Vaikų alergijos maistui pirminė prevencija

Vaikų alergijos maistui pirminė prevencija

PRIMARY FOOD ALLERGY PREVENTION IN CHILDREN

 

Ieva Polianskytė

Vilniaus universiteto Medicinos fakultetas

 

Raktažodžiai: alergija maistui, hidrolizuoti pieno mišiniai, atopija, sensitizacija.

Santrauka

Alergija maistui – imuninių mechanizmų valdoma nepageidaujama reakcija į maistą, galinti sukelti reikšmingą ligą ir, kai kuriais atvejais, būti pavojinga gyvybei. Alergija maistui sukelia didelę ekonominę naštą dėl didesnio medicininių vizitų ir gydymo poreikio. Dėl šių priežasčių būtinas moksliškai pagrįstas alergijos maistui prevencijos metodų įvertinimas.

 

Įvadas

Alergija maistui – tai nepageidaujama reakcija į maistą, kurioje dalyvauja imunologiniai mechanizmai [1, 2]. Ši sąvoka apima imunoglobulinų E (IgE) sukeliamas ir nuo IgE nepriklausomas alergijas maistui. Alergija maistui gali sukelti ligą, kai kuriais atvejais – gyvybei pavojingų anafilaksinių reakcijų [3–5]. Alergija maistui gali turėti reikšmingą įtaką sergamumui, pacientų gyvenimo kokybei ir būti finansiškai nepalanki dėl dažnesnių medicininių vizitų ir gydymo poreikio. Todėl kyla svarbus profesinis, mokslinis interesas, atrasti būdus, kurie galėtų sumažinti alergijos maistui išsivystymo riziką [6]. Tikėtina, kad alergijos maistui išsivystymo priežastys yra genetinių veiksnių ir aplinkos poveikio sąveika. Kadangi šiuo metu genetiniai veiksniai negali būti modifikuojami, šios alergijos prevencijos strategija akcentuoja ankstyvą ekspoziciją maisto baltymams, kurie, kaip spėjama, labiausiai dalyvauja alergijos maistui patogenezėje. Šios strategijos gali būti taikomos antenataliai ar žindant, sutelkiant dėmesį į motinos dietą arba tiesiogiai – į kūdikio mitybą. Taip pat tiriami mitybos veiksniai ar papildai, kurie galėtų teigiamai modifikuoti imuninę sistemą.

Šiame straipsnyje maisto alergijos prevencija yra apibrėžiama kaip alergijos maistui išsivystymo prevencija. Atlikta nemažai tyrimų, nagrinėjusių antenataliniu, perinataliniu, neonataliniu ir vaikystės periodais taikytas strategijas, siekiant išvengti alergijos maistui išsivystymo. Šis apžvalginis straipsnis parengtas remiantis Europos alergologų ir klinikinių imunologų akademijos (EAACI) alergijos maistui ir anafilaksijos gairėmis, sudarytomis darbo grupės, vadovaujamos A. Muraro, bei Amerikos pediatrų akademijos (APA) klinikine ataskaita – Ankstyvų mitybos intervencijų efektas atopinės ligos išsivystymui kūdikiams ir vaikams [6, 7].

Remiantis akademijų išvadomis, šiame straipsnyje apžvelgiamos alergijos maistui ir atopinių ligų prevencijos taktikos ir jų efektyvumas antenataliniu periodu (nėščių moterų mitybos pokyčiai ir / ar maisto papildų įvedimas) ir įvairiais postnataliniais kūdikio raidos periodais (žindymo reikšmė, karvės pieno mišiniai, maisto papildai, mitybos pokyčiai, papildomo maitinimo įvedimas ir kitos priemonės), priskiriant vaikus didelės rizikos ir normalios rizikos šeimoms. Didelei rizikai literatūroje yra priskiriami kūdikiai ar vaikai, turintys bent vieną tėvą ir / ar brolį, seserį su alerginės ligos anamneze. EAACI gairėse ir šiame straipsnyje didelei rizikos grupei priskiriami vaikai ir kūdikiai, kurie turi padidėjusią riziką sirgti atopine liga ar alergija maistui dėl šeiminės alerginės anamnezės. Normalios rizikos grupei priklauso kūdikiai ir vaikai, kurių tėvai, broliai ar seserys anamnezėje nėra sirgę alerginėmis ligomis.

 

Antenatalinė prevencija

Nėra įrodymų, leidžiančių rekomenduoti dietos pakeitimus ar bet kokių papildų vartojimą nėštumo metu, siekiant išvengti alergijos maistui išsivystymo vaikams.

 

Didelės rizikos šeimos

Šiuo metu trūksta įrodymų, kurie pagrįstų specifinį dietos vaidmenų nėštumo metu, siekiant perspėti alergijos maistui išsivystymą didelės rizikos vaikams. Sisteminėje apžvalgoje [8] ir dviejuose atsitiktinių imčių, kontroliuojamuose tyrimuose [9, 10] nustatyta, kad dažniausių alergenų ribojimas nėščių moterų dietoje nepasižymi prevenciniu poveikiu.

Duomenų apie žuvies taukų prevencinį poveikį yra nedaug. Dviejuose atsitiktinių imčių, kontroliuojamuose tyrimuose nustatyta, kad įsijautrinimas kiaušinio baltymui buvo mažesnis tiems vaikams, kurių motinos nėštumo metu vartojo žuvies taukus [11–13]. Vienoje studijoje nustatyta, kad probiotikai, kuriuos vartojo didelės rizikos šeimų nėščiosios, sumažino alerginį įsijautrinimą, tačiau nebuvo duomenų apie probiotikų naudą mažinant alergijos ar įsijautrinimo maistui riziką [14].

 

Normalios rizikos šeimos

Kohortiniu tyrimu nustatyta, kad 4 paskutinių nėštumo savaičių metu motinos mityba, kuriose gausu polinesočiųjų omega-6 riebalų rūgščių ir alergizuojančio maisto, vaikams gali padidinti įsijautrinimo maisto alergenams riziką, palyginti su maistu, kuriame gausu polinesočiųjų omega-3 riebalų rūgščių. Gausus salierų ir citrusinių vaisių vartojimas buvo susijęs su padidėjusiu įsijautrinimu maistui, tačiau duomenų apie alergiją maistui nebuvo [15].

 

Prevencijos metodai žindančioms motinoms

Nepakanka įrodymų žindančioms motinoms rekomenduoti modifikuoti dietą ar papildų vartojimą, siekiant apsaugoti vaikus nuo alergijos maistui.

 

Didelės rizikos šeimos

Šiuo metu nėra įrodymų, leidžiančių pagrįsti intervencijų strategijų žindančioms motinoms efektyvumą. Dviejuose prastos kokybės neatsitiktinių imčių tyrimuose nustatyta, kad motinos dietos pokyčiai, pavyzdžiui, alergizuojančių produktų vengimas žindymo metu, gali būti neefektyvūs siekiant išvengti alergijos maistui išsivystymo [16, 17]. Viename atsitiktinės imties tyrime, kuriame analizuota probiotikų vartojimo nėštumo ir laktacijos metu įtaka atopinių ligų rizikai, nenustatyta jokio reikšmingo poveikio sensitizacijai maistui, tačiau nustatytas mažesnis vaikų atopinio dermatito dažnis probiotikus vartojusių motinų grupėje [18, 19].

 

Normalios rizikos šeimos

Vienoje sisteminėje apžvalgoje [20] ir dviejuose atsitiktinių imčių, kontroliuojamuose tyrimuose [21, 22] palygintas vaikų alerginių ligų dažnis grupėse, kuriose nėščiosios vartojo ir nevartojo žuvų taukus. Reikšmingų skirtumų tarp grupių nenustatyta.

 

Prevencijos strategijos kūdikystėje

Žindymas

Žindymas yra naudingas motinai ir vaikui, todėl rekomenduojama žindyti visus kūdikius. Yra nedaug įrodymų, kad žindymas gali sumažinti alergijos maistui išsivystymo riziką. Vis dėlto patikimai įvertinti apsauginį žindymo poveikį sunku, nes imunomoduliuojamųjų komponentų (ilgųjų grandinių riebalų rūgščių ir oligosacharidų) kiekis skirtingų motinų piene skiriasi [23–25].

 

Didelės rizikos šeimos

Nors žindymas yra labai naudingas ir skatinamas, įrodymų apie jo naudą alergijos maistui prevencijoje didelės rizikos vaikams yra labai nedaug. Vienoje sisteminėje apžvalgoje [26] nustatyta, kad žindyti vaikai turėjo mažesnę riziką, kad išsivystys alergija maistui ir egzema. Vienoje atsitiktinių imčių studijoje, į kurią įtraukti neišnešioti naujagimiai, nustatyta, kad motinos pienu maitinti kūdikiai turėjo mažesnę riziką, kad išsivystys alergija karvės pieno baltymams, palyginti su vaikais, maitintais neišnešiotiems naujagimiams skirtu mišiniu [27]. Kiek kitokie duomenys gauti kohortinėje studijoje: nustatyta, kad 5 mėnesius ir ilgiau žindyti vaikai turėjo didesnę riziką būti sensitizuoti kiaušiniams sulaukę metukų, bet ne dvejų metų [28]. Kitoje studijoje nustatyta, kad ilgesnis nei 6 mėnesių žindymas bei papildomas primaitinimas nuo 3 mėnesių buvo susijęs su padidėjusia atopijos išsivystymo rizika ir dažnesne sensitizacija maistui sulaukus 5 metų [29]…

Daugiau skaitykite žurnale „Pediatrija“ Nr.2, 2017 m.


142 mintys apie “Vaikų alergijos maistui pirminė prevencija

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  140. I’ll gear this review to 2 types of people: current Zune owners who are considering an upgrade, and people trying to decide between a Zune and an iPod. (There are other players worth considering out there, like the Sony Walkman X, but I hope this gives you enough info to make an informed decision of the Zune vs players other than the iPod line as well.)

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