My fiancé seems to be allergic to the world and seeing as I will be marrying him I decided I need to figure out how to give my future children the best chance possible (since I will be an older mother and we all know the multitude of risks associated with that).
I found the article which helped me dive a little deeper into prevention of atopy. Atopy is the genetic tendency to develop allergic diseases. There are three categories of prevention strategies: primary prevention strategies are where you prevent it from occurring. Secondary prevention is where you can undergo immunotherapy or are recommended to avoid the allergen. Tertiary prevention is pharmacotherapy that helps with decreasing the symptoms that occur due to atopy. There is a lot of research out there about the secondary and tertiary prevention strategies but there is not a lot out there about primary prevention.
There is evidence that says in utero exposures increase the likelihood of developing atopic disease. This paper looks at how maternal exposure while pregnant effects the chances of the infant developing atopic diseases. There is data that stated maternal farm animal exposure during pregnancy decreased offspring allergic sensitization. So to be able to control this they had mothers go under immunotherapy during pregnancy. It was found that there was an 8% lower incidence of atopy from children whose mothers received immunotherapy during pregnancy compared to children whose mothers did not receive immunotherapy.
There is still more to be done in the research of immunotherapy to prevent atopy. It sound like a positive advance science could be taking but it could also have negative effects.We know the point of beneficence is for the future child not to have to worry about life threatening situations in their everyday life and justice for a chance at a healthier life but does it follow non-maleficence? The mother could have a variety of side effects from undergoing the immunotherapy which would cause stress on the child. With more research It will be better understood if this would be more beneficial than it could cause harm.
Tran, Quynh T., and Jay Adam Lieberman. “Allergy Immunotherapy: Target for Primary Prevention of Atopy?” Annals of Allergy, Asthma & Immunology, vol. 114, no. 3, 2015, pp. 162-163., doi:10.1016/j.anai.2014.11.001.
This is really interesting! I actually had no idea how heritable certain allergies are, so this is a concept I haven't spent much time thinking about. According to a paper I found after a quick search, food allergies in the U.S. are increasing in prevalence. As a result, I assume more research will be done into the areas you mention in order to combat a growing problem.
ReplyDeleteYour comments on the ethics of the issue are right on point, and I think there's a lot to consider in order to reach "What ought to be done". These treatments are obviously given with beneficence being the main goal, and non-maleficence closely underpinning that principle (in regards to both the mother and child). If the immunotherapy treatments work as planned, then both of these principles will be upheld for both individuals. However, any type of trial treatment that's delivered to pregnant women makes me nervous. I know there are risks with all clinical trials, but I'm concerned that the autonomy of the child could be jeopardized if the treatment actually has adverse affects. The mother is also at risk of adverse affects, but she consented for the treatment, while the child wasn't able to. I realize this leads back to the constant discussion of child autonomy under a parent/guardian, but I think this situation in particular takes the discussion one step further because the child really has no idea what's going on.
All of that being said, I think this is really promising research, and it should definitely continue. Though pharmaceutical companies makes quite a bit off of devices like epipens (as the recent Senate hearings have shown) and other drugs, I hope that they would do all they could to provide justice to the future populations who will suffer from food allergies through these primary atopy prevention strategies.
Here's that article if you're interested
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1679775/
The first thing that came to mind when I read your post was peanut allergies. Recently the prevention of peanut allergies has become a hot topic, as the prevalence of this allergy has increased among child over the past decade. Similar to what you said about exposure to farm animals during pregnancy, mothers who eat peanuts decrease their child's possibility of developing an allergy. Furthermore, for infants that have an increased risk to develop allergies, such as those who genetically have atopy, it is recommended to introduce the allergen earlier and often in their diets (Lappe,2015). This can be done as early as 4 months, which could be somewhat of a scary experience, not knowing how the infant will react. From what I understand, it sounds like immunotherapy could expose fetus' to peanuts as well and prevent the development of an intolerance before they are even born. Possibly, pairing immunotherapy and then following up with early exposure could begin to reduce the commonality of peanut allergies all together.
ReplyDeleteLappe, M.D., S. (n.d.). Peanut Allergy Prevention: Introduce Infants Early and Often. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/07/30/peanut-allergy-prevention-introduce-infants-early-and-often
Amanda, what an interesting topic! We won’t have to worry about treating allergies if we can just prevent them, right? The term “programming” is used to mean the process by which a stimulus (or insult) during a vulnerable developmental period has a long-lasting or permanent effect (Davis & Sandman, 2010). So, I wonder if programming earlier during pregnancy would lead to a greater reduction of atopy?
ReplyDeleteThis paper on the timing of prenatal exposure to maternal cortisol suggests that exposure during early gestation (<18 weeks) was associated with a slower rate of development over the first postnatal year (Davis & Sandman, 2010). Perhaps when the fetus’ organ systems are in the phase of differentiation and rapid development the effects on the system are greater.
Therefore, I would love to see a follow-up study in which mothers receive immunotherapy during different trimesters. Perhaps those who receive it earliest would receive the most benefit (decrease in atopy).
Davis, E. P., & Sandman, C. A. (2010, January). The Timing of Prenatal Exposure to Maternal Cortisol and Psychosocial Stress is Associated with Human Infant Cognitive Development. Retrieved October 13, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846100/
I can empathize with your fiance as I am also allergic to a lot of things (mostly to whatever is floating around in the library). It would be great if future generations didn't have to rely on taking a daily antihistamine to prevent the symptoms of allergies. I also didn't realize how much of it was inherited. Along with maternal exposure, they are also giving pregnant women allergy shots in hopes to prevent allergy development. It is interesting to think that the allergy shot could become another "vaccine". By giving the allergy shots, it could also solve the problem of not being able to expose mothers to something they are already allergic to in hopes of preventing it in their children. More research on this is also needed!
ReplyDeleteI agree with you about wanting to know more about the potential side effects of the immunotherapy. After the first few weeks of anatomy, it is crazy to see how much goes on in the first few weeks of development. Seeing all of the stages and the signaling going on it makes me wonder if this exposure could alter healthy development. It will be interesting to see what research finds and if there are adverse side effects to the baby.
Allergy Shots During Pregnancy May Decrease Allergies In Children.” ACAAI Public Website, 29 Sept. 2015, acaai.org/news/allergy-shots-during-pregnancy-may-decrease-allergies-children