Susanne Halken1, Antonella Muraro2, Debra de Silva3, Ekaterina Khaleva4, Elizabeth Angier5, Stefania Arasi6, Hasan Arshad7,8,9, Henry T Bahnson10, Kirsten Beyer11, Robert Boyle12,13, George du Toit14, Motohiro Ebisawa15, Philippe Eigenmann16, Kate Grimshaw8,17, Arne Hoest1, Carla Jones18, Gideon Lack19,20,21,22, Kari Nadeau23, Liam O'Mahony24, Hania Szajewska25, Carina Venter26, Valérie Verhasselt27, Gary W K Wong28, Graham Roberts4,7,9. 1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. 2. Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy. 3. The Evidence Centre Ltd, London, UK. 4. Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK. 5. Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK. 6. Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 7. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 8. Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. 9. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK. 10. Benaroya Research Institute and Immune Tolerance Network, Seattle, WA, USA. 11. Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany. 12. National Heart and Lung Institute, Imperial College London, London, UK. 13. Centre for Evidence-based Dermatology, University of Nottingham, Nottingham, UK. 14. Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK. 15. Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan. 16. Pediatric Allergy Unit, Department of Women-Children-Teenagers, University Hospitals of Geneva, Geneva, Switzerland. 17. Department of Dietetics, Salford Royal NHS Foundation Trust, Salford, UK. 18. Allergy UK, Sidcup, UK. 19. Paediatric Allergy Research Group, Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, London, UK. 20. Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK. 21. Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK. 22. Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK. 23. Department of Paediatrics, Stanford University School of Medicine, Stanford, CA, USA. 24. Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland. 25. Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland. 26. Section of Allergy and Immunology, University of Colorado and Children's Hospital Colorado, Aurora, CO, USA. 27. School of Molecular Sciences, University of Western Australia, Perth, WA, Australia. 28. Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Abstract
BACKGROUND: This guideline from the European Academy of Allergy and Clinical Immunology (EAACI) recommends approaches to prevent the development of immediate-onset / IgE-mediated food allergy in infants and young children. It is an update of a 2014 EAACI guideline. METHODS: The guideline was developed using the AGREE II framework and the GRADE approach. An international Task Force with representatives from 11 countries and different disciplinary and clinical backgrounds systematically reviewed research and considered expert opinion. Recommendations were created by weighing up benefits and harms, considering the certainty of evidence and examining values, preferences and resource implications. The guideline was peer-reviewed by external experts, and feedback was incorporated from public consultation. RESULTS: All of the recommendations about preventing food allergy relate to infants (up to 1 year) and young children (up to 5 years), regardless of risk of allergy. There was insufficient evidence about preventing food allergy in other age groups. The EAACI Task Force suggests avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first week of life. The EAACI Task Force suggests introducing well-cooked, but not raw egg or uncooked pasteurized, egg into the infant diet as part of complementary feeding. In populations where there is a high prevalence of peanut allergy, the EAACI Task Force suggests introducing peanuts in an age-appropriate form as part of complementary feeding. According to the studies, it appears that the most effective age to introduce egg and peanut is from four to 6 months of life. The EAACI Task Force suggests against the following for preventing food allergy: (i) avoiding dietary food allergens during pregnancy or breastfeeding; and (ii) using soy protein formula in the first 6 months of life as a means of preventing food allergy. There is no recommendation for or against the following: use of vitamin supplements, fish oil, prebiotics, probiotics or synbiotics in pregnancy, when breastfeeding or in infancy; altering the duration of exclusive breastfeeding; and hydrolysed infant formulas, regular cow's milk-based infant formula after a week of age or use of emollients. CONCLUSIONS: Key changes from the 2014 guideline include suggesting (i) the introduction of peanut and well-cooked egg as part of complementary feeding (moderate certainty of evidence) and (ii) avoiding supplementation with regular cow's milk formula in the first week of life (low certainty of evidence). There remains uncertainty in how to prevent food allergy, and further well-powered, multinational research using robust diagnostic criteria is needed.
BACKGROUND: This guideline from the European Academy of Allergy and Clinical Immunology (EAACI) recommends approaches to prevent the development of immediate-onset / IgE-mediated food allergy in infants and young children. It is an update of a 2014 EAACI guideline. METHODS: The guideline was developed using the AGREE II framework and the GRADE approach. An international Task Force with representatives from 11 countries and different disciplinary and clinical backgrounds systematically reviewed research and considered expert opinion. Recommendations were created by weighing up benefits and harms, considering the certainty of evidence and examining values, preferences and resource implications. The guideline was peer-reviewed by external experts, and feedback was incorporated from public consultation. RESULTS: All of the recommendations about preventing food allergy relate to infants (up to 1 year) and young children (up to 5 years), regardless of risk of allergy. There was insufficient evidence about preventing food allergy in other age groups. The EAACI Task Force suggests avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first week of life. The EAACI Task Force suggests introducing well-cooked, but not raw egg or uncooked pasteurized, egg into the infant diet as part of complementary feeding. In populations where there is a high prevalence of peanutallergy, the EAACI Task Force suggests introducing peanuts in an age-appropriate form as part of complementary feeding. According to the studies, it appears that the most effective age to introduce egg and peanut is from four to 6 months of life. The EAACI Task Force suggests against the following for preventing food allergy: (i) avoiding dietary food allergens during pregnancy or breastfeeding; and (ii) using soy protein formula in the first 6 months of life as a means of preventing food allergy. There is no recommendation for or against the following: use of vitamin supplements, fish oil, prebiotics, probiotics or synbiotics in pregnancy, when breastfeeding or in infancy; altering the duration of exclusive breastfeeding; and hydrolysed infant formulas, regular cow's milk-based infant formula after a week of age or use of emollients. CONCLUSIONS: Key changes from the 2014 guideline include suggesting (i) the introduction of peanut and well-cooked egg as part of complementary feeding (moderate certainty of evidence) and (ii) avoiding supplementation with regular cow's milk formula in the first week of life (low certainty of evidence). There remains uncertainty in how to prevent food allergy, and further well-powered, multinational research using robust diagnostic criteria is needed.
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