Prvention primaire des allergies Caroline Roduit, MD, MPH, PhD - - PowerPoint PPT Presentation

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Prvention primaire des allergies Caroline Roduit, MD, MPH, PhD - - PowerPoint PPT Presentation

Nov 19, 2023 138 likes •621 views

Prvention primaire des allergies Caroline Roduit, MD, MPH, PhD Zrich University childrens hospital and Center for Allergy Research and Education (CK-care), Prof. Roger Lauener research group, childrens hospital St.Gallen CHUV,

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Prévention primaire des allergies

Caroline Roduit, MD, MPH, PhD Zürich University children’s hospital and Center for Allergy Research and Education (CK-care), Prof. Roger Lauener research group, children’s hospital St.Gallen CHUV, Lausanne– 11 février 2016

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Eder, Ege, von Mutius, NEJM 2006

The prevalence of asthma in childhood

‐ Asthma is the most common chronic non‐communicable diseases, with the earliest onset. ‐ It is expected that more than 50%

  • f all European will be affected in 10

years’ time

‐> need for effective allergy prevention

Allergy epidemic

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  • Why there is an increase of allergic diseases?
  • The hygiene hypothesis
  • The biodiversity hypothesis
  • Changes in diet
  • Which factors could prevent the development of allergy?
  • Allergen avoidance strategies have not been successful, as

preventive measure.

Allergy prevention

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Strachan D. Br. Med J. 1989

‐ Less hay fever and atopic dermatitis among children with sibilings, large families, having most likely more infections by contact as single children. ‐ Evidences from various studies suggested that “the hygiene hypothesis” plays a large role in the allergy epidemic.

The hygiene hypothesis

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Farm environment protects against allergies

Riedler et al. Lancet 2001

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Prenatal exposition to farm protects against allergies: PASTURE study*

*Protection against Allergies Study in Rural Environments

Roduit et al. JACI 2011

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Roduit et al. JACI 2011

Prenatal exposure to an increasing number of farm animal species protects against atopic dermatitis

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Ege et al. NEJM 2011

Exposure to a large diversity of microbes reduces the risk of asthma

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Ege et al. NEJM 2011

The biodiversity hypothesis

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Infant’s diet and atopic dermatitis

Roduit et al. JACI 2012

*adjusted for farmer, center breastfeeding, parental history of allergies

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Diversity of food introduced in the 1st year of life and atopic dermatitis

Roduit et al. JACI 2012 *Diversity score with major food items: vegetables or fruits, any cereals, meat, bread, cake and yogurt

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Diversity of food introduced in the 1st year of life and asthma

*Diversity score with major food items: vegetables or fruits, any cereals, meat, bread, cake and yogurt Roduit et al. JACI 2014

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Diversity of food introduced in the 1st year of life and asthma

Nwaru et al. JACI 2014

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Lifestyle changes in diet in westernised countries:

Reduction of consumption of fiber in industrialized countries compared to developing countries: Average consumption of fibers: ‐In westernised countries: 20‐25 g per day ‐In developing countries: 100 g per day

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Julia Bollrath and Fiona Powrie, Science 2013

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Trompette et al. Nature medicine 2014

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Trompette et al. Nature medicine 2014

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Cells:

  • 10% human
  • 90% microbes
  • > Microbiota = micro-organism within a

given niche

  • Ley R., et al. Ecological and evolutionary forces shaping microbial diversity in the human intestine. Cell 2006
  • Qin J., et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature 2010

Genes:

  • 1% human
  • 99% microbes
  • > Microbiome = all the genetic material of

micro-organisms within a given niche

Human microbiome

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Roduit C. et al. Thorax 2008

Cesarean section

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Huang L. et al. J Asthma 2015

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Dominguez-Bello M. et al. Nature Med. 2016

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JACI 2009

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Cuello-Garcia C. Probiotics for the prevention of allergy. JACI 2015

Probiotics

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Probiotics

  • 29 studies fulfilled a priori specified inclusion criteria for the analyses.
  • Probiotics reduced the risk of eczema:
  • > when used by women during the last trimester of pregnancy

RR 0.71; 95% CI, 0.60-0.84

  • > when used by breast-feeding mothers

RR, 0.57; 95% CI, 0.47-0.69

  • > or when given to infants

RR, 0.80; 95% CI, 0.68-0.94 Conclusion: Probiotics used by pregnant women or breastfeeding mothers and/or given to infants reduced the risk of eczema in infants; however, the certainty in the evidence is low. No effect was observed for the prevention of other allergic conditions.

Cuello-Garcia C. Probiotics for the prevention of allergy. JACI 2015

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Cochrane Database Syst Rev. 2013 Prebiotics in infants for prevention of allergy. Osborn DA, Sinn JK

  • Cochrane review:

„Further research is needed before routine use of prebiotics can be recommended for prevention of allergy in formula fed infants. There is some evidence that a prebiotic supplement added to infant feeds may prevent eczema. It is unclear whether the use of prebiotic should be restricted to infants at high risk of allergy or may have an effect in low risk populations.“

Prebiotics for allergy prevention

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Primary prevention of allergic diseases: Nutrition

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Maternal diet during pregnancy

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Breastfeeding

  • A meta-analysis of 18 prospective studies:
  • Protective effect on atopic dermatitis of exclusive breastfeeding

for 3 months (OR: 0.68; 95% CI: 0.52–0.88), only for infants with a family history of allergy.

Gdalevich M, et al. Breastfeeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of of prospective studies. J Am Acad Dermatol. 2001

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Breastfeeding (exclusive at least 3 months): slightly decreased risk of AD (OR 0.89; 95% CI 0.76–1.04)

Yang et al. Exclusive breastfeeding and incident of artopic dermatitis in childhood. A systematic review and meta- analysis of prospective cohort studies. British Journal of Dermatology 2009

Breastfeeding

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Results: GINI study III

  • 2000 children,

with family history of allergies

  • 4 blinded

formula in first 4 months

Hydrolysed formulas for allergy prevention

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Complementary feeding

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Complementary feeding

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cow milk products was defined as artificial formulas (including hypoallergenic formulas), raw/pasteurized milk, porridge, dairy products, and yogurts

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Nwaru, B et al. Timing of infant feeding in relation to childhood asthma and allergic diseases. JACI 2013

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Du Toit G. et al. NEJM 2015

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Recommandations actuelles:

Roethlisberger S. et al. Pediatrica 2016

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Recommandations actuelles: Tableau 1

Roethlisberger S. et al. Pediatrica 2016

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Roethlisberger S. et al. Pediatrica 2016

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Thank you for your attention