O pelo de cachorros e gatos é um alérgeno comum, e pode causar sintomas de RA perenes.[36]Wallace DV. Pet dander and perennial allergic rhinitis: therapeutic options. Allergy Asthma Proc. 2009 Nov-Dec;30(6):573-83.
http://www.ncbi.nlm.nih.gov/pubmed/20031003?tool=bestpractice.com
[37]National Institute for Health and Care Excellence. Clinical knowledge summaries: allergic rhinitis. Aug 2021 [internet publication].
https://cks.nice.org.uk/topics/allergic-rhinitis
A exposição a um cachorro no primeiro ano de vida pode reduzir o risco de RA e asma.[38]Ojwang V, Nwaru BI, Takkinen HM, et al. Early exposure to cats, dogs and farm animals and the risk of childhood asthma and allergy. Pediatr Allergy Immunol. 2020 Apr;31(3):265-72.
http://www.ncbi.nlm.nih.gov/pubmed/31829464?tool=bestpractice.com
[39]Fall T, Lundholm C, Örtqvist AK, et al. Early exposure to dogs and farm animals and the risk of childhood asthma. JAMA Pediatr. 2015 Nov;169(11):e153219.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2467334
http://www.ncbi.nlm.nih.gov/pubmed/26523822?tool=bestpractice.com
Gestação e início da vida
As evidências atuais não respaldam uma dieta com restrição de antígenos para as gestantes, incluindo aquelas com alto risco de dar à luz uma criança com doença atópica.[45]Greer FR, Sicherer SH, Burks AW, et al; American Academy of Pediatrics: Committee on Nutrition; Section on Allergy and Immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods. Pediatrics. 2019 Apr;143(4):e20190281.
https://publications.aap.org/pediatrics/article/143/4/e20190281/37226/The-Effects-of-Early-Nutritional-Interventions-on
http://www.ncbi.nlm.nih.gov/pubmed/30886111?tool=bestpractice.com
[46]Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD000133.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000133.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/22972039?tool=bestpractice.com
Embora as evidências disponíveis no momento não indiquem que a suplementação com probióticos reduza o risco de distúrbios atópicos, a Organização Mundial de Alergia (World Allergy Organization, WAO) recomenda o uso de probióticos em: gestantes com alto risco de ter um filho alérgico; mulheres que estejam amamentando bebês com alto risco de desenvolver alergia; e bebês com alto risco de desenvolver alergia.[28]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/s40413-015-0055-2
http://www.ncbi.nlm.nih.gov/pubmed/25628773?tool=bestpractice.com
[47]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.
https://www.jacionline.org/article/S0091-6749(15)00636-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26044853?tool=bestpractice.com
Não há evidências suficientes para determinar a relação entre a idade na qual os alimentos complementares são introduzidos e o risco de desenvolver RA durante a infância.[48]Obbagy JE, English LK, Wong YP, et al. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr. 2019 Mar 1;109(suppl_7):890S-934S.
https://academic.oup.com/ajcn/article/109/Supplement_1/890S/5456693
http://www.ncbi.nlm.nih.gov/pubmed/30982864?tool=bestpractice.com
Em um estudo multicêntrico de alergia, nenhum aspecto modificável do ambiente do início da vida ou do estilo de vida foi identificado como meta de prevenção primária da RA.[49]Grabenhenrich LB, Keil T, Reich A, et al. Prediction and prevention of allergic rhinitis: a birth cohort study of 20 years. J Allergy Clin Immunol. 2015 Oct;136(4):932-40.e12.
https://www.jacionline.org/article/S0091-6749(15)00492-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/25976706?tool=bestpractice.com