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Protecting Baby: Can allergies be prevented?

Posted By Sarah Elton On 2010/07/02 @ 2:30 pm In Food Allergy | No Comments

The answer to why a baby becomes an allergic child is the modern version of the Poincaré conjecture – a puzzle for which we have yet to find the solution. In this age of unparalleled understanding of the human body, scientists still don’t know why it is one child develops an allergic reaction to, say, peanuts while another child can eat them by the handful.

At a time when allergy and asthma have risen at rates never seen before in human history, such questions have become pressing. Between 1997 and 2002, according to a study by allergy researchers at the Mount Sinai School of Medicine in New York, the prevalence of food allergy alone doubled in North America; about 6 per cent of young children today have food allergies. After a surge that started in the 1980s, asthma rates have leveled off, but at least 12 per cent of children on this continent have been diagnosed with the disease.

In pursuit of elusive answers, scientists have turned to the beginning of life. The time in the womb, and the first days, months and years of a human being’s existence, they believe, are critical to the understanding of allergic disease. “Your immune system goes to school in the first couple of years. We know that’s a very unique time when we think we can influence allergies,” says Dr. Michael Cyr, an allergist and clinical immunologist at McMaster University in Hamilton, Ontario.

Scientists hypothesize that it’s something the baby with an allergic tendency is coming in contact with in the early days – or possibly not coming in contact with – that is causing the allergies. If they could discover what these factors are, then perhaps the incidence of allergy could be significantly curtailed.

While so much about allergy is a mystery, one thing is certain: genes play an important role. According to the World Health Organization, if both of a baby’s parents have allergies, that infant has a risk four times greater of getting asthma and allergies than the baby born to parents who don’t have allergic disease. If only one parent has allergies, then the child is twice as likely to develop allergies.

As well, a 2000 study of peanut allergy, done by researchers at Mount Sinai’s Jaffe Food Allergy Institute, found that a sibling of a peanut allergic person is 10 times as likely to develop a peanut allergy as the general population.

There is much interest in “atopy,” the inherited predisposition to allergy. But scientists now know that the development of allergy is not only about genes. “Family history plays a big role, but it is not definitive,” says Dr. Padmaja Subbarao, a pediatric respirologist at the Hospital for Sick Children in Toronto and an assistant professor at the University of Toronto. “That cuts both ways for the predisposed and the genetically free. Just because you don’t have risk factors, doesn’t mean your child won’t have asthma.”

In researching allergy, scientists have a wide range of factors to consider: from maternal diet during breastfeeding through the age at which a child first eats solid food; exposure to air pollution – outside and indoors; even ethnicity, birth order and delivery by Caesarean section.

A major Canadian study has applied for funding to begin assessing the different variables. The study, called the Canadian Healthy Infant Longitudinal Development Study (or CHILD cohort study for short), will recruit several thousand pregnant women in Canada. CHILD is led by Dr. Malcolm Sears, the research director of the Firestone Institute for Respiratory Health and a professor of medicine at McMaster, and involves a cross-country team of experts from about 20 medical and academic disciplines. CHILD’s researchers will examine environmental and genetic factors in allergy and asthma: everything from the levels of dust in the pregnant women’s homes to lifestyle factors such as stress and their family’s medical history. The researchers plan to follow the babies through childhood and, if the funding is available, into adolescence.

But even if CHILD does start to find clues, it will be a few years before it can show results. Its findings then need to be compared to other large cohort studies to draw definitive conclusions. That leaves expectant parents today wondering what they can do to help prevent their newborns from going on to develop allergies and asthma.

Allergies in Pregnancy

Questions first arise during pregnancy, when a mother-to-be in a family with allergies starts to think about the food she eats and the effect on her fetus. She is likely to wonder: will succumbing to late-night cravings for peanut butter cups mean my child will be burdened with anaphylaxis to that legume? It’s still common for general practitioners to counsel pregnant patients to avoid highly allergenic foods in the last trimester. But there is a gulf between that advice and what scientists in the know believe is necessary.

For instance, Cyr says, “There’s little evidence that avoiding nuts or allergenic foods in pregnancy is helpful. A lot of people still say it. We don’t have evidence that says it’s harmful.”
So little has been proven definitively that perhaps even the precautions an expecting mother takes to minimize the risk of allergy – such as avoiding peanuts – might in fact make the fetus more susceptible. “It is possible that avoiding peanuts is harmful,” says Cyr, an investigator working with AllerGen, the federally funded allergy research network. Peanut exposure might actually mitigate against allergy. The fact is, scientists do not yet know.

The New Mother’s Questions:

Q: If my baby has eczema, does this mean she will develop asthma or a food allergy?

A: Eczema, or atopic dermatitis, is an indication of the tendency to develop allergy (known as atopy). While the itchy rash doesn’t guarantee that your child will develop food allergies or asthma, this condition indicates there is a much higher chance of either.

Q: If there are only environmental allergies in our family, is my baby at risk of developing food allergies?

A: Yes. Allergic disease is hereditary and can manifest itself in one (or all) of: hayfever, eczema, asthma and food allergies.

Q: Can I use my EpiPen if I have an allergic reaction while pregnant?

A: Yes. One obstetrician put it bluntly: “It’s better for the baby if you’re not dead.” Dr. Michael Cyr reminds that, “in a life-threatening reaction, use it right away.”

First published in Allergic Living magazine.
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