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Dietary prevention of allergic diseases in infants and small children

Dietary prevention of allergic diseases in infants and small children
Dietary prevention of allergic diseases in infants and small children
Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP-EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer-reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer-reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high-risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4-6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months.
breast feeding, cows milk allergy, food allergy, eczema, atopy, prevention, review, statements of evidence
0905-6157
1-4
Høst, Arne
dc3028ed-43bf-41c6-ae2e-115254e48210
Halken, Susanne
2d3b1100-70d1-46e1-8466-15990d478a9f
Muraro, Antonella
c554bef5-502b-4540-a6f0-a3f7c37f0075
Dreborg, Sten
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Niggemann, Bodo
84ce41bf-21b4-4a9f-8592-2ffae64a0de5
Aalberse, Rob
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Arshad, Syed H.
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von Berg, Andrea
caef3359-e855-4a42-8029-875cb8661312
Carlsen, Kai-Håkon
f7ee8349-9c44-4d3d-8cec-eb6395bd4c85
Duschén, Karel
9365ec8d-8c49-424d-b5cf-3b3955e49ba8
Eignmann, Philippe A.
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Hill, David
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Jones, Catherine
e64b54f6-98fd-46f3-bd89-5a0bd1bb29f0
Mellon, Michael
afcbd380-a168-4119-a20e-fd8ecc3ee367
Oldeus, Göran
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Oranje, Arnold
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Pascual, Christina
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Prescott, Susan
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Sampson, Hugh
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Svartengren, Magnus
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Wahn, Ulrich
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Warner, Jill A.
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Warner, John O.
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Vandenplas, Yvan
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Wickman, Magnus
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Zeiger, Robert S.
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Høst, Arne
dc3028ed-43bf-41c6-ae2e-115254e48210
Halken, Susanne
2d3b1100-70d1-46e1-8466-15990d478a9f
Muraro, Antonella
c554bef5-502b-4540-a6f0-a3f7c37f0075
Dreborg, Sten
98b99ba2-f575-4cc2-af06-120126a4c4ca
Niggemann, Bodo
84ce41bf-21b4-4a9f-8592-2ffae64a0de5
Aalberse, Rob
6a623b81-263c-424f-b88c-1c2072b4755c
Arshad, Syed H.
917e246d-2e60-472f-8d30-94b01ef28958
von Berg, Andrea
caef3359-e855-4a42-8029-875cb8661312
Carlsen, Kai-Håkon
f7ee8349-9c44-4d3d-8cec-eb6395bd4c85
Duschén, Karel
9365ec8d-8c49-424d-b5cf-3b3955e49ba8
Eignmann, Philippe A.
ae6156cd-c64c-4063-a66c-9aaa861966ef
Hill, David
5d8b9125-4615-4946-918b-e4193a1eb9e7
Jones, Catherine
e64b54f6-98fd-46f3-bd89-5a0bd1bb29f0
Mellon, Michael
afcbd380-a168-4119-a20e-fd8ecc3ee367
Oldeus, Göran
89271bcc-87a7-41c7-b2cd-bc1eff721ce1
Oranje, Arnold
45789d18-b2cf-47f9-8ded-2a041a35888b
Pascual, Christina
084c06ce-c15a-4b5e-abc7-2d9845469d94
Prescott, Susan
a81e2cd6-dafc-464b-9ed3-4a9a0e24bbb6
Sampson, Hugh
334d352b-56cd-4a38-9c03-ccee6e9417b1
Svartengren, Magnus
490ad915-9dce-4380-93ad-b0e7652d24ed
Wahn, Ulrich
902b5866-4133-4792-93e6-27c4d9dc9f1f
Warner, Jill A.
277d6d32-d31d-417c-866a-054f9d07633f
Warner, John O.
50630e99-8486-4859-ade3-cd2c79c5a153
Vandenplas, Yvan
88fd20c1-642e-42f2-8fd0-1aed71be79e9
Wickman, Magnus
14ed9eaf-8409-47c1-bf53-ec3d72adb134
Zeiger, Robert S.
38076061-d971-4f46-8bc7-301359966637

Høst, Arne, Halken, Susanne, Muraro, Antonella, Dreborg, Sten, Niggemann, Bodo, Aalberse, Rob, Arshad, Syed H., von Berg, Andrea, Carlsen, Kai-Håkon, Duschén, Karel, Eignmann, Philippe A., Hill, David, Jones, Catherine, Mellon, Michael, Oldeus, Göran, Oranje, Arnold, Pascual, Christina, Prescott, Susan, Sampson, Hugh, Svartengren, Magnus, Wahn, Ulrich, Warner, Jill A., Warner, John O., Vandenplas, Yvan, Wickman, Magnus and Zeiger, Robert S. (2008) Dietary prevention of allergic diseases in infants and small children. Pediatric Allergy and Immunology, 19 (1), 1-4. (doi:10.1111/j.1399-3038.2007.00680.x). (PMID:18199086)

Record type: Article

Abstract

Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP-EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer-reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer-reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high-risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4-6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months.

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More information

Published date: 10 January 2008
Keywords: breast feeding, cows milk allergy, food allergy, eczema, atopy, prevention, review, statements of evidence

Identifiers

Local EPrints ID: 70840
URI: http://eprints.soton.ac.uk/id/eprint/70840
ISSN: 0905-6157
PURE UUID: 86665389-c637-40a5-9ed3-b8b01fd17520

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Date deposited: 10 Mar 2010
Last modified: 13 Mar 2024 20:09

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Contributors

Author: Arne Høst
Author: Susanne Halken
Author: Antonella Muraro
Author: Sten Dreborg
Author: Bodo Niggemann
Author: Rob Aalberse
Author: Syed H. Arshad
Author: Andrea von Berg
Author: Kai-Håkon Carlsen
Author: Karel Duschén
Author: Philippe A. Eignmann
Author: David Hill
Author: Catherine Jones
Author: Michael Mellon
Author: Göran Oldeus
Author: Arnold Oranje
Author: Christina Pascual
Author: Susan Prescott
Author: Hugh Sampson
Author: Magnus Svartengren
Author: Ulrich Wahn
Author: Jill A. Warner
Author: John O. Warner
Author: Yvan Vandenplas
Author: Magnus Wickman
Author: Robert S. Zeiger

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