Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials

Debra de Silva¹, Susanne Halken², Chris Singh¹, Antonella Muraro³, Elizabeth Angier⁴, Stefania Arasi⁵, Hasan Arshad^{6

7

8}, Kirsten Beyer⁹, Robert Boyle¹⁰, George du Toit¹¹, Philippe Eigenmann¹², Kate Grimshaw^{7

13}, Arne Hoest², Carla Jones¹⁴, Ekaterina Khaleva¹⁵, Gideon Lack¹¹, Hania Szajewska¹⁶, Carina Venter¹⁷, Valérie Verhasselt¹⁸, Graham Roberts^{6

8

15}; European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

Affiliations

¹ The Evidence Centre Ltd, London, UK.
² Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
³ Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy.
⁴ Primary Care and Population Sciences, University of Southampton, Southampton, UK.
⁵ Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy.
⁶ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁸ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
⁹ Department of Pediatric Pneumology and Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany.
¹⁰ Imperial College London, London, UK.
¹¹ Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹² Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
¹³ Department of Dietetics, Salford Royal NHS Foundation Trust, Salford, UK.
¹⁴ Allergy UK, Sidcup, UK.
¹⁵ Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁶ Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland.
¹⁷ Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Aurora, Colorado, USA.
¹⁸ University of Western Australia, Perth, WA, Australia.

PMID: 32396244
DOI: 10.1111/pai.13273

Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials

Debra de Silva et al. Pediatr Allergy Immunol. 2020 Oct.

. 2020 Oct;31(7):813-826.

doi: 10.1111/pai.13273. Epub 2020 Jun 18.

Authors

Affiliations

¹ The Evidence Centre Ltd, London, UK.
² Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
³ Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy.
⁴ Primary Care and Population Sciences, University of Southampton, Southampton, UK.
⁵ Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy.
⁶ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁸ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
⁹ Department of Pediatric Pneumology and Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany.
¹⁰ Imperial College London, London, UK.
¹¹ Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹² Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
¹³ Department of Dietetics, Salford Royal NHS Foundation Trust, Salford, UK.
¹⁴ Allergy UK, Sidcup, UK.
¹⁵ Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁶ Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland.
¹⁷ Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado Aurora, Colorado, USA.
¹⁸ University of Western Australia, Perth, WA, Australia.

PMID: 32396244
DOI: 10.1111/pai.13273

Abstract

Background: This systematic review of ways to prevent immediate-onset/IgE-mediated food allergy will inform guidelines by the European Academy of Allergy and Immunology (EAACI).

Methods: The GRADE approach was used. Eleven databases were searched from 1946 to October 2019 for randomized controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations, and outcomes and so were summarized narratively.

Results: Forty-six studies examined interventions to reduce the risk of food allergy in infancy (up to 1 year) or early childhood. The following interventions for pregnant or breastfeeding women and/or infants may have little to no effect on preventing food allergy, but the evidence is very uncertain: dietary avoidance of food allergens, vitamin supplements, fish oil, probiotics, prebiotics, synbiotics, and emollients. Breastfeeding, hydrolyzed formulas, and avoiding cow's milk formula may not reduce the risk of cow's milk protein allergy; however, temporary supplementation with cow's milk formula in the first week of life may increase the risk of cow's milk allergy. Introducing well-cooked egg, but not pasteurized raw egg, from 4 to 6 months probably reduces the risk of hen's egg allergy. Introducing regular peanut consumption into the diet of an infant at increased risk beginning from 4 to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions about introducing peanut are based on moderate certainty evidence, from single trials in high-income countries.

Conclusions: Sixty percent of the included studies were published in the last 10 years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations.

Keywords: IgE-mediated; early introduction; food allergy; immediate-onset; prevention.

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References

REFERENCES

1. Protudjer JL, Jansson SA, Arnlind MH, et al. Household costs associated with objectively diagnosed allergy to staple foods in children and adolescents. J Allergy Clin Immunol Pract. 2015;3(1):68-75.
1. Loh W, Tang MLK. The epidemiology of food allergy in the global context. Int J Environ Res Public Health. 2018;15(9):2043.
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Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials

Affiliations

Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical