Debra de Silva1, Susanne Halken2, Chris Singh1, Antonella Muraro3, Elizabeth Angier4, Stefania Arasi5, Hasan Arshad6,7,8, Kirsten Beyer9, Robert Boyle10, George du Toit11, Philippe Eigenmann12, Kate Grimshaw7,13, Arne Hoest2, Carla Jones14, Ekaterina Khaleva15, Gideon Lack11, Hania Szajewska16, Carina Venter17, Valérie Verhasselt18, Graham Roberts6,8,15. 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.
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.
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 proteinallergy; 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 peanutallergy 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.
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