forebyggelse-af-atopisk-sygdom-og-allergi-hos-boern (LH Indholdsside)

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    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger</h2>
<ul>
    <li>
    Forekomsten af atopisk sygdom (atopisk eksem, h&oslash;feber, astma og f&oslash;devareallergi) steg fra 60'erne til &aring;rtusindskiftet, men man har ikke kunne pege p&aring; en enkelt udl&oslash;sende faktor. Det er derfor ogs&aring; vanskeligt at komme med anbefalinger om forebyggelse af disse sygdomme. Som anf&oslash;rt nedenfor er der dog faktorer, der er associeret med henholdsvis nedsat og &oslash;get risiko for atopisk sygdom
    </li>
</ul>
<p>Faktorer associeret med nedsat risiko for atopisk sygdom&nbsp;</p>
<ul>
    <li>
    Opv&aelig;kst p&aring; bondeg&aring;rd&nbsp;<a href=" " data-type="journal-reference" data-value="von Mutius E, Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease. Curr Opin Gastroenterol 2012;28: 570-6" data-value-piped="von Mutius E|Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease.|Curr Opin Gastroenterol|2012|28|570-6|23041676" data-url="reference-link" data-pubmedid="23041676" title="von Mutius E, Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease. Curr Opin Gastroenterol 2012;28: 570-6">1</a>
    </li>
    <li>
    Indtag af upasteuriseret kom&aelig;lk (ikke anbefalelsesv&aelig;rdig pga. infektionsrisiko)&nbsp;<a href=" " data-type="journal-reference" data-value="von Mutius E, Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease. Curr Opin Gastroenterol 2012;28: 570-6" data-value-piped="von Mutius E|Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease.|Curr Opin Gastroenterol|2012|28|570-6|23041676" data-url="reference-link" data-pubmedid="23041676" title="von Mutius E, Maternal farm exposure/ingestion of unpasteurized cow's milk and allergic disease. Curr Opin Gastroenterol 2012;28: 570-6">1</a>
    </li>
    <li>
    Perinatal eksposition for hund (associeret med 50 % nedsat risiko for atopisk eksem)&nbsp;<a href=" " data-type="journal-reference" data-value="Carson CG, Risk factors for developing atopic dermatitis.. Dan Med J 2013;60: B4687" data-value-piped="Carson CG|Risk factors for developing atopic dermatitis.|Dan Med J|2013|60|B4687|23809981" data-url="reference-link" data-pubmedid="23809981" title="Carson CG, Risk factors for developing atopic dermatitis.. Dan Med J 2013;60: B4687">2</a>
    </li>
    <li>
    Profylaktisk anvendelse af fugtighedscreme til b&oslash;rn disponeret til atopisk eksem viste i mindre studier effekt, men effekten kunne ikke bekr&aelig;ftes i st&oslash;rre studier&nbsp;<a href=" " data-type="journal-reference" data-value="Skjerven HO, Rehbinder EM, Vettukattil R, et al,  Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2020;395: 951-61" data-value-piped="Skjerven HO, Rehbinder EM, Vettukattil R, et al| Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial|Lancet|2020|395|951-61|" data-url="reference-link" title="Skjerven HO, Rehbinder EM, Vettukattil R, et al,  Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2020;395: 951-61">3</a><sup>,</sup><a title="Chalmers JR, Haines RH, Bradshaw LE et al, Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet 2020;395: 962-72" data-url="reference-link" data-value-piped="Chalmers JR, Haines RH, Bradshaw LE et al|Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial|Lancet|2020|395|962-72|" data-value="Chalmers JR, Haines RH, Bradshaw LE et al, Daily emollient during infancy for prevention of eczema: the BEEP randomised controlled trial. Lancet 2020;395: 962-72" data-type="journal-reference" href=" ">4</a>
    </li>
    <li>
    Indgift af peanuts hos b&oslash;rn disponeret for peanutallergi kan forebygge peanutallergi <a title="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team., Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372: 803-13" href=" " data-type="journal-reference" data-value="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team., Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372: 803-13" data-value-piped="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team.|Randomized trial of peanut consumption in infants at risk for peanut allergy.|N Engl J Med|2015|372|803-13|25705822" data-url="reference-link" data-pubmedid="25705822">5</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team, Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372: 803-13" data-value-piped="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team|Randomized trial of peanut consumption in infants at risk for peanut allergy.|N Engl J Med|2015|372|803-13|25705822" data-url="reference-link" data-pubmedid="25705822" title="Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP Study Team, Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372: 803-13">6</a><sup>,</sup><a title="Natsume O, Kabashima S, Nakazato J et al, Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet 2017;389: 276-86" data-url="reference-link" data-value-piped="Natsume O, Kabashima S, Nakazato J et al|Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial|Lancet|2017|389|276-86|" data-value="Natsume O, Kabashima S, Nakazato J et al, Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet 2017;389: 276-86" data-type="journal-reference" href=" ">7</a></li>
    <li>Diversitet i kosten indenfor f&oslash;rste leve&aring;r. Jo flere forskellige f&oslash;deemner barnet indtager, jo mindre er risikoen for udvikling af astma, atopisk dermatitis og f&oslash;demiddelallergi&nbsp;<a title="Roduit C, Frei R, Depner M, Schaub B, Loss G, Genuneit J, Pfefferle P, Hyvärinen A, Karvonen AM, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, PASTURE study group., Increased food diversity in the first year of life is inversely associated with allergic diseases. J Allergy Clin Immunol 2014;133: 1056-64" href=" " data-type="journal-reference" data-value="Roduit C, Frei R, Depner M, Schaub B, Loss G, Genuneit J, Pfefferle P, Hyvärinen A, Karvonen AM, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, PASTURE study group., Increased food diversity in the first year of life is inversely associated with allergic diseases. J Allergy Clin Immunol 2014;133: 1056-64" data-value-piped="Roduit C, Frei R, Depner M, Schaub B, Loss G, Genuneit J, Pfefferle P, Hyvärinen A, Karvonen AM, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, PASTURE study group.|Increased food diversity in the first year of life is inversely associated with allergic diseases.|J Allergy Clin Immunol|2014|133|1056-64|24508301" data-url="reference-link" data-pubmedid="24508301">8</a></li>
    <li>Indgift af yoghurt indenfor f&oslash;rste leve&aring;r er associeret med 60 % reduceret risiko for atopisk dermatitis&nbsp;<a title="Roduit C, Frei R, Loss G, Büchele G, Weber J, Depner M, Loeliger S, Dalphin ML, Roponen M, Hyvärinen A, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, Protection Against Allergy–Study in Rural Environments study group., Development of atopic dermatitis according to age of onset and association with early-life exposures. J Allergy Clin Immunol 2012;130: 130-6.e5" href=" " data-type="journal-reference" data-value="Roduit C, Frei R, Loss G, Büchele G, Weber J, Depner M, Loeliger S, Dalphin ML, Roponen M, Hyvärinen A, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, Protection Against Allergy–Study in Rural Environments study group., Development of atopic dermatitis according to age of onset and association with early-life exposures. J Allergy Clin Immunol 2012;130: 130-6.e5" data-value-piped="Roduit C, Frei R, Loss G, Büchele G, Weber J, Depner M, Loeliger S, Dalphin ML, Roponen M, Hyvärinen A, Riedler J, Dalphin JC, Pekkanen J, von Mutius E, Braun-Fahrländer C, Lauener R, Protection Against Allergy–Study in Rural Environments study group.|Development of atopic dermatitis according to age of onset and association with early-life exposures.|J Allergy Clin Immunol|2012|130|130-6.e5|22521248" data-url="reference-link" data-pubmedid="22521248">9</a></li>
    <li>Indgift af ost ved 18-mdrs.-alderen er associeret med 50 % reduceret risiko for atopisk dermatitis og 70 % reduceret risiko for f&oslash;demiddelallergi&nbsp;<a title="Nicklaus S, Divaret-Chauveau A, Chardon ML, Roduit C, Kaulek V, Ksiazek E, Dalphin ML, Karvonen AM, Kirjavainen P, Pekkanen J, Lauener R, Schmausser-Hechfellner E, Renz H, Braun-Fahrländer C, Riedler J, Vuitton DA, Mutius EV, Dalphin JC, Pasture Study Group., The protective effect of cheese consumption at 18 months on allergic diseases in the first 6 years. Allergy 2019;74: 788-798" href=" " data-type="journal-reference" data-value="Nicklaus S, Divaret-Chauveau A, Chardon ML, Roduit C, Kaulek V, Ksiazek E, Dalphin ML, Karvonen AM, Kirjavainen P, Pekkanen J, Lauener R, Schmausser-Hechfellner E, Renz H, Braun-Fahrländer C, Riedler J, Vuitton DA, Mutius EV, Dalphin JC, Pasture Study Group., The protective effect of cheese consumption at 18 months on allergic diseases in the first 6 years. Allergy 2019;74: 788-798" data-value-piped="Nicklaus S, Divaret-Chauveau A, Chardon ML, Roduit C, Kaulek V, Ksiazek E, Dalphin ML, Karvonen AM, Kirjavainen P, Pekkanen J, Lauener R, Schmausser-Hechfellner E, Renz H, Braun-Fahrländer C, Riedler J, Vuitton DA, Mutius EV, Dalphin JC, Pasture Study Group.|The protective effect of cheese consumption at 18 months on allergic diseases in the first 6 years.|Allergy|2019|74|788-798|30368847" data-url="reference-link" data-pubmedid="30368847">10</a></li>
</ul>
<p>Faktorer associeret med &oslash;get risiko for atopisk sygdom</p>
<ul>
    <li>
    Arv&nbsp;
    </li>
    <li>
    Alkoholindtag under graviditeten er associeret med &oslash;get risiko for atopisk eksem&nbsp;<a href=" " data-type="journal-reference" data-value="Carson CG, Risk factors for developing atopic dermatitis.. Dan Med J 2013;60: B4687" data-value-piped="Carson CG|Risk factors for developing atopic dermatitis.|Dan Med J|2013|60|B4687|23809981" data-url="reference-link" data-pubmedid="23809981" title="Carson CG, Risk factors for developing atopic dermatitis.. Dan Med J 2013;60: B4687">2</a>
    </li>
    <li>
    Eksposition for tobaksr&oslash;g&nbsp;<a href=" " data-type="journal-reference" data-value="Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, Britton JR, McKeever TM, Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis.. Pediatrics 2012;129: 735-44" data-value-piped="Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, Britton JR, McKeever TM|Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis.|Pediatrics|2012|129|735-44|22430451" data-url="reference-link" data-pubmedid="22430451" title="Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, Britton JR, McKeever TM, Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis.. Pediatrics 2012;129: 735-44">11</a>
    </li>
    <li>F&oslash;dsel ved sectio. Specielt elektivt sectio er associeret med &oslash;get risiko for astma&nbsp;<a title="Kristensen K, Henriksen L, Cesarean section and disease associated with immune function. J Allergy Clin Immunol 2016;137: 587 - 90" href="%20" data-type="journal-reference" data-value="Kristensen K, Henriksen L, Cesarean section and disease associated with immune function. J Allergy Clin Immunol 2016;137: 587 - 90" data-value-piped="Kristensen K, Henriksen L|Cesarean section and disease associated with immune function|J Allergy Clin Immunol|2016|137|587 - 90" data-url="reference-link">12</a></li>
</ul>
<h3>Faktorer, hvis association til atopisk sygdom er usikker&nbsp;<a href=" " data-type="journal-reference" data-value="Van Bever HP, Nagarajan S, Shek LP, Lee BW, OPINION: Primary prevention of allergy - Will it soon become a reality?. Pediatr Allergy Immunol 2016;27: 6-12" data-value-piped="Van Bever HP, Nagarajan S, Shek LP, Lee BW|OPINION: Primary prevention of allergy - Will it soon become a reality?|Pediatr Allergy Immunol|2016|27|6-12|26456367" data-url="reference-link" data-pubmedid="26456367" title="Van Bever HP, Nagarajan S, Shek LP, Lee BW, OPINION: Primary prevention of allergy - Will it soon become a reality?. Pediatr Allergy Immunol 2016;27: 6-12">13</a></h3>
<ul>
    <li>Probiotika, prebiotika og synbiotika</li>
    <li>Tidlig introduktion af overgangskost&nbsp;</li>
</ul>
<h3>G&aelig;ldende anbefalinger&nbsp;<a href="https://www.sst.dk/-/media/Udgivelser/2022/Ern%C3%A6ring/B%C3%B8rn/Notat_Anbefalinger-om-forebyggelse-af-foedevareallergi-hos-spaedboern_opdateret16112022.ashx" data-type="other-reference" data-value="Sundhedsstyrelsen notat 16. november" data-url="https://www.sst.dk/-/media/Udgivelser/2022/Ern%C3%A6ring/B%C3%B8rn/Notat_Anbefalinger-om-forebyggelse-af-foedevareallergi-hos-spaedboern_opdateret16112022.ashx" title="Sundhedsstyrelsen notat 16. november">14</a></h3>
<ul>
    <li>
    Sundhedsstyrelsen anbefaler amning frem til 6-m&aring;nedersalderen med introduktion af overgangskost fra 4-m&aring;nedersalderen
    </li>
    <li>Med henblik p&aring; at forebygge allergi overfor kom&aelig;lk anbefaler Sundhedsstyrelsen p&aring; baggrund af 1 arbejde, at raske, mature b&oslash;rn, der ammes, men har behov for tilskud af moderm&aelig;lkserstatning i f&oslash;rste leveuge, gives h&oslash;jt hydrolyseret moderm&aelig;lkserstatning eller aminosyrebaseret moderm&aelig;lkserstatning i denne periode. B&oslash;rn som ikke &oslash;nskes ammet fuldt, hvor der stiles mod regelm&aelig;ssigt tilskud af eller fuld ern&aelig;ring med almindelig moderm&aelig;lkserstatning, kan starte med almindelig kom&aelig;lksbaseret moderm&aelig;lkserstatning i f&oslash;rste leveuge&nbsp;</li>
    <li>2 store metaanalyser kunne ikke underbygge nogen profylaktisk effekt af h&oslash;jt hydrolyseret moderm&aelig;lkserstatning <a title="Boyle R, Lerodiakonou d, Khan T et al, Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ 2016;352: i974" href="%20" data-type="journal-reference" data-value="Boyle R, Lerodiakonou d, Khan T et al, Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ 2016;352: i974" data-value-piped="Boyle R, Lerodiakonou d, Khan T et al|Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis|BMJ|2016|352|i974" data-url="reference-link">15</a><sup>,</sup><a title="Osborn DA, Sinn JK, Jones LJ, Infant formulas containing hydrolysed protein for prevention of allergic disease. Cochrane Database Syst Rev 2018;10: CD003664" href=" " data-type="journal-reference" data-value="Osborn DA, Sinn JK, Jones LJ, Infant formulas containing hydrolysed protein for prevention of allergic disease. Cochrane Database Syst Rev 2018;10: CD003664" data-value-piped="Osborn DA, Sinn JK, Jones LJ|Infant formulas containing hydrolysed protein for prevention of allergic disease.|Cochrane Database Syst Rev|2018|10|CD003664|30338526" data-url="reference-link" data-pubmedid="30338526">16</a></li>
    <li>Et prospektivt ikke interventionsstudie omfattende 13019 b&oslash;rn viste, at eksposition for kom&aelig;lksprotein indenfor de f&oslash;rste 14 levedage var associeret med en 19 gange lavere risiko for allergi overfor kom&aelig;lksprotein&nbsp;<a href=" " data-type="journal-reference" data-value="Katz Y, Rajuan N, Goldberg MR, Eisenberg E, Heyman E, Cohen A, Leshno M, Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. J Allergy Clin Immunol 2010;126: 77-82.e1" data-value-piped="Katz Y, Rajuan N, Goldberg MR, Eisenberg E, Heyman E, Cohen A, Leshno M|Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy.|J Allergy Clin Immunol|2010|126|77-82.e1|20541249" data-url="reference-link" data-pubmedid="20541249" title="Katz Y, Rajuan N, Goldberg MR, Eisenberg E, Heyman E, Cohen A, Leshno M, Early exposure to cow's milk protein is protective against IgE-mediated cow's milk protein allergy. J Allergy Clin Immunol 2010;126: 77-82.e1">17</a>
    </li>
</ul>
<h3>&nbsp;Anbefales ikke</h3>
<ul>
    <li>Undg&aring;else af allergener. Der er ikke holdepunkter for, at b&oslash;rn, som er disponerede for atopisk sygdom, b&oslash;r undg&aring; bestemte f&oslash;deemner eller at omg&aring;s dyr</li>
    <li>Di&aelig;t til gravide eller ammende kvinder</li>
    <li>Soyabaserede eller gedem&aelig;lksbaserede produkter&nbsp;</li>
    <li>Sen introduktion af gluten</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation&nbsp;</h2>
<h3>Hvad findes af skriftlig information</h3>
<ul>
    <li><a href="~/link.aspx?_id=32257B074E274D219F7C9E17FD115579&amp;_z=z">Forebyggelse af atopisk sygdom og allergi hos b&oslash;rn</a></li>
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      <HtmlField Name="Resume"><![CDATA[<h2>Resum&eacute;</h2>
<ul>
    <li>Atopiske sygdomme er multifaktorielle sygdomme, og man har ikke kunnet pege p&aring; en enkelt modificerbar faktor som m&aring;l for profylaktiske tiltag</li>
    <li>Forebyggelse af atopisk sygdom er derfor ikke mulig&nbsp;aktuelt&nbsp;</li>
    <li>Dog har randomiserede studier vist, at indgift af peanut og &aelig;g hos b&oslash;rn i h&oslash;j risiko for f&oslash;demiddelallergi, dvs. med tidlig atopisk dermatitis, kan forebygge udvikling af henholdsvis peanutallergi og &aelig;ggeallergi</li>
    <li>En r&aelig;kke faktorer vides at v&aelig;re associeret med henholdsvis nedsat og &oslash;get risiko for atopisk sygdom jvf. nedenst&aring;ende</li>
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