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Adherence to allergy prevention recommendations in children with a family history of asthma

Authors

  • S. Mihrshahi,

    1. Department Allergy Immunology and Infectious Diseases, The Children’s Hospital, Westmead, Sydney, NSW 2145, Australia
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  • K. Webb,

    1. School of Public Health and Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, Sydney, NSW 2006, Australia
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  • C. Almqvist,

    1. The Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW 2006, Australia
    2. Department of Woman and Child Health, Astrid Lindgren Children’s Hospital and Karolinska Institutet, Stockholm, Sweden
    3. NHMRC Centre for Clinical Research Excellence in Respiratory and Sleep Medicine, Sydney, NSW, Australia
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  • A. S. Kemp for the CAPS Team

    1. Department Allergy Immunology and Infectious Diseases, The Children’s Hospital, Westmead, Sydney, NSW 2145, Australia
    2. Discipline of Paediatrics and Child Health, Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia
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Andrew Kemp, Department Allergy Immunology and Infectious Diseases, The Children’s Hospital, Westmead, NSW 2145, Australia
Tel.: 61 2 9845 3416
Fax: 61 2 9845 3421
E-mail: andrewk5@chw.edu.au

Abstract

Allergen avoidance has been a major component of most programs for primary prevention of asthma and allergic diseases in childhood. As a part of the Childhood Asthma Prevention Study, families were provided with written and oral information on measures considered to be helpful in the primary prevention of allergic disease in high-risk infants. Dietary measures included advice to breastfeed for 6 months or longer, to delay the introduction of solid foods until after the infant turned 6 months of age, and to delay giving allergenic foods (egg and peanut butter) until after 12 months of age. In the active group of the randomized controlled trial aimed at reducing house dust mite (HDM) allergen levels, parents were advised to use an HDM-impermeable study mattress cover and an acaricide, to avoid sheep skins, and not to use a pillow before 12 months of age. Families received regular visits from the research nurses at 1, 3, 6, 9 and 12 months and phone calls every 6 wk. Only 43.4% of mothers were breastfeeding by 6 months and less than 20% by 12 months. The introduction of solid foods before 6 months was common, 26% by 3 months and 96% by 6 months. Adherence to infant-feeding recommendations was significantly greater in women over 30 yr of age, women who did not smoke during pregnancy, and women who had a tertiary education. Adherence to HDM reduction measures was greater than to those for infant feeding. The presence of symptoms in the form of an itchy rash by 4 wk did not significantly increase adherence. Complete adherence to infant-feeding recommendations in this intervention study of high-risk infants was low despite the provision of written information and reinforcement at home visits. In considering allergy prevention advice offered during clinical care, the likelihood of adherence is a factor which needs to be evaluated in assessing any potential benefits of allergy prevention regimens.

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