The Cochrane Library and dietary prevention of allergic disease and food hypersensitivity in children: an umbrella review

Abstract

AbstractBackgroundDietary interventions, including avoiding allergy‐inducing foods in pregnant or lactating women and their infants, and the use dietary modifications such as prebiotics and probiotics, may prevent sensitization and subsequent allergic disease and food hypersensitivity in infants.ObjectivesTo determine the evidence from Cochrane Systematic Reviews for dietary interventions for the primary prevention of clinical allergic disease or food hypersensitivity.MethodsThe Cochrane Database of Systematic Reviews was searched for systematic reviews examining prevention of allergic disease and/or food hypersensitivity. Two reviewers independently assessed review quality, reviewed assessments of study quality and extracted reported data.Main resultsSix reviews were eligible. All reviews had concerns regarding the methodological quality of included studies and several had insufficient numbers of enrolled infants to provide precise estimates of effect. There is insufficient evidence to support the use and safety of maternal dietary allergen restriction during pregnancy and/or lactation for prevention of allergic disease in high‐risk infants. In high‐risk infants unable to be exclusively breast‐fed, there is some evidence for use of a hydrolysed infant formula for prevention of allergic disease, although the evidence is not conclusive. Evidence suggests that soy‐based infant formula should not be recommended. One trial of prebiotic supplemented formula reported a significant reduction in eczema up to 6 months of age. Meta‐analysis of 5 trials of probiotic supplements found a significant reduction in infant eczema, although trial results were heterogeneous.Authors' conclusionsIn high‐risk infants, there is no evidence to support the use of dietary interventions in pregnant or lactating women, or the use of soy‐based formula in infants for prevention of allergic disease. There is insufficient evidence to recommend the use of prebiotics or probiotics. Further trials of hydrolysed infant formula, prebiotics and probiotics are warranted. Copyright © 2007 John Wiley & Sons, Ltd.