450 Systematic Review of the Recommendations on the Prevention of Allergic Manifestations in Children

Abstract

BackgroundA systematic review of the literature was performed to gather all official recommendations on the prevention in infants of allergic manifestations (AM), and, more specifically, atopic dermatitis (AD), by using hydrolyzed infant formulas (HF) whether partially or extensively hydrolyzed (PHF; EHF).MethodsOVID MEDLINE and the grey literature were searched by 2 reviewers using the keywords AM, AD, prevention and guidelines. A third person acted as adjudicator in case of disagreement. Of interest were recommendations pertaining to the prevention of AM issued by national or regional associations of medical professionals.ResultsThis review yielded 11 sets of guidelines published for Australia, France, Germany, Spain, Switzerland (all n = 1), Europe and the US (both n = 3), 1999 to 2010. Most guidelines included AD either specifically (n = 3) or within AMs. Most guidelines recommended a period of exclusive breastfeeding ranging from 4 to 6 months, and mentioned it as a major component of the primary prevention of allergic manifestations. Six guidelines (of which 2 recommended PHF over EHF) endorsed the use of HFs for the prevention of AM in “at risk” infants when exclusive breastfeeding was not or no longer possible. Two other publications did not recommend specific HFs, but formulas with documented reduced allergenicity. The need for an appropriate level of nutritional support was stressed in one publication. Five guidelines acknowledged that not all HFs have the same clinical protective benefit. Four publications underlined the importance of sound clinical evidence when determining the preventive efficacy of HFs and questioned the process leading to the development of national recommendations. None of the guidelines based their recommendations on recent evidence from meta-analyses of a specific brand of PHF.ConclusionsHFs, specifically PHFs, is endorsed for the prevention of AMs, but not consistently. The need for a strong validity of the clinical evidence is acknowledged by national or regional medical associations without however specific steps for relying on all the published evidence. Hence, recent evidence regarding the preventive efficacy of a specific brand of PHF, based rigorous clinical research, should provide the basis for new evidence-based recommendations.