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Preventing Allergies & Atopy in Children

It’s no secret that allergies are an epidemic, a modern plague. Say the word peanut in any grade school classroom in North America and you might as well be dropping the F-bomb. It’s a dirty word to say in schools and that’s not a joke.

There are a myriad of theories as to why, and I’m sure I’ll delve deeper into those hypotheses in further posts, but really.... What can you do now, while pregnant or preconception to prevent allergies, asthma and atopy in your future children? Genetics does play a role, epigenetics plays one too. Allergies can be preventable. Much more so than previously considered.

First, let’s define what we’re talking about. What is atopy? Atopy is the genetic tendency to develop allergic reactions and conditions such as asthma, eczema/ atopic dermatitis, and allergic rhinitis/hayfever. Atopic kids are 'hypersensitive". They have heightened immune responses to common allergens and they are more likely to be anaphylactic. I was a textbook atopic child, even before the term was widely used. When I was pregnant with my first child in 2005 a well meaning allergist told me I should avoid eating peanuts, even though my particular anaphylaxis is not nut-related. I walked out of there craving peanut butter all of a sudden. (OK, chocolate peanut butter cups) and ate them with regularity throughout my pregnancy. Thankfully, my child was born with no anaphylaxis.

Less than 2 years later I was again pregnant and in that short time span the recommendations had changed regarding exposure to common allergens during pregnancy and when to introduce them to babies. Now we were to expose the mother and baby in utero to as many allergens as possible during pregnancy to prevent allergies. The recommendation to wait until after the age of 2 to expose kids to nuts also changed dramatically, now we were supposed to give all foods to the babies as early as possible. This was a recommendation developed after the landmark study on Ashkenazi Jews in Israel and the UK that showed children exposed to peanuts earlier in life had less chance of being allergic. (Du Toit G, 2008). Another study of 1200 mother-child pairs found that when pregnant women eat peanuts, milk and wheat early during their pregnancies – their babies have a significant reduction in odds of developing anaphylactic peanut allergies, allergic rhinitis, atopic dermatitis and asthma. (Bunyavanich S, 2014)

The biggest risk factor for food allergy development is a history of eczema or asthma. What do these disorders have in common? They are chronic inflammatory conditions. So part of preventing an immune system disruption like the development of food allergies starts with reducing the inflammation.

Your personal microbiota – the community of amazing bacteria inhabiting your own body - is said to be a major determinant of your health. This is a huge area of study in medicine right now and for good reason. We don’t know the whole story yet, but what we do know is that the more diverse your microbiome is – the more varied the strains of bacteria you have inhabiting your body – the better. This is one of the reasons why allergic diseases are more prevalent in affluent countries – where we place a higher importance on anti-bacterial cleanliness. More studies are showing now that the window of opportunity to effect change through intervention begins during pregnancy and not just infancy. Fetal exposure to diverse strains of bacteria from the mother's diet and environment seems to increase protective benefit and reduce atopy in the future children by priming their immune systems in utero (Abrahamsson TR, 2015)

What are the big risk factors for developing asthma and eczema in the first place - birth by Cesarean section and antibiotic use in the first few years of life. Why? Because both of these interventions reduce the diversity of baby's microbiome. Birth by Cesarean bypasses the inoculation of essential vaginal flora to the baby that is crucial for imprinting their own microbiome. Antibiotics wipe out their precious microbiota. The rise in frequency of atopy and anaphylaxis mirrors the increase in rates of Cesarean delivery in the developed world. Coincidence? Maybe. Probably not. Sometimes a Cesarean section is unavoidable and saves lives. Sometimes it is unnecessary and preventable. In future posts we will definitely touch on ways to avoid unnecessary Cesarean. That is a conversation for another time. For now, there is a cutting edge practice being performed in hospitals all over the world in order to inoculate an Cesarean section born baby with essential bacteria. Vaginal seeding is a simple and effective practice that is gaining evidence and popularity. The basics are that a piece of gauze is inoculated with vaginal fluids and then swiped over the sectioned newborn's mouth, nose & skin. This transfers the mother's essential bacteria to her newborn in a way that mimics a vaginal birth.(Dominguez-Bello MG, 2016) As always, please discuss first with your birth provider.

Many studies have shown that it’s not the same for everyone. Wait, what? Medicine is not one size fits all? No friends, it's not. TREAT THE INDIVIDUAL, not the condition. However... we all agree that diets rich in fruits & vegetables, omega 3s & Vitamin D are protective against the development of the atopic disorders of childhood (Netting MJ, 2014). Fruits and Vegetables are protective?? Where have I heard that before??

One amazing study showed that for babies who used pacifiers – if the parents cleaned their pacifier by sucking on it themselves – their babies were less likely to have eczema, asthma and allergies at 18 months of age compared with parents who washed it with water or sterilized it. This is another way of influencing the microbiota – parents are transferring their own microbes to the infant and these microbes help diversify their own. Good bacteria for the win! (Hesselmar B, 2013). If your child is not a pacifier kid - no worries - just lick them every now and then. Or share a plate of food, whatever you prefer.

So, without further ado... Here are the top 10 things you can do to prevent allergies, asthma and eczema in children.

  1. Eat a varied diet during pregnancy, the more foods the fetus is exposed to, the less foods their immune systems may one day perceive to be allergenic.

  2. Take a good, multi strain Probiotic throughout pregnancy (Zhang G-Q, 2016) (Cuello-Garcia CA, 2015)

  3. Supplement with Vitamin D drops throughout pregnancy – increased vitamin D status is associated with a decrease in allergies and eczema in infants (Jones AP, 2012) (Papadopoulou A, 2015)

  4. Eat clean fish and/or take Omega 3 Fatty Acids. Supplementation during pregnancy is protective of allergy in infants and children. (Miles EA, 2017)

  5. Reduce exposure to environmental toxins - this is essential not only during pregnancy but also during preconception. Environmental toxins to avoid include: heating and storing food in plastic, BPA in cans, Teflon, cosmetics & body products with questionable ingredients (an excellent resource is the Environmental Working Group's Skin Deep Database where you can search all your favourite products and brands and find out if the ingredients are harmful or helpful). Also, avoiding pesticides in foods, meaning eating organic where possible. Another good EWG resource is the Dirty Dozen/ Clean 15 - an up to date list of produce with the most and least amount of pesticide residue, so you know which fruits and vegetables are most important to eat organic. (Donohue KM, 2014) (Jedrychowski, 2010) (Dick S, 2014)

  6. Early, regular exposure to all the foods in the first year of life (Amarasekera M, 2013)

  7. Don’t take acid-suppressing medications or Acetaminophen/Tylenol during pregnancy - these medications in particular show links to development of allergies in children. (Devine RE, 2016) (Jedrychowski W, 2012)

  8. Do all you can to give birth vaginally. If this is not an option - talk to your doctor or midwife about Vaginal Seeding

  9. If you have to take antibiotics during pregnancy or during labour, continue taking probiotics & administer probiotics to the baby for the first 9 months. (Romm A, 2015)

  10. Breastfeed. You knew this one was coming. If you are able to do it, there are so many benefits, this is just one of them. The World Health Organization recommends exclusive breastfeeding for the first 6 months and then as a complement to food introduction up to the age of two years and beyond.

If you are long past the prenatal stage, all is not lost. There are many things we can do to influence your current physiological terrain. Atopic children don't necessarily need to become atopic adults. Healthy diet and lifestyle, correcting nutrient deficiencies, including fermented foods in a varied diet, all of these things and more can help create a healthy microbiome and healthy, robust children.

*Disclaimers: None of this information is a replacement for individualized medical advice. Please see your Personal Health Care Provider for advice regarding your particular needs.

Abrahamsson TR, W. R. (2015). Gut microbiota and allergy: the importance of the pregnancy period. Pediatric Research , 214-219.

Amarasekera M, P. S. (2013). Nutrition in early life, immune-programming and. Asian Pacific Journal of Allergy & Immunology , 175-82.

Bunyavanich S, R.-S. S.-M. (2014). Peanut, milk, and wheat intake during pregnancy is associated with reduced allergy and asthma in children. The Journal of Allergy and Clinical Immunology , 1373-82.

Cuello-Garcia CA, B. J.-N. (2015). Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. The journal of Allergy and Clinical Immunology , 952-961.

Devine RE, S. A. (2016). Acid-suppressive medications during pregnancy and risk of asthma and allergy in the offspring: protocol for a systematic review. NPJ Primary Care Respiratory Medicine .

Dick S, F. A. (2014). A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years. British Medical Journal Open .

Dominguez-Bello MG, D. J.-L.-V. (2016). Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nature Medicine , 250-53.

Donohue KM, M. R. (2014). Prenatal and postnatal bisphenol A exposure and asthma development among inner-city children. Journal of Allergy and Clinical Immunology , 736-42.

Du Toit G, K. Y.-M. (2008). Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. The Journal of Allergy and Clinical Immunology , 984-91.

Hesselmar B, S. F. (2013). Pacifier cleaning practices and risk of allergy development. Pediatrics , 1829-37.



Jones AP, P. D. (2012). The journal of Allergy and Clinical Immunology . Pediatrics .

Miles EA, C. P. (2017). Can Early Omega-3 Fatty Acid Exposure Reduce Risk of Childhood Allergic Disease? Nutrients .

Netting MJ, M. P. (2014). Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches. Nutrition , 1225-1241.

Papadopoulou A, B. E. (2015). Maternal Vitamin D Status and Development of Asthma and Allergy in Early Childhood. Mini Reviews in Medicinal Chemistry , 900-12.

Romm, A. (2015). Preventing a Modern Plague: Food Allergies.

Zhang G-Q, H. H.-J.-Y. (2016). Proiotics for Prevention of Atopy and Food Hypersensitivity in Early Childhood . Medicine (Baltimore) .

Dr Dori Skye Engel,
Naturopathic Doctor & Doula

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