Primary prevention

Probiotic supplementation during pregnancy and breastfeeding may reduce the risk of atopic disease.[47] Fish oil supplementation during pregnancy and breastfeeding may reduce risk of sensitisation to food allergens.[47] Maternal allergenic food avoidance during pregnancy or lactation does not appear to reduce the risk of allergic or autoimmune disease.[47]

Early introduction of peanuts and eggs into the infant diet can reduce the risk of those respective allergies.[48][49] Other common allergens can be introduced around the same time as well.[48] In infants with no history of egg allergy, and no, or mild-to-moderate atopic disease, peanut-containing foods can be introduced during weaning.[49] In infants with severe eczema and/or egg allergy, screening for peanut allergy should occur before introduction of peanut-containing foods.[49]

Precautions against exposure to insect stings includes closed footwear and thick socks when outside. Windows should be closed when driving and when at home (insect protection windows are recommended for the home). Drinking or eating outdoors requires special care, as honeybees seek all fluids, especially in hot weather, and wasps seek the sugar in drinks. These recommendations are crucial for individuals with known allergies and individuals at high risk, such as children from allergic families or atopic children. Avoiding exposure to insect stings (e.g., bees, wasps, and ants) is recommended for the general population, as individuals might not be aware of their allergy.

Medical personnel and high-risk patient groups (e.g., patients with spina bifida) can be protected from developing latex allergy by avoidance of latex-containing materials and catheters.[30]

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Secondary prevention

Prevention of subsequent allergic reactions starts with clear identification of the causative allergen and allergen avoidance. Patient and carer awareness and education is crucial.[150]

Refer patients to an age-appropriate specialist allergy service for accurate investigation, diagnosis, monitoring, ongoing management, patient education, and possible immunotherapy.[32][52][59]

For food allergies, awareness includes careful attention to food labelling, caution with take-away and restaurant foods, and an allergen-free environment. Many industrial countries mandate the precise labelling of all foods. Restaurants often specify special additives and ingredients. This is helpful as even traces of an allergen may be sufficient to trigger a full-blown allergic attack. See Food allergy for more information.

Latex-free precautions are necessary in surgical or dental procedures in people with latex allergy.[151] Medicine allergies require a medical record alert and a MedicAlert-type bracelet or necklace. Possible cross-reactivity must also be considered.

Prevention of insect stings is crucial in allergic individuals. Venom immunotherapy is recommended for patients who have experienced severe systemic reactions to insect stings and have specific IgE to venom allergens.[9][14][59] [ Cochrane Clinical Answers logo ]

A prescription of two adrenaline (epinephrine) auto-injectors must be given to all patients after any episode of anaphylaxis.[9][52][144] The patient or carer should carry both of them at all times and be familiar with their use.[152] For children at risk of anaphylaxis, the adrenaline auto-injectors should be prescribed in conjunction with a personalised written emergency plan.[152][153]

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