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IJPD SYMPOSIUM
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 181-182

Maternal dietary antigen avoidance during pregnancy or lactation


1 Department of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India
2 Department of Pediatric Dermatology, Wadia Children Hospital, Mumbai, Maharashtra, India
3 Consultant Pediatric Dermatologist, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
4 Consultant Pediatric Dermatologist, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
5 Department of DVL-1, CMC, Vellore, Tamil Nadu, India
6 Department of Dermatology, Sri B M Patil Medical College, BLDE University, Bijapur, Karnataka, India
7 Hon. Pediatric Dermatologist, Wadia Hospital for Children, Mumbai, Maharashtra, India
8 Professor of Dermatology, Vivekananda Institute of Medical Science, Kolkata, West Bengal, India
9 Department of Dermatology, Sharda Hospital, Greater Noida, Uttar Pradesh, India
10 Department of Dermatology, Lady Hardinge Medical College, Delhi, India
11 Department of Dermatology, MAMC and Associated LNGP Hospital, New Delhi, India
12 Consultant, Dermatologist, S D M Hospital, Jaipur, Rajasthan, India

Date of Web Publication7-Jun-2017

Correspondence Address:
Sandipan Dhar
Flat 9C, Palazzo, 35, Panditia Road, Kolkata - 700 029
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Dhar S, Parikh D, Rammoorthy R, Srinivas S, Sarkar R, Inamadar A, Shah M, Banerjee R, Kanwar AJ, Mendiratta V, George R, Gulati R. Maternal dietary antigen avoidance during pregnancy or lactation. Indian J Paediatr Dermatol 2017;18:181-2

How to cite this URL:
Dhar S, Parikh D, Rammoorthy R, Srinivas S, Sarkar R, Inamadar A, Shah M, Banerjee R, Kanwar AJ, Mendiratta V, George R, Gulati R. Maternal dietary antigen avoidance during pregnancy or lactation. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Sep 26];18:181-2. Available from: http://www.ijpd.in/text.asp?2017/18/3/181/207615

Breast Feeding

Most studies have shown a lack of evidence of a protective effect of exclusive breastfeeding on childhood eczema. Exclusive breastfeeding for 6–7 months conferred no protection against the development of AD at 5–7 years compared to exclusive breastfeeding for 3–4 months (Strength of recommendation A, Level of evidence 1).[1]

The conclusions of a Cochrane review states that prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and as such a diet may adversely affect maternal and fetal nutrition or both. The results of antigen avoidance during lactation may reduce the child's risk of developing atopic eczema, but better trials were needed.[2]

Prebiotics and Probiotics

Prebiotics are nondigestible food components that benefit the host by selectively stimulating the growth or activity of bacteria in the colon. They have been added to infant formula. The most common prebiotic used in infant food are indigestible oligosaccharide, galacto- and fructo-oligosaccharide. Probiotics are viable microorganisms that may exert beneficial health effects on the host. Neither have been found to be effective in the treatment of AD (Strength of recommendation A, Level of evidence 1).[3] The role of pro and prebiotics in the prevention of AD by their addition to the prenatal maternal diet is beyond the scope of this guideline.

Food Allergies [4],[5],[6],[7],[8]

Food allergies may coexist and represent important triggers in a small subset of individuals with AD with moderate-severe disease. Food allergy testing is recommended in the following situations if a child <5 years of age has moderate to severe AD and the following: (1) persistent disease in spite of optimized management and topical therapy; (2) a reliable history of an immediate allergic reaction after ingestion of a specific food; or (3) both.[4],[5] A simple strategy is to maintain a food diary that may help in identifying a specific food trigger. An elimination diet excluding the suspected food item may be tried for 4–6 weeks. If symptoms improve, an oral food challenge should be performed as the skin improvement may have been coincidental or due to a placebo effect. Positive tests resulting from in vitro testing for food allergies and skin prick tests should be verified with careful history taking as false positive and false negative results are possible. Professionally monitored elimination diets are advisable to avoid unnecessary restrictions impacting the child's nutrition and growth. Dietary modification in cases of proven food allergy helps to decrease severity but does not replace the standard topical or systemic treatment of AD.

Immunization

Live vaccines are contraindicated for children who are immunosuppressed. If needed, live vaccines can be given at least 4 weeks, and inactivated vaccines can be given at least 2 weeks before the start of therapy with immunosuppressants. Live vaccines should not be given within 3 months of stopping prednisolone or 6 months of stopping other immunosuppressants.[9],[10] Children with an infection or fever usually need to recover before vaccines are given. This also applies to badly infected eczema. If the patient has developed an anaphylactic reaction to a vaccine, further doses should be withheld. The food allergies that may be a problem with vaccination are an allergy to egg and or gelatin. Indian Association of Pediatrics recommends that Influenza and yellow fever vaccines should not be given to those with severe egg allergy.[11],[12]

Recommendations

  • Prolonged exclusive breastfeeding for up to 7 months will not reduce the risk of developing AD in infants compared with shorter periods. Maternal antigen avoidance does not reduce the risk of AD and therefore should not be advocated
  • Based on current evidence pre and probiotics do not appear to be beneficial in the treatment of AD
  • Food allergies may be present in a subset of patients with moderate to severe AD Food elimination diets should be carried out under professional guidance
  • Live vaccines should be avoided in immunosuppressed children
  • Vaccinations are best avoided in the presence of infection and fever including badly infected eczema.


Financial Support and Sponsorship

This activity was sponsored by Curatio Health Care (I)Pvt. Ltd. from their unlimited Educational Grant.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Madhok V, Futamura M, Thomas KS, Barbarot S. What's new in atopic eczema? An analysis of systematic reviews published in 2012 and 2013. Part 2. Treatment and prevention. Clin Exp Dermatol 2015;40:349 54.   Back to cited text no. 1
    
2.
Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev 2012;62:CD000133.   Back to cited text no. 2
    
3.
Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002;135:CD003517.   Back to cited text no. 3
    
4.
van der Aa LB, Heymans HS, van Aalderen WM, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: Review of the theoretical background and clinical evidence. Pediatr Allergy Immunol 2010;21(2 Pt 2):e355 67.   Back to cited text no. 4
    
5.
Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014;71:1218 33.   Back to cited text no. 5
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6.
NIAID Sponsored Expert Panel, Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID Sponsored Expert Panel. J Allergy Clin Immunol 2010;126 6 Suppl:S1 58.   Back to cited text no. 6
    
7.
Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract 2013;1:22 8.   Back to cited text no. 7
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8.
Werfel T, Ballmer Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K, et al. Eczematous reactions to food in atopic eczema: Position paper of the EAACI and GA2LEN. Allergy 2007;62:723 8.   Back to cited text no. 8
    
9.
The Factsheet. Immunisation and Eczema. National Eczema Society; November, 2016. Available from: http://www.eczema.org. [Last accessed on 2017 may 17].   Back to cited text no. 9
    
10.
British Academy Association of Dermatologists. Immunisation Recommendations for Children and Adult Patients Treated with Immune suppressing Medicines. London: British Academy Association of Dermatologists; May, 2015.   Back to cited text no. 10
    
11.
Vaishishtha VM, Choudhury P, Kalra A, Bose A. Indian academy of pediatrics (IAP) recommended immunization schedule for children aged o through 18 years. India, 2014 and Updates or immunization. Indian Pediatr 2014;51:785 800.   Back to cited text no. 11
    
12.
Available from: http://www.indianpediatrics.net/oct2017/287.pdf. [Last accessed on 2017 may 20].  Back to cited text no. 12
    




 

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