Subject(s)
Asthma/prevention & control , Dietary Fats, Unsaturated/administration & dosage , Fatty Acids, Omega-3/administration & dosage , Fatty Acids, Omega-6/administration & dosage , Pyroglyphidae , Age Factors , Animals , Asthma/epidemiology , Asthma/etiology , Child , Child, Preschool , Dietary Fats, Unsaturated/pharmacokinetics , Fatty Acids, Omega-3/pharmacokinetics , Fatty Acids, Omega-6/pharmacokinetics , Female , Follow-Up Studies , Humans , Male , Prevalence , Risk FactorsABSTRACT
BACKGROUND: Early life exposures may be important in the development of asthma and allergic disease. OBJECTIVE: To test house dust mite (HDM) avoidance and dietary fatty acid modification, implemented throughout the first 5 years of life, as interventions to prevent asthma and allergic disease. METHODS: We recruited newborns with a family history of asthma antenatally and randomized them, separately, to HDM avoidance or control and to dietary modification or control. At age 5 years, they were assessed for asthma and eczema and had skin prick tests for atopy. RESULTS: Of 616 children randomized, 516 (84%) were evaluated at age 5 years. The HDM avoidance intervention resulted in a 61% reduction in HDM allergen concentrations (microg/g dust) in the child's bed but no difference in the prevalence of asthma, wheeze, or atopy (P > .1). The prevalence of eczema was higher in the active HDM avoidance group (26% vs 19%; P = .06). The ratio of omega-6 to omega-3 fatty acids in plasma was lower in the active diet group (5.8 vs 7.4; P < .0001). However, the prevalence of asthma, wheezing, eczema, or atopy did not differ between the diet groups (P > .1). CONCLUSION: Further research is required to establish whether other interventions can be recommended for the prevention of asthma and allergic disease. CLINICAL IMPLICATIONS: House dust mite avoidance measures and dietary fatty acid modification, as implemented in this trial during infancy and early childhood, did not prevent the onset of asthma, eczema, or atopy in high-risk children.
Subject(s)
Asthma/prevention & control , Animals , Child, Preschool , Eczema/etiology , Fatty Acids/administration & dosage , Female , Humans , Infant , Infant, Newborn , Mites/immunology , Patient ComplianceABSTRACT
BACKGROUND: Two factors thought to influence the risk of asthma are the promoting effect of sensitization to house dust mites and the preventive effect of increased omega-3 fatty acids. Although house dust mite allergen avoidance has been used as a preventive strategy in several trials, the effect of omega-3 fatty acid supplementation in the primary prevention of asthma and allergic disease is not known. OBJECTIVE: To measure the effects of dietary supplementation with omega-3 fatty acids and house dust mite allergen avoidance in children with a family history of asthma. METHODS: A total of 616 children at high risk of asthma were enrolled antenatally in a randomized controlled trial, and 526 children remained in the trial at age 3 years. The outcomes were symptoms of allergic disease and allergen sensitization. RESULTS: There was a significant 10.0% (95% CI, 3.7-16.4) reduction in the prevalence of cough in atopic children in the active diet group ( P=.003; number needed to treat, 10) but a negligible 1.1% (95% CI, -7.1 to 9.5) reduction cough among nonatopic children. There was a 7.2% (95% CI, 10.11-14.3) reduction in sensitization to house dust mite in the active allergen avoidance group ( P=.05; number needed to treat, 14). No significant differences in wheeze were found with either intervention. CONCLUSION: These results suggest that our interventions, designed to be used in simple public health campaigns, may have a role in preventing the development of allergic sensitization and airways disease in early childhood. This offers the prospect of reducing allergic disease in later life.
Subject(s)
Air Pollution, Indoor/prevention & control , Allergens/immunology , Asthma/prevention & control , Dietary Supplements , Fatty Acids, Omega-3/therapeutic use , Pyroglyphidae/immunology , Adult , Asthma/diet therapy , Bedding and Linens , Child, Preschool , Cohort Studies , Dietary Fats/therapeutic use , Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , Treatment OutcomeABSTRACT
Childhood atopic dermatitis is a disorder with considerable social and financial costs. Consideration of these costs is increasingly important in view of the growing prevalence of atopic dermatitis, particularly in developed countries over recent decades. The family stress related to the care of children with moderate or severe atopic dermatitis is significantly greater than that of the care of children with type 1 diabetes mellitus. The factors contributing to family stress include sleep deprivation, loss of employment, time taken for care of atopic dermatitis and financial costs. The financial costs for the family and community include medical and hospital direct costs of treatments and indirect costs from loss of employment. There are many interventions utilised in the treatment of childhood atopic dermatitis which involve not only medical practitioners but nurses, pharmacists, dieticians, psychologists and purveyors of so-called alternative therapies such as naturopathy, aromatherapy and bioresonance, all of which contribute to the financial burdens on the parents and the community. It is possible that appropriate interventions directed to reducing trigger factors might produce worthwhile savings, although the cost benefit of these measures has not been demonstrated. In conclusion, atopic dermatitis should not be regarded as a minor skin disorder but as a condition which has the potential to be a major handicap with considerable personal, social and financial consequences both to the family and the community.