对于 AR 一级预防,可以提倡以下做法:吸烟母亲戒烟,出生后最初 3 个月进行纯母乳喂养,以及在 6 月龄之后才能再加入固体食物。
一项 meta 分析纳入了有关妊娠期或哺乳期女性所服用益生菌(作为对婴儿特应性疾病的初级预防)的随机对照试验,结果未发现益生菌对湿疹以外的变应性疾病具有防护作用。[39]Cuello-Garcia CA, Brożek JL, Fiocchi A, et al. Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2015 Oct;136(4):952-61.http://www.jacionline.org/article/S0091-6749(15)00636-3/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/26044853?tool=bestpractice.com然而,尽管关于益生菌预防变应性疾病的证据有限,但来自世界变态反应组织 (World Allergy Organization, WAO) 的指南建议,对于存在娩出过敏儿童风险高的妊娠女性、所哺乳婴儿变态反应发生风险高的女性以及发生变态反应风险高的婴儿,可使用益生菌。[18]Fiocchi A, Pawankar R, Cuello-Garcia C, et al. World Allergy Organization-McMaster University guidelines for allergic disease prevention (GLAD-P): probiotics. World Allergy Organ J. 2015 Jan 27;8(1):4.https://waojournal.biomedcentral.com/articles/10.1186/s40413-015-0055-2http://www.ncbi.nlm.nih.gov/pubmed/25628773?tool=bestpractice.com WAO 指南还建议对非纯母乳喂养的婴儿使用益生菌,但不建议用于纯母乳喂养的婴儿。[19]Cuello-Garcia CA, Fiocchi A, Pawankar R, et al. World Allergy Organization-McMaster University guidelines for allergic disease prevention (GLAD-P): prebiotics. World Allergy Organ J. 2016 Mar 1;9:10.https://waojournal.biomedcentral.com/articles/10.1186/s40413-016-0102-7http://www.ncbi.nlm.nih.gov/pubmed/26962387?tool=bestpractice.com
一项 Cochrane 评价显示,没有证据表明在婴儿期补充多不饱和脂肪酸 (polyunsaturated fatty acid, PUFA) 对婴儿或儿童变态反应或其他变应性疾病有影响。[40]Schindler T, Sinn JK, Osborn DA. Polyunsaturated fatty acid supplementation in infancy for the prevention of allergy. Cochrane Database Syst Rev. 2016 Oct 28;10:CD010112.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010112.pub2/abstract;jsessionid=48AD95559D8963C46816A22A3C571238.f02t03http://www.ncbi.nlm.nih.gov/pubmed/27788565?tool=bestpractice.com