The optimum means to prevent the development of allergies in high risk individuals remains an area of controversy. Recommendations have been made in the United States and in Europe for infants with a strong family history of atopy at risk of developing food and other allergies and include the exclusive use of breastfeeding for at least 4 to 6 months, delayed introduction of solid foods until after 4 to 6 months of age, particularly allergenic foods such as egg, wheat, nuts, and fish, avoidance of all CMP, and if formula is needed, to use only extensively hydrolyzed or amino-acid based formulas. Partially hydrolyzed cow's milk, soy, and goat or sheep milk products are not recommended. Hypoallergenic diets have been recommended during pregnancy and with breastfeeding for atopic mothers to reduce the incidence of food allergy in their offspring.
Probiotics offer another means to prevent the development of food allergy. The rationale for using probiotics in allergic diseases is that normal enteric flora established shortly after birth provides counter regulatory signals against a sustained T-helper type 2 cell (Th2)-skewed immune response (Isolauri, 2002). A number of randomized placebo controlled studies show that Lactobacillus GG (also called Lactobacillus rhamnosus [ATCC 53103]) given to women before and during subsequent breastfeeding reduced the occurrence of allergic eczema in their offspring. Other studies suggest that probiotics such as Lactobacillus GG may also be beneficial in ameliorating the severity of allergic responses in established food allergy particularly in younger subjects.
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