Abstract
Food allergy (FA) is a significant health issue which considerably influences the quality of life of both children and their family. The increasing prevalence of FA, documented in the last 3 decades, has led to the reassessment of FA prevention strategies and particularly to giving up the approach based on delaying the introduction of potential food allergens. Several observational and interventional studies demonstrated a potential effectiveness of the early food introduction strategy in FA prevention, although strong evidence from randomized controlled trials are lacking and, sometimes, contrasting. The current approach to FA is mainly based on avoidance diet and the use of rescue medications in case of allergic reaction, although active allergen immunotherapy has recently become an increasingly important therapeutic strategy to approach IgE-mediated FA, potentially able to induce improvement through desensitization to a specific food. This review provides an overview on the historical evolution of recommendations about FA and on evidence published in the last 15 years on nutritional intervention strategy, i.e., early introduction of allergen or avoidance diet, in the prevention and management of IgE-mediated and non-IgE-mediated FA in children.
Highlights
We focused on the nutritional and avoidance approach in food protein-induced enterocolitis syndrome (FPIES), food proteininduced allergic proctocolitis (FPIAP) and food protein-induced enteropathy (FPE), while eosinophilic esophagitis will not be discussed in this review
Delayed food introduction as well as assumption of allergenic foods before 4 months of age has been proven ineffective in Food allergy (FA) prevention, while early introduction of potential trigger food, between 4 and 6 months of age, has been suggested as a preventive strategy for FA, reliable evidence is available only for peanut allergy
The current approach to FPIES, FPIAP, and FPE is based on elimination diet and nutritional counseling; strong supporting evidence on dietary management are lacking
Summary
Food allergy (FA) is a significant health issue with an increasing prevalence in the last 30 years, affecting up to 6–8% of children worldwide [1,2,3,4] and up to 10% in high-income countries [5]. Authors demonstrated that the delayed introduction of CM proteins and other solid foods was associated with an increased risk for atopic manifestations, such as eczema and recurrent wheeze [36] In another largescale population-based prospective study, a significantly lower frequency of IgE-mediated CM allergy was documented in infants precociously exposed to CM proteins (within 14 days of life) compared to delayed introduction (between 105 and 194 days of life), allowing authors to conclude that early exposure to CM proteins, in association to breastfeeding, might promote tolerance [37]. Authors highlighted that early exposure to whole egg reduced
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