Prevention is better than cure, so they say. British researchers have found that it could be possible to prevent asthma in those at high risk by avoiding certain foods and dust mites in the first few months of life.

Professor Syed Hasan Arshad and his team from the David Hide Asthma and Allergy Centre in the Isle of Wight have been monitoring 120 children since 1990 in the Isle of Wight Primary Prevention Study. The children were considered to be at high risk of developing allergic disease on the basis that two or more family members had an allergic disorder. 

“The 58 infants up to one year old and their mothers in the prevention group followed a diet that avoided dairy products, soya and nuts”, said Professor Arshad. “We checked their compliance by randomly testing breast milk,” he added. The infants were also given vinyl mattresses and covers, and acracide was used to reduce the level of house dust mite. The mothers of the 62 infants in the control group did not make these changes to their diet and bedding. 

Dr Martha Scott, who conducted 18 year follow-up of the children, presented the results at the congress of the European Academy of Allergy and Clinical Immunology today. She reported that at one, two, four and eight years old, there was a consistent reduction in atopy (an immediate allergic reaction) in those children in the prevention group. At 18 years of age, there was significantly less asthma in the prevention group compared to the control group. A further analysis of allergic and non-allergic asthma found lower rates of allergic asthma in the prevention group. 

Previous research has shown the complexity of asthma and the importance of the interaction between genetic and environmental factors particularly, but not exclusively, in the early years of life. Atopy is arguably the most significant genetic risk factor for asthma. Despite intensive efforts to develop new treatments, asthma is still an incurable disease.

Evidence of changes in the child’s airways consistent with asthma suggests that early intervention within the first few months of life is likely to be crucial in preventing the remodelling of airways which is the hallmark of asthma. 

“Whilst this study is small it does suggest that it is possible to prevent the onset of asthma in high-risk individuals by instituting a strict regime that avoids some of the common triggers for asthma in the first year of life. We have shown that the beneficial effect lasts for many years,” said Dr Scott.
This study is important as a proof of the concept that environmental manipulation in early life reduces the prevalence of asthma in high risk individuals. This small study needs to be repeated on a larger scale to identify who is most likely to benefit from this type of prevention strategy.

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