Previous recommendations for preventing allergic disease need to be critically re-examined
A marked increase in allergic disease has occurred over the past century. For example, between 1992 and 1997, the prevalence of asthma increased by 26% and skin-prick sensitivity to house dust mite (HDM) increased by 63% in Australian children.1 In determining the causes of this increase it is important to distinguish between primary and secondary causes of allergic disease. Primary causes are those considered to induce allergic disease in a non-sensitised person, while secondary causes are those that trigger symptoms in people who are already sensitised. Primary prevention strategies are aimed at reducing sensitisation. In the early 1980s it was considered that a clean environment, avoidance of pets, the provision of synthetic "allergy free" bedding (rather than feather bedding) and prolonged breastfeeding were all important in primary prevention. But recent epidemiological studies have challenged these beliefs.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Sydney, NSW.
- 1. Downs SH, Marks GB, Sporik R, et al. Continued increase in the prevalence of asthma and atopy. Arch Dis Child 2001; 84: 20-23.
- 2. von Mutius E, Martinez FD, Fritzsch C, et al. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med 1994; 149: 358-364.
- 3. Hesselmar B, Aberg N, Aberg B, et al. Does early exposure to cat or dog protect against later allergy development? Clin Exp Allergy 1999; 29: 611-617.
- 4. Perzanowski MS, Ronmark E, Platts-Mills TA, Lundback B. Effect of cat and dog ownership on sensitization and development of asthma among preteenage children. Am J Respir Crit Care Med 2002; 166: 696-702.
- 5. Ponsonby AL, Kemp A, Dwyer T, et al. Feather bedding and house dust mite sensitization and airway disease in childhood. J Clin Epidemiol 2002; 55: 556-562.
- 6. Nafstad P, Nystad W, Jaakkola JJ. The use of a feather quilt, childhood asthma and allergic rhinitis: a prospective cohort study. Clin Exp Allergy 2002; 32: 1150-1154.
- 7. Ponsonby AL, Dwyer T, Kemp A, et al. Synthetic bedding and wheeze in childhood: a prospective cohort study. Epidemiology 2003; 14: 37-44.
- 8. Kull I, Wickman M, Lilja G, et al. Breast feeding and allergic diseases in infants — a prospective birth cohort study. Arch Dis Child 2002; 87: 478-481.
- 9. Sears MR, Greene JM, Willan AR, et al. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet 2002; 360: 901-907.
- 10. Wright AL, Holberg CJ, Taussig LM, Martinez FD. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax 2001; 56: 192-197.