Healthcare Professional Survey on Complementary Feeding and Allergy Prevention in High- Versus Low-Risk Infants: An EAACI Task Force Report

Emilia Vassilopoulou^{1

2

3

4}, Sophia Tsabouri⁵, Stefania Arasi⁶, Anna Comotti⁷, Gregorio Paolo Milani^{2

3}, Klaudia Ryczaj⁸, Carlo Agostoni^{2

3}, Ioannis Pagkalos¹, Berber Vlieg-Boerstra^{9

10}, Chrystopherson Gengyny Caballero-Lopez¹¹, Gavriela Feketea^{12

13}, Anna Nowak-Wegrzyn^{14

15}, Susanne Halken¹⁶, Burcin Beken¹⁷, Montserrat Alvaro-Lozano^{18

19}, Ines Padua^{20

21

22}, Mattia Giovannini^{23

24}, George Du Toit²⁵, Alberto Alvarez-Perea^{26

27}, Roberto Berni Canani^{28

29}, Diego Peroni³⁰, Marina Pérez-Gordo³¹, Mohamed H Shamji^{32

33

34}, Ludger Klimek³⁵, Ioana Agache³⁶, Elena Camelia Berghea^{37

38}, Franziska Roth-Walter³⁹, Cevdet Ozdemir^{40

41}, Peter Smith⁴², Liam O' Mahony^{43

44}, Rosan W Meyer⁴⁵, Carina Venter⁴⁶

Affiliations

¹ Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece.
² Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
³ Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
⁴ Department of Life Sciences, School of Life and Health Sciences, Universiy of Nicosia, Nicosia, Cyprus.
⁵ Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Ioannina, Greece.
⁶ Pediatric Allergology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
⁷ Occupational Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁸ Pediatric Teaching Hospital of the Medical University of Warsaw, Warsaw, Poland.
⁹ Department of Paediatrics, OLVG Hospital, Amsterdam, the Netherlands.
¹⁰ Rijnstate Allergy Center, Rijnstate Hospital, Arnhem, the Netherlands.
¹¹ Allergology and Clinical Immunology Department, Hospital Universitario de Puebla-Faculty of Medicine, Benemerita, Universidad Autonoma de Puebla, Puebla, Mexico.
¹² Pediatric Allergy Outpatient Clinic, Department of Pediatrics, "Karamandaneio" Children's Hospital of Patra, Patras, Greece.
¹³ Atena Medical Center, Bucharest, Romania.
¹⁴ Department of Pediatrics, Division of Allergy and Immunology, NYU Grossman School of Medicine, New York, New York, USA.
¹⁵ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
¹⁶ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁷ Department of Pediatric Allergy and Immunology, Acibadem University, Istanbul, Türkiye.
¹⁸ Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
¹⁹ Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
²⁰ Department of Sciences, University Institute of Health Sciences, Gandra, Portugal.
²¹ i4HB/UCIBIO Translational Toxicology Research Laboratory, Gandra, Portugal.
²² CUF Porto Trindade Hospital, Porto, Portugal.
²³ Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
²⁴ Department of Health Sciences, University of Florence, Florence, Italy.
²⁵ Guy's and St. Thomas' 25 National Health Service Foundation Trust and Kings College, London, UK.
²⁶ Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
²⁷ Gregorio Marañón Health Research Institute, Madrid, Spain.
²⁸ Department of Translational Medical Science, ImmunoNutritionLab at CEINGE Biotechnologies, Naples, Italy.
²⁹ Research Center and Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy.
³⁰ Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
³¹ Departamento de Ciencias Médicas Básicas, Facultad de Medicina, Instituto de Medicina Molecular Aplicada (IMMA) Nemesio Díez, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain.
³² National Heart and Lung Institute, Imperial College London, London, UK.
³³ NIHR Imperial Biomedical Research Centre, London, UK.
³⁴ Franklin-Kay Alleergy Center, Imperial College London, London, UK.
³⁵ Center for Rhinology and Allergology, Wiesbaden, Germany.
³⁶ Transylvania University, Brasov, Romania.
³⁷ Marie S. Curie Emergency Children's Clinical Hospital, Bucharest, Romania.
³⁸ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
³⁹ Department of Biological Sciences and Pathobiology, University of Veterinary Medicine Vienna, Wien, Austria.
⁴⁰ Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Türkiye.
⁴¹ Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
⁴² Clinical School of Medicine, Griffith University, Southport, Queensland, Australia.
⁴³ Department of Medicine, APC Microbiome Ireland, University College Cork, Cork, Ireland.
⁴⁴ School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
⁴⁵ Department of Medicine, KU Leuven, Leuven, Belgium.
⁴⁶ Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Boulder, Colorado, USA.

PMID: 41388872
DOI: 10.1111/all.70188

Healthcare Professional Survey on Complementary Feeding and Allergy Prevention in High- Versus Low-Risk Infants: An EAACI Task Force Report

Emilia Vassilopoulou et al. Allergy. 2025.

. 2025 Dec 13.

doi: 10.1111/all.70188. Online ahead of print.

Authors

Affiliations

¹ Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece.
² Pediatric Area, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
³ Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
⁴ Department of Life Sciences, School of Life and Health Sciences, Universiy of Nicosia, Nicosia, Cyprus.
⁵ Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Ioannina, Greece.
⁶ Pediatric Allergology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
⁷ Occupational Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁸ Pediatric Teaching Hospital of the Medical University of Warsaw, Warsaw, Poland.
⁹ Department of Paediatrics, OLVG Hospital, Amsterdam, the Netherlands.
¹⁰ Rijnstate Allergy Center, Rijnstate Hospital, Arnhem, the Netherlands.
¹¹ Allergology and Clinical Immunology Department, Hospital Universitario de Puebla-Faculty of Medicine, Benemerita, Universidad Autonoma de Puebla, Puebla, Mexico.
¹² Pediatric Allergy Outpatient Clinic, Department of Pediatrics, "Karamandaneio" Children's Hospital of Patra, Patras, Greece.
¹³ Atena Medical Center, Bucharest, Romania.
¹⁴ Department of Pediatrics, Division of Allergy and Immunology, NYU Grossman School of Medicine, New York, New York, USA.
¹⁵ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
¹⁶ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁷ Department of Pediatric Allergy and Immunology, Acibadem University, Istanbul, Türkiye.
¹⁸ Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
¹⁹ Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
²⁰ Department of Sciences, University Institute of Health Sciences, Gandra, Portugal.
²¹ i4HB/UCIBIO Translational Toxicology Research Laboratory, Gandra, Portugal.
²² CUF Porto Trindade Hospital, Porto, Portugal.
²³ Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
²⁴ Department of Health Sciences, University of Florence, Florence, Italy.
²⁵ Guy's and St. Thomas' 25 National Health Service Foundation Trust and Kings College, London, UK.
²⁶ Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
²⁷ Gregorio Marañón Health Research Institute, Madrid, Spain.
²⁸ Department of Translational Medical Science, ImmunoNutritionLab at CEINGE Biotechnologies, Naples, Italy.
²⁹ Research Center and Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy.
³⁰ Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
³¹ Departamento de Ciencias Médicas Básicas, Facultad de Medicina, Instituto de Medicina Molecular Aplicada (IMMA) Nemesio Díez, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain.
³² National Heart and Lung Institute, Imperial College London, London, UK.
³³ NIHR Imperial Biomedical Research Centre, London, UK.
³⁴ Franklin-Kay Alleergy Center, Imperial College London, London, UK.
³⁵ Center for Rhinology and Allergology, Wiesbaden, Germany.
³⁶ Transylvania University, Brasov, Romania.
³⁷ Marie S. Curie Emergency Children's Clinical Hospital, Bucharest, Romania.
³⁸ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
³⁹ Department of Biological Sciences and Pathobiology, University of Veterinary Medicine Vienna, Wien, Austria.
⁴⁰ Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Türkiye.
⁴¹ Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
⁴² Clinical School of Medicine, Griffith University, Southport, Queensland, Australia.
⁴³ Department of Medicine, APC Microbiome Ireland, University College Cork, Cork, Ireland.
⁴⁴ School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
⁴⁵ Department of Medicine, KU Leuven, Leuven, Belgium.
⁴⁶ Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Boulder, Colorado, USA.

PMID: 41388872
DOI: 10.1111/all.70188

Abstract

Complementary feeding (CF) influences infants' long-term dietary preferences, growth, and food allergy (FA) risk. However, guidance given to families and the implementation of FA prevention guidelines by healthcare professionals (HCPs) remain unclear. This study explored HCPs' perspectives and practices regarding CF strategies in the context of FA prevention across different regions and professional backgrounds. An online survey conducted by an EAACI task force between December 2023 and May 2024 assessed CF timing, allergenic food introduction, nutrient supplementation, and FA preventive measures. 550 HCPs (pediatricians, allergists, dietitians), 68% from Europe, participated. HCPs recommended CF initiation at a median of six months for breastfed infants and five months for formula-fed and FA high-risk infants. Atopic dermatitis (94%) and family history of allergies (87%) were the most recognized FA risk factors. Vitamin D (49%), probiotics (28%), and omega-3 fatty acids (18%) were commonly recommended supplements. Regional, professional, and educational influences differences emerged, with Northern European HCPs favoring earlier CF and allergen introduction, often without structured guidance. Southern European HCPs preferred a structured sequence and later CF initiation. A flexible, evidence-based framework is needed to guide FA prevention while accommodating cultural and geographical differences.

Keywords: allergy prevention; complementary feeding; dietary guidelines; early life nutrition; regional feeding practices.

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References

1. E. D'Auria, B. Borsani, E. Pendezza, et al., “Complementary Feeding: Pitfalls for Health Outcomes,” International Journal of Environmental Research and Public Health 17, no. 21 (2020): 7931.
1. Y. Shi, R. Yin, J. Pang, et al., “Impact of Complementary Feeding on Infant Gut Microbiome, Metabolites and Early Development,” Food & Function 15, no. 21 (2024): 10663–10678.
1. World_Health_Organization, “WHO Guideline for Complementary Feeding of Infants and Young Children 6–23 Months of Age 2023,” https://www.who.int/publications/i/item/9789240081864.
1. EFSA Panel on Nutrition NF, Allergens F, J. Castenmiller, S. de Henauw, K.‐I. Hirsch‐Ernst, J. Kearney, et al., “Appropriate Age Range for Introduction of Complementary Feeding Into an Infant's Diet,” EFSA Journal 17, no. 9 (2019): e05780.
1. European_Food_Safety_Authority, Age to Start Complementary Feeding of Infants (EFSA, 2019).

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Healthcare Professional Survey on Complementary Feeding and Allergy Prevention in High- Versus Low-Risk Infants: An EAACI Task Force Report

Affiliations

Healthcare Professional Survey on Complementary Feeding and Allergy Prevention in High- Versus Low-Risk Infants: An EAACI Task Force Report

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources