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EAACI guideline: preventing the development of food allergy in infants and young children (2020 update)

EAACI guideline: preventing the development of food allergy in infants and young children (2020 update)
EAACI guideline: preventing the development of food allergy in infants and young children (2020 update)

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 one year) and young children (up to five 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 breast fed infants in the first week of life. The EAACI Task Force suggests introducing well cooked, but not raw egg or uncooked pasteurised 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 six 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 six 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; 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.

food allergy, guidelines, prevention
0905-6157
843-858
Halken, Susanne
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Muraro, Antonella
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de Silva, Debra
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Khaleva, Ekaterina
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Angier, Elizabeth
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Arasi, Stefania
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Arshad, Hasan
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Bahnson, Henry T
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Beyer, Kirsten
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Boyle, Robert
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du Toit, George
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Ebisawa, Motohiro
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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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Lack, Gideon
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Nadeau, Kari
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O'Mahony, Liam
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Szajewska, Hania
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Venter, Carina
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Verhasselt, Valérie
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Wong, Gary WK
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Roberts, Graham
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European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group
Halken, Susanne
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Muraro, Antonella
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de Silva, Debra
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Khaleva, Ekaterina
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Angier, Elizabeth
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Arasi, Stefania
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Arshad, Hasan
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Bahnson, Henry T
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Beyer, Kirsten
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Boyle, Robert
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du Toit, George
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Ebisawa, Motohiro
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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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Lack, Gideon
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Nadeau, Kari
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O'Mahony, Liam
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Szajewska, Hania
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Venter, Carina
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Verhasselt, Valérie
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Wong, Gary WK
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Roberts, Graham
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Halken, Susanne, Muraro, Antonella, de Silva, Debra, Khaleva, Ekaterina, Angier, Elizabeth, Arasi, Stefania, Arshad, Hasan, Bahnson, Henry T, Beyer, Kirsten, Boyle, Robert, du Toit, George, Ebisawa, Motohiro, Eigenmann, Philippe, Grimshaw, Kate, Hoest, Arne, Jones, Carla, Lack, Gideon, Nadeau, Kari, O'Mahony, Liam, Szajewska, Hania, Venter, Carina, Verhasselt, Valérie, Wong, Gary WK and Roberts, Graham , European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group (2021) EAACI guideline: preventing the development of food allergy in infants and young children (2020 update). Pediatric Allergy and Immunology, 32 (5), 843-858. (doi:10.1111/pai.13496).

Record type: Article

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 one year) and young children (up to five 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 breast fed infants in the first week of life. The EAACI Task Force suggests introducing well cooked, but not raw egg or uncooked pasteurised 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 six 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 six 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; 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.

Text
EAACI prevention guideline FINAL 14 11 2020 Post IG review V2 - Accepted Manuscript
Restricted to Repository staff only until 12 March 2022.
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Text
EAACI Prevention Guideline online supplement tables FINAL 14 11 2020 Post IG review V2 - Other
Restricted to Repository staff only until 12 March 2022.
Request a copy

More information

Accepted/In Press date: 27 February 2021
e-pub ahead of print date: 12 March 2021
Keywords: food allergy, guidelines, prevention

Identifiers

Local EPrints ID: 448271
URI: http://eprints.soton.ac.uk/id/eprint/448271
ISSN: 0905-6157
PURE UUID: eb0ba35d-493a-412e-9c46-32df75c60684
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 16 Apr 2021 16:35
Last modified: 26 Nov 2021 02:49

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Contributors

Author: Susanne Halken
Author: Antonella Muraro
Author: Debra de Silva
Author: Ekaterina Khaleva
Author: Elizabeth Angier
Author: Stefania Arasi
Author: Hasan Arshad
Author: Henry T Bahnson
Author: Kirsten Beyer
Author: Robert Boyle
Author: George du Toit
Author: Motohiro Ebisawa
Author: Philippe Eigenmann
Author: Kate Grimshaw
Author: Arne Hoest
Author: Carla Jones
Author: Gideon Lack
Author: Kari Nadeau
Author: Liam O'Mahony
Author: Hania Szajewska
Author: Carina Venter
Author: Valérie Verhasselt
Author: Gary WK Wong
Author: Graham Roberts ORCID iD
Corporate Author: European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group

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