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

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

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 randomised controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations and outcomes so were summarised narratively.

RESULTS: Forty-six studies examined interventions to reduce the risk of food allergy in infancy (up to one 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, hydrolysed 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 pasteurised raw egg, from four to six 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 four to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions 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 ten 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.

IgE-mediated, early introduction, food allergy, immediate-onset, prevention
0905-6157
813-826
de Silva, Debra
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Halken, Susanne
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Singh, Chris
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Antonella, Muraro
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Angier, Elizabeth
d98c8257-d8b2-4aa6-bb77-42ba29757c52
Arasi, Stefania
ae1cb6ec-1484-4fc9-aac6-3a18aeae18e4
Arshad, Hasan
b90c87e5-8abf-4ef2-aeb9-40b60f824843
Beyer, Kirsten
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Boyle, Robert
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du Toit, George
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Eigenmann, Philippe
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Grimshaw, Kate
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Hoest, Arne
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Jones, Carla
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Khaleva, Ekaterina
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Lack, Gideon
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Szajewska, Hania
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Venter, Carina
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Verhasselt, Valérie
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Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group
de Silva, Debra
bebaefba-beb5-460f-acbd-9354a549dc9a
Halken, Susanne
2d3b1100-70d1-46e1-8466-15990d478a9f
Singh, Chris
726a2b16-f817-4a0c-995a-7c32507da2a7
Antonella, Muraro
6dc1ad49-c423-49f8-9729-92320f80d576
Angier, Elizabeth
d98c8257-d8b2-4aa6-bb77-42ba29757c52
Arasi, Stefania
ae1cb6ec-1484-4fc9-aac6-3a18aeae18e4
Arshad, Hasan
b90c87e5-8abf-4ef2-aeb9-40b60f824843
Beyer, Kirsten
488431f6-cbca-4249-b806-ecda3c541726
Boyle, Robert
cce30158-f576-4cd3-a790-421decaccec5
du Toit, George
7930b820-e6f7-4c4c-866c-4334017d1106
Eigenmann, Philippe
3e63730f-7e33-412f-9e2d-64d607922647
Grimshaw, Kate
cfc33d1c-2e2f-4e8e-ad6d-e88a56570757
Hoest, Arne
6f30f954-1861-4cb1-a74b-7765968402ea
Jones, Carla
25959da6-5dee-4225-b7e7-ad534bf54ac0
Khaleva, Ekaterina
0143fad8-e8b7-4286-997b-368a23488ca8
Lack, Gideon
cac030a2-c358-4880-a91d-d67d06e8e321
Szajewska, Hania
84cfc816-e146-4417-930d-df9ec827f52b
Venter, Carina
a9b7dd5e-b0cb-4068-be82-e15b587cc20b
Verhasselt, Valérie
ff711e60-ee9e-4d71-9d32-4e23bb7c7efb
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3

de Silva, Debra, Halken, Susanne, Singh, Chris, Antonella, Muraro, Angier, Elizabeth, Arasi, Stefania, Arshad, Hasan, Beyer, Kirsten, Boyle, Robert, du Toit, George, Eigenmann, Philippe, Grimshaw, Kate, Hoest, Arne, Jones, Carla, Khaleva, Ekaterina, Lack, Gideon, Szajewska, Hania, Venter, Carina, Verhasselt, Valérie and Roberts, Graham , European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group (2020) Preventing food allergy in infancy and childhood: systematic review of randomised controlled trials. Pediatric Allergy and Immunology, 31 (7), 813-826. (doi:10.1111/pai.13273).

Record type: Article

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 randomised controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations and outcomes so were summarised narratively.

RESULTS: Forty-six studies examined interventions to reduce the risk of food allergy in infancy (up to one 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, hydrolysed 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 pasteurised raw egg, from four to six 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 four to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions 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 ten 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.

Text
pai.13273 - Accepted Manuscript
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Accepted/In Press date: 5 May 2020
e-pub ahead of print date: 12 May 2020
Keywords: IgE-mediated, early introduction, food allergy, immediate-onset, prevention

Identifiers

Local EPrints ID: 441210
URI: http://eprints.soton.ac.uk/id/eprint/441210
ISSN: 0905-6157
PURE UUID: a17d3be9-6df3-420a-aefd-89529df13306
ORCID for Ekaterina Khaleva: ORCID iD orcid.org/0000-0002-2220-7745
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 04 Jun 2020 16:32
Last modified: 04 Aug 2022 04:07

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Contributors

Author: Debra de Silva
Author: Susanne Halken
Author: Chris Singh
Author: Muraro Antonella
Author: Elizabeth Angier
Author: Stefania Arasi
Author: Hasan Arshad
Author: Kirsten Beyer
Author: Robert Boyle
Author: George du Toit
Author: Philippe Eigenmann
Author: Kate Grimshaw
Author: Arne Hoest
Author: Carla Jones
Author: Ekaterina Khaleva ORCID iD
Author: Gideon Lack
Author: Hania Szajewska
Author: Carina Venter
Author: Valérie Verhasselt
Author: Graham Roberts ORCID iD
Corporate Author: European Academy of Allergy, Clinical Immunology Food Allergy, Anaphylaxis Guidelines Group

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