Problemi correnti
La dieta dei primi mesi e lo sviluppo dell’atopia
DIET DURING THE FIRST FEW MONTHS AND THE DEVELOPMENT OF ATOPY
GIORGIO LONGO, FRANCO PANIZON1
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
1Professore Emerito, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste
Marzo 2009 - pagg. 162 -167
Abstract
In the last few years, sufficient evidences have been collected to consider the delayed administration
of heterologus and allergogenous food, in the hope of avoiding the IgE sensitization,
useless and probably counterproductive. Actually, the passage of food through
the oro-gastric-intestinal tract is indispensable for the production of the immunological tolerance
with the activation, through GALT, of the Th1 system. In fact, the peanut allergy is
common in those countries where peanuts are not consumed during the first few months or
years of life, whereas it is rare where their consumption is abundant since infancy. Asthma,
eczema and anaphylaxis are typical manifestations of the IgE -mediated atopy. Actually,
both asthma and eczema are IgE-mediated only in some cases and in all cases they
need specific organ sensitivity; only anaphylaxis is always IgE-mediated and has not a specific
target organ. Atopic dermatitis represents another paradoxical condition: it is not the
result of sensitization; it occurs consequentially and transcutaneously and is facilitated by
any food avoidance that short-circuits the intestinal tolerogenous system.
Observational and experimental data suggest that the best age to obtain the immunological
tolerance is the forth-fifth month of life.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
il latte materno fa male. Medico e Bambino
2003;22:35-9.
2. Tamburlini G. La legge inversa dell’evidenza. Medico e Bambino 2003;22:7-8.
3. Polly GE. Latte e asma. Medico e Bambino 2003;22:40-1.
4. Host A, Haiken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol 2008; 19:1-4.
5. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008;12:183-91.
6. Fiocchi A. Alimenti solidi, evidenze liquide? Non direi. Medico e Bambino 2008;27:27-31.
7. Miceli Sopo S. I cibi solidi nella dieta del bambino. Serve tardarne l’introduzione ai fini della prevenzione delle allergie? Medico e Bambino 2008;27:21-6.
8. Allen CW, Campbell DE, Kemp AS. Food allergy: is strict avoidance the only answer? Pediatr Allergy Immunol 2008 Sep 15 [Epub ahead of print].
9. Longo G. Serve ritardare l’introduzione di cibi solidi per prevenire le allergie? Medico e Bambino 2008;27:7-8.
10. Longo G, Barbi E, Meneghetti R, et al. Anafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale. Medico e Bambino 2004;23: 20-29.
11. Longo G, Barbi E, Berti I, et al. Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J Allergy Clin Immunol 2008;121:343-7.
12. Barbi E, Berti I, Longo G. Food allergy: from the of loss of tolerance induced by exclusion diets to specific oral tolerance induction. Recent Pat Inflamm Allergy Drug Discov 2008;2:212-4.
13. Longo G, Berti I. La fabbrica dei superallergici: chiude i battenti o apre nuove filiali? RIAP 2006;6:11-5.
14. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol 2008;121:1331-6.
15. Hammelmann K, Beyer KI, Gruber C, et al. Primary prevention of allergy: avoiding risk or providing protection? Clin Exp Allergy 2007;38:233-45.
16. Strid J, Thomson M, Hourihane J, et al. A novel model of sensitization and oral tolerance to peanut protein. Immunology 2004;113:293- 303.
17. Prescott SL, Smith P, Tang M, et al. The importance of early complementary feeding in the development of oral tolerance: concerns and controversies. Pediatr Allergy and Immunol 2008;19:375-80.
18. Tomicic S, Norman G, Faelth-Magnusson K, et al. Hight levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol 2009;20:35-41.
19. Poole JA, Barriga K, Leung DY, et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006; 117:2175-82.
20. Sicherer SH, Burks AW. Maternal and infants diets for prevention of allergic diseases: understanding menu changes in 2008. J Allergy Clin Immunol 2008;122:29-33.
21. Kull I, Bergstroem A, Lilja G, et al. Fish consumption during the first year of life and the development of allergic diseases during childhood. Allergy 2006;61:1009-15.
22. Penttila I. Effects of transforming growth factor-beta and formula feeding on systemic immunoresponses to dietary beta-lactoglobulin in allergy-prone rats. Pediatr Res 2006;59: 650-5.
23. Akiyama H, Sato Y, Watanabe T, et al. Dietary unripe apple polyphenol inhibits the development of food allergies in murine models. FEBS Lett 2005;579:4485-91.
24. Bieber T. Atopic dermatitis. N Engl J Med 2008;358:1483-94.
25. Strid J, Thomson M, Hourihane J, at al. A novel model of sensitization and oral tolerance to peanut protein. Immunology 2004;113:293- 303.
26. Alm B, Aberg N, Erdes L, et al. Early introduction of fish decreases the risk of eczema in infants. Arch Dis Child 2009;94:11-5.
27. Laerum BN, Wentzel-Larsen T, Gulsvik A, et al. Relationship of fish and cod oil intake with adult asthma. Clin Exp Allergy 2007;37: 1616-23.
28. Calvani M, Alessandri C, Miceli Sopo S, et al; Lazio Association of Pediatric Allergology (APAL) Study Group. Consumption of fish, butter and margarine during pregnancy and development of allergic sensitizations in the offspring: role of maternal atopy. Pediatr Allergy Immunol 2006;17:94-102.
29. Rancé F, Boguniewicz M, Lau S. New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol 2008;19(S19):17-25.
30. Strid J, Hourihane J, Kimber I. Disruption of stratum corneum allows potent epicutaneous immunization with protein antigens resulting in a dominant systemic Th2 response. Eur J Immunol 2004;34:2100-9.
31. Rowlands D, Tofte SJ, Hanifin JM. Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. Dermatol Ther 2006;19:97-103.
32. Cork MJ, Robinson DA, Vasilopoulos Y, et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006;118:3-21.
33. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122:984-91.
34. Lack G, Fox D, Northstone K, et al.; Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003;348:977-85.
35. Wright AL, Sherrill D, Holberg CJ, Halonen M, Martinez FD. Breast-feeding, maternal IgE, and total serum IgE in childhood. J Allergy Clin Immunol 1999;104:526-9.
36. 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;360:901-7.
37. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008;121:183-91.
38. Høst A, Halken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Amendment to previous published articles in Pediatric Allergy and Immunology 2004, by an expert group set up by the Section on Pediatrics European Academy of Allergology and Clinical Immunology. Pediatr Allergy Immunol 2008;19:1-4.
39. Agostoni C, Decsi T, Fewtrell M, et al.; ESPGHAN Committee on Nutrition: Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110.
2. Tamburlini G. La legge inversa dell’evidenza. Medico e Bambino 2003;22:7-8.
3. Polly GE. Latte e asma. Medico e Bambino 2003;22:40-1.
4. Host A, Haiken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol 2008; 19:1-4.
5. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008;12:183-91.
6. Fiocchi A. Alimenti solidi, evidenze liquide? Non direi. Medico e Bambino 2008;27:27-31.
7. Miceli Sopo S. I cibi solidi nella dieta del bambino. Serve tardarne l’introduzione ai fini della prevenzione delle allergie? Medico e Bambino 2008;27:21-6.
8. Allen CW, Campbell DE, Kemp AS. Food allergy: is strict avoidance the only answer? Pediatr Allergy Immunol 2008 Sep 15 [Epub ahead of print].
9. Longo G. Serve ritardare l’introduzione di cibi solidi per prevenire le allergie? Medico e Bambino 2008;27:7-8.
10. Longo G, Barbi E, Meneghetti R, et al. Anafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale. Medico e Bambino 2004;23: 20-29.
11. Longo G, Barbi E, Berti I, et al. Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J Allergy Clin Immunol 2008;121:343-7.
12. Barbi E, Berti I, Longo G. Food allergy: from the of loss of tolerance induced by exclusion diets to specific oral tolerance induction. Recent Pat Inflamm Allergy Drug Discov 2008;2:212-4.
13. Longo G, Berti I. La fabbrica dei superallergici: chiude i battenti o apre nuove filiali? RIAP 2006;6:11-5.
14. Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol 2008;121:1331-6.
15. Hammelmann K, Beyer KI, Gruber C, et al. Primary prevention of allergy: avoiding risk or providing protection? Clin Exp Allergy 2007;38:233-45.
16. Strid J, Thomson M, Hourihane J, et al. A novel model of sensitization and oral tolerance to peanut protein. Immunology 2004;113:293- 303.
17. Prescott SL, Smith P, Tang M, et al. The importance of early complementary feeding in the development of oral tolerance: concerns and controversies. Pediatr Allergy and Immunol 2008;19:375-80.
18. Tomicic S, Norman G, Faelth-Magnusson K, et al. Hight levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol 2009;20:35-41.
19. Poole JA, Barriga K, Leung DY, et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics 2006; 117:2175-82.
20. Sicherer SH, Burks AW. Maternal and infants diets for prevention of allergic diseases: understanding menu changes in 2008. J Allergy Clin Immunol 2008;122:29-33.
21. Kull I, Bergstroem A, Lilja G, et al. Fish consumption during the first year of life and the development of allergic diseases during childhood. Allergy 2006;61:1009-15.
22. Penttila I. Effects of transforming growth factor-beta and formula feeding on systemic immunoresponses to dietary beta-lactoglobulin in allergy-prone rats. Pediatr Res 2006;59: 650-5.
23. Akiyama H, Sato Y, Watanabe T, et al. Dietary unripe apple polyphenol inhibits the development of food allergies in murine models. FEBS Lett 2005;579:4485-91.
24. Bieber T. Atopic dermatitis. N Engl J Med 2008;358:1483-94.
25. Strid J, Thomson M, Hourihane J, at al. A novel model of sensitization and oral tolerance to peanut protein. Immunology 2004;113:293- 303.
26. Alm B, Aberg N, Erdes L, et al. Early introduction of fish decreases the risk of eczema in infants. Arch Dis Child 2009;94:11-5.
27. Laerum BN, Wentzel-Larsen T, Gulsvik A, et al. Relationship of fish and cod oil intake with adult asthma. Clin Exp Allergy 2007;37: 1616-23.
28. Calvani M, Alessandri C, Miceli Sopo S, et al; Lazio Association of Pediatric Allergology (APAL) Study Group. Consumption of fish, butter and margarine during pregnancy and development of allergic sensitizations in the offspring: role of maternal atopy. Pediatr Allergy Immunol 2006;17:94-102.
29. Rancé F, Boguniewicz M, Lau S. New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol 2008;19(S19):17-25.
30. Strid J, Hourihane J, Kimber I. Disruption of stratum corneum allows potent epicutaneous immunization with protein antigens resulting in a dominant systemic Th2 response. Eur J Immunol 2004;34:2100-9.
31. Rowlands D, Tofte SJ, Hanifin JM. Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. Dermatol Ther 2006;19:97-103.
32. Cork MJ, Robinson DA, Vasilopoulos Y, et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006;118:3-21.
33. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122:984-91.
34. Lack G, Fox D, Northstone K, et al.; Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003;348:977-85.
35. Wright AL, Sherrill D, Holberg CJ, Halonen M, Martinez FD. Breast-feeding, maternal IgE, and total serum IgE in childhood. J Allergy Clin Immunol 1999;104:526-9.
36. 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;360:901-7.
37. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008;121:183-91.
38. Høst A, Halken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Amendment to previous published articles in Pediatric Allergy and Immunology 2004, by an expert group set up by the Section on Pediatrics European Academy of Allergology and Clinical Immunology. Pediatr Allergy Immunol 2008;19:1-4.
39. Agostoni C, Decsi T, Fewtrell M, et al.; ESPGHAN Committee on Nutrition: Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46:99-110.
Corrispondenza: longog@burlo.trieste.it