Early intervention for the prevention of atopic dermatitis

Based on a lecture given to the European Society for Pediatric Allergy and Clinical Immunology. Diseases associated with atopy are increasing throughout the world. Individuals appear to have a genetic predisposition to atopy which is then provoked by environmental influences. Ingested or inhaled allergens provoke an antibody response and a state of sensitization. In many but not all sensitized individuals subsequent exposure to allergen will provoke a release of histamine and other mediators from sensitized mast cells and produce clinical signs of an allergic reaction in the target organ or throughout the body. At the present time one approach to the prevention or reduction of such reactions appears to be the identification of the high-risk infant and then preventing or limiting exposure to the potentially allergenic protein materials in the child's diet or immediate environment. This paper outlines the problems of identifying high-risk infants and comments on the success claimed in the intervention studies that have been undertaken. The possible hazards to mothers and infants of dietary exclusion are emphasized and the provision of appropriate medical and dietetic support are regarded as of paramount importance. Although more studies are needed, the Isle of Wight intervention programme offers hope to families at high-risk of atopy that the problem can be reduced for the next generation.