Non-drug interventions: peanut allergy, glue ear and more

We look at the latest non-drug intervention updates provided by the RACGP

Glue ear

Glue ear is the most common chronic condition of childhood, says the RACGP, with 80% of children affected at some point.

For children with deafness due to glue ear, autoinflation can avoid the need for tympanoplasty tubes (grommets).

In a trial of using Otovent® in children, 50% had tympanometric resolution by three months, compared with 38% of controls.

Devices include balloon-based Otovent®and air-pump device EarPopper™.

Infant atopic dermatitis

Daily application of a moisturiser (emollient) for first 6–8 months of life can help prevent infant atopic dermatitis.

In high-risk newborns (those with a family history of allergies), daily application of a moisturiser may reduce the incidence of atopic dermatitis or delay its onset.

Moisturisers should have low (or zero) water content and high oil content. Choice of moisturiser will depend on parent preference. Appropriate options include:

  • creams, lotions or gels (e.g. Cetaphil®)
  • oils (e.g. sunflower seed oil)
  • ointments (e.g. white soft paraffin, Aquaphore®).

Application involves daily application to the baby’s entire body surface except the scalp as soon as possible after birth (within the first 1–3 weeks after birth) for 6–8 months, says the RACGP.

Other tips for maintaining skin hydration include:

  • Avoiding soap and bubble bath;
  • Using a mild, fragrance-free synthetic cleanser designed specifically for babies;
  • Avoiding bath oils and additives;
  • Using a mild, fragrance-free shampoo designed specifically for babies;
  • Avoiding washing the suds over the baby’s body; and
  • Avoiding baby wipes, where possible.

Peanut allergy

Infants with severe eczema and/or egg allergy are at high risk of developing peanut allergy.

Sustained consumption of peanut protein beginning between ages 4–11 months may help, suggests the RACGP.

Compared with peanut avoidance, early introduction of peanut protein has been shown to lead to a significant reduction in peanut allergy in children up to the age of five years (70% relative reduction).

The Australasian Society of Clinical Immunology and Allergy (ASCIA) recommends introduction of solids, including peanuts, for all infants between four and six months, with a new food every few days.

“Consumption not avoidance reduces the risk of developing peanut allergy,” says the RACGP.

“This is part of a broader message of early introduction of a range of foodstuffs.”

Obstructive sleep apnoea

Around one in four men aged over 30 years have some degree of obstructive sleep apnoea, says the RACGP, making the condition more common than asthma.

Nightly use of a mandibular advancement device (MAD) is an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA).

There are several types of MADs including:

  • thermoplastic ‘boil and bite’ devices
  • semi-tailored devices, where the patient creates their own dental impression mould (using something similar to a boil and bite device) and sends it away to have a MAD made
  • tailored MADs, which are custom-made by sleep specialists or dentists

MADs are worn in the mouth during sleep to hold the mandible and tongue forward and therefore maintain upper airway patency.

Ideally patients should have a follow-up sleep study to see if the device is working, says the RACGP.

For more information see HANDI: The Handbook of Non-Drug Interventions

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