Adherence to allergy prevention recommendations in children with a family 
history of asthma 

Abstract:

Mihrshahi S, Webb K, Almqvist C, Kemp AS for the CAPS Team. Adherence to 
allergy prevention recommendations in children with a family history of asthma.

Pediatr Allergy Immunol 2008: 19: 355-362.

Allergen avoidance has been a major component of most programs for primary 
prevention of asthma and allergic diseases in childhood. As a part of the 
Childhood Asthma Prevention Study, families were provided with written and 
oral information on measures considered to be helpful in the primary prevention 
of allergic disease in high-risk infants. Dietary measures included advice to 
breastfeed for 6 months or longer, to delay the introduction of solid foods 
until after the infant turned 6 months of age, and to delay giving allergenic 
foods (egg and peanut butter) until after 12 months of age. In the active 
group of the randomized controlled trial aimed at reducing house dust mite 
(HDM) allergen levels, parents were advised to use an HDM-impermeable study 
mattress cover and an acaricide, to avoid sheep skins, and not to use a pillow 
before 12 months of age. Families received regular visits from the research 
nurses at 1, 3, 6, 9 and 12 months and phone calls every 6 wk. Only 43.4% 
of mothers were breastfeeding by 6 months and less than 20% by 12 
months. The introduction of solid foods before 6 months was common, 26% 
by 3 months and 96% by 6 months. Adherence to infant-feeding 
recommendations was significantly greater in women over 30 yr of age, 
women who did not smoke during pregnancy, and women who had a tertiary 
education. Adherence to HDM reduction measures was greater than to those 
for infant feeding. The presence of symptoms in the form of an itchy rash by 4
 wk did not significantly increase adherence. Complete adherence to infant-
feeding recommendations in this intervention study of high-risk infants was 
low despite the provision of written information and reinforcement at home 
visits. In considering allergy prevention advice offered during clinical care, the 
likelihood of adherence is a factor which needs to be evaluated in assessing 
any potential benefits of allergy prevention regimens. 
Keywords: allergy; breastfeeding; diet; house dust mites; guideline 
adherence; patient compliance; primary prevention 

Affiliations: 1: Department Allergy Immunology and Infectious Diseases, The 
Children's Hospital, Westmead, Sydney, NSW 2145, Australia 2: School of 
Public Health and Human Nutrition Unit, School of Molecular and Microbial 
Biosciences, University of Sydney, Sydney, NSW 2006, Australia 

Ellen Penchuk, IBCLC, RLC

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