitlich weisen auch die aktuellen Leitlinien zur Allergieprävention darauf hin, dass eine verzö-gerte Einführung von Beikost oder aber eine Verlängerung der Stillzeit keinen zusätzlichen protektiven Effekt bewirkt [18].…”