Avoidance or exposure to foods in prevention and treatment of food allergy?

Abstract

Purpose of review: To caution against premature proposals advocating change before epidemiological and clinical evidence warrants such a paradigm shift.

Recent findings: Until 2007, all allergy societies advocated allergen avoidance for prevention and therapy in food allergy. Since then, new evidence has prompted careful re-evaluation of the literature. In primary prevention, delayed introduction of allergenic foods to prevent food allergy was removed from most recommendations. However, there is currently no evidence that allergenic foods ought to be introduced earlier than is recommended for complementary foods, at 4-6 months of age. Here we uphold the view against an emerging school of thought that early and deliberate exposure to allergenic foods may prevent or delay the onset food allergy. While notions of promoting early oral tolerance may have some merit in theory, in practice research remains inconclusive. Of recent development are treatment advances as regards established food allergy, using food allergens to induce tolerance in highly selected populations of allergic children. However, the investigators themselves strongly warn of significant risks and stress the need to optimize safety and understand longer-term implications before these trials can be applied to routine clinical practice. In this paper we endorse the current recommendation that children with confirmed food allergy should avoid foods implicated in immediate reactions.

Summary: It is currently inappropriate and potentially dangerous to advocate deliberate exposure to foods involved in serious reactions against current recommendations and particularly so among food allergic children until more basic and clinical research become available.