Introduction Of Allergenic Foods Research Articles

Maternal awareness to the timing of allergenic food introduction in Saudi infants: A cross-sectional study.

BackgroundCurrent guidelines recommend the introduction of allergenic foods as early as 4–6 months of age to decrease the risk of food allergy. However, caregivers’ knowledge about such practices and adherence to them is ambiguous.ObjectivesThe purpose of this study was to evaluate the timing of introduction of potentially allergenic foods into children’s diet and the level of maternal awareness about and degree of compliance with current recommendations.Materials and methodsWe conducted a cross-sectional study from May 2019 to January 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 405 mothers were enrolled in the study. The eligibility criteria included mothers of children between the ages of 12 and 36 months.ResultsMost mothers in this study had initiated allergenic foods, and the average time of introduction was 9.84 ± 3.16 months for eggs, 14.6 ± 5.78 months for peanuts, and 13.6 ± 5.37 months for fish. Around one-quarter (n = 102, 25.2%) of the children were identified as being in the high-risk group. Most mothers did not know or disagreed that the timing of introducing allergenic foods might help in preventing food allergy, but there was no difference between the risk groups (33.8% and 26.2%, respectively). Moreover, only 18.6% and 13.2% of the high- and low-risk groups, respectively, received correct information from their health care providers (P = .004). Mothers with only one child were less likely to start eggs at an early age (odds ratio [OR] = 0.5 and P = .005). Furthermore, children at a high risk of food allergy were two times more likely to start eggs at an earlier age (OR = 2.12 and P = .003).ConclusionIn this study, the allergenic food feeding practices being followed for infants and young children were found to be suboptimal. Parental education level and the number of siblings were identified as potential barriers to the implementation of and adherence to recent guidelines. There is a need for corrective measures to ensure safe and appropriate feeding practices in the Saudi community.

Update on food allergy.

Food allergy is a major public health issue with growing prevalence in the urbanized world and significant impact on the lives of allergic patients and their families. Research into the risk factors that have contributed to this increase and their underlying immune mechanisms could lead us to definitive ways for treatment and prevention of food allergy. For the time being, introduction of peanut and other allergenic foods in the diet at the time of weaning seems to be an effective way to prevent the development of food allergy. Improved diagnosis and appropriate management and support of food allergic patients are central to patient care with food immunotherapy and biologics making the transition to clinical practice. With the new available treatments, it is becoming increasingly important to include patients' and family preferences to provide a management plan tailored to their needs.

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence. A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored. Montevideo, the capital city of Uruguay (Latin America). A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics. The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses. Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

Prevention of food allergy: can we stop the rise of IgE mediated food allergies?

Food allergy has become more prevalent in recent decades. Without a curative treatment for food allergy, prevention is key. Can we intervene and halt the food allergy epidemic? There are three main hypotheses to explain the rise in food allergy: the dual-allergen exposure hypothesis, the hygiene hypothesis and the vitamin D hypothesis. In a recent systematic review of randomized controlled trials, only introduction of allergenic foods, namely egg and peanut, in the diet at the time of weaning and avoidance of temporary supplementation with cow's milk formula in the first few days of life showed low to moderate evidence of a preventive effect. For primary prevention, introduction of allergenic foods at the time of weaning and avoidance of temporary supplementation with cow's milk formula in the first few days of life has been recommended. Introduction of foods once allergy has been excluded may be beneficial for sensitized subjects (secondary prevention). Once food allergy has been established, it is important to minimise complications (tertiary prevention) through allergen avoidance, timely treatment of allergic reactions, control of atopic co-morbidities and dietetic and psychological support, as appropriate. Immunomodulatory treatments can potentially be disease-modifying and require further research.

Efficacy of the Inquiring About Tolerance (EAT) Study Among Infants at High Risk of Developing Food Allergy

MR Perkin, K Logan, HT Bahnson. J Allergy Clin Immunol . 2019;144(6):1606–1614.e2 The EAT study was a large randomized trial examining early introduction of common allergenic foods and risk of food allergy in children. This study examined the benefit of early food introduction in infants at high risk of developing food allergy. Participants were recruited from England and Wales. Secondary analysis was performed for 3 groups of high-risk infants: non-white ( n = 199), visible eczema ( n = 317), and infants with food sensitization defined as a serum IgE >0.01 kU/L ( n = 157). Infants were randomized into a …

Earlier Ingestion of Peanut After Changes to Infant Feeding Guidelines: The EarlyNuts Study

VX Soriano, RL Peters, AL Ponsonby. J Allergy Clin Immunol. 2019;144(5):1327–1335.e5 In 2016, Australian feeding guidelines were updated to recommend early introduction of peanut (PN) and egg without screening high-risk infants beforehand. The aim of this study was to assess the consequences of that change on the rate of early introduction and the prevalence of PN and egg allergy as compared with the HealthNuts study ( J Allergy Clin Immunol 2014;133(2):476-484). This was a population-based, cross-sectional, observational study. The first 860 infants (11–15 months) who agreed to participate were recruited from immunization sessions in Melbourne. Feeding practices were compared with those identified after 2008 when Australian guidelines removed recommendations to avoid early introduction of allergenic foods. PN introduction was earlier …

M311 ALLERGIC REACTION TO A MULTI-ALLERGEN FOOD SUPPLEMENT IN AN INFANT WITH ATOPIC DERMATITIS

Early introduction and ongoing inclusion of allergenic foods during infancy is currently recommended as a method to prevent food allergy development. Several commercial products have been developed to provide a simplified way for parents to introduce allergenic proteins into their infants’ diets.

Food allergy epidemiology and racial and/or ethnic differences.

In recent decades, immunoglobulin E (IgE) mediated food allergy has become a growing public health concern. Converging evidence from cross-sectional prevalence studies, health care utilization records, and cohort studies indicate that food allergies are increasingly prevalent and often severe. Although IgE-mediated food allergy has long been considered a predominantly pediatric concern, analysis of recent self-reported data suggests that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies as well as persistent childhood-onset allergies. Results of studies also suggest that food allergy-related health care utilization is increasing as more individuals seek emergency treatment for food-induced anaphylaxis. Analysis of epidemiologic data also indicates that the burden of food allergies is unequally distributed. Published prevalence rates are highest in Western countries, e.g., the United States, United Kingdom, and Australia. Within these countries, there also is heterogeneity across racial and/or ethnic groups, with non-White and second-generation immigrant populations disproportionately affected. Importantly, such observations can shed light on the etiology of food allergy and inform improved clinical management, treatment, and prevention efforts. For example, there is a growing consensus that earlier introduction of allergenic foods, e.g., peanut, promotes oral tolerance and can dramatically reduce food allergy risk. In addition, much attention has been paid to the potentially deleterious effects of cutaneous allergen exposure, e.g., through eczematous skin, which can skew the immune response away from tolerance and toward allergic sensitization, thereby increasing food allergy risk. Furthermore, there is a growing appreciation for the potential protective effects of diverse microbial exposures, given mounting evidence for the immunomodulatory effects of the human microbiome. Also, when considering the geographic variability in the prevalence of certain food and environmental allergies as well as their structural similarities at the molecular level, it is believed that co-sensitization between food and environmental allergens may be a key driver of rising food allergy prevalence.

Low allergen content of commercial baby foods.

Introduction of allergenic solid foods, especially peanut and hen's egg reduces the risk of food allergy development in early childhood. Ideally, parents will offer their infants home-prepared foods; however, many rely on the availability of convenient ready to purchase infant foods. This audit aimed to assess the major food allergen content of commercial infant foods. Infant foods available for sale in 2019 in Australia were the focus of this audit. The major food allergens investigated were peanut, tree nuts, hen's egg, cows milk, wheat, fish, shellfish, soy, sesame and lupin. Websites of infant food manufacturers and major supermarkets were used to identify ingredient lists of infant foods available for purchase. Where ingredients listings were unavailable this information was sourced directly from the product labels in the supermarket. Fourteen companies were identified, manufacturing over 251 foods specifically for the infants aged less than 1 year of age. Although there were many choices available containing wheat (27 products) and cows milk proteins (73 products), none contained peanut, tree nuts, sesame, shellfish or lupin. Despite infant feeding advice encouraging early introduction to food allergens, of 251 commercial baby foods surveyed only 1% contained egg and none contained peanut, the most common food allergies in young Australian infants. This low food allergen content may be disadvantageous for infants fed mostly commercial infant foods as they are unlikely to be exposed to sufficient amounts of the major food allergens on a regular basis during infancy.

Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance.

Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.

Pediatric provider knowledge of early peanut introduction recommendations

Peanut allergy affects approximately 2% of children in the United States. 1 Gupta R.S. Springston E.E. Warrier M.R. et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011; 128: e9-e17 Crossref PubMed Scopus (973) Google Scholar Delayed introduction of allergenic foods was recommended by the American Academy of Pediatrics in 2000 in an effort to reduce the incidence of allergic disease. 2 American Academy of PediatricsCommittee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106: 346-349 PubMed Google Scholar This recommendation was withdrawn in 2008 owing to insufficient evidence, and no specific guidance was provided on the timing of allergenic food introduction. 3 Greer F.R. Sicherer S.H. Burks A.W. American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008; 121: 183-191 Crossref PubMed Scopus (857) Google Scholar In January 2017, evidence-based recommendations for the early introduction of peanut were made. 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Allergy Asthma Clin Immunol. 2017; 13: 1 Crossref Scopus (25) Google Scholar The results of the Learning Early About Peanut (LEAP) trial suggest that early introduction of peanut may prevent peanut allergy among high-risk infants. 5 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1226) Google Scholar Currently, the guidelines of the National Institute of Allergy and Infectious Diseases (NIAID) recommend the introduction of peanut around 6 months of age in infants with mild to moderate eczema. For infants with severe eczema, egg allergy, or both, it is recommended to strongly consider testing for peanut sensitivity, and if appropriate, introduce peanut as early as 4 to 6 months of age. 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Allergy Asthma Clin Immunol. 2017; 13: 1 Crossref Scopus (25) Google Scholar

Food allergy prevention: current evidence.

The aim of the article is to critically appraise the most relevant studies in the rapidly advancing field of food allergy prevention. Epidemiologic studies identified atopic dermatitis as a strong risk factor for food allergy, with mounting evidence for impaired skin barrier and cutaneous inflammation in the pathogenesis. Additional risk factors include a family history of atopy, the timing of allergenic food introduction into the infant's diet, dietary diversity, vitamin D, and environmental factors, such as dog ownership. Early introduction of allergenic foods (such as peanut) into the infant diet was shown to significantly reduce the risk of food allergy in infants with risk factors, whereas studies targeting skin barrier function have produced conflicting results. Cumulative evidence supports dietary diversity during pregnancy, breastfeeding, infancy, and early childhood. A variety of interventions have been evaluated for the prevention of atopic dermatitis and food allergy, often producing conflicting results. At present, official guidelines encourage breastfeeding and early allergenic food introduction for infants at risk for food allergy, with an emphasis on dietary diversity, fruits, vegetables, fish, and food sources of vitamin D during pregnancy, lactation, and early life for all infants.

Low-dose peanut challenges can facilitate infant peanut introduction regardless of skin prick test size

The Learning Early About Peanut Allergy (LEAP) trial and other studies recommend early peanut introduction to prevent peanut allergy in at-risk infants. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar ,2 Perkin M.R. Logan K. Tseng A. et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016; 374: 1733-1743 Crossref PubMed Scopus (497) Google Scholar In addition, peanut oral immunotherapy (OIT) shows increased rates of sustained unresponsiveness in children younger than 5 years with known peanut allergy, 3 Vickery B.P. Berglund J.P. Burk C.M. et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017; 139: 173-181.e8 Abstract Full Text Full Text PDF PubMed Scopus (219) Google Scholar suggesting better outcomes with early exposure. The LEAP trial excluded infants with skin prick tests (SPTs) greater than 4 mm. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar The guidelines recommend peanut introduction or oral food challenge (OFC) only in infants who have SPTs less than or equal to 7 mm and do not specifically address management of infants with SPTs greater than 7 mm (or high peanut IgE levels). 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar Data suggest that patients with peanut SPT greater than 7 mm are likely to react, 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar ,5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar but most reference values for SPT and peanut IgE levels are not standardized for infants. 5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar ,6 Hill D.J. Heine R.G. Hosking C.S. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol. 2004; 15: 435-441 Crossref PubMed Scopus (201) Google Scholar It is unknown whether infants with SPT greater than 7 mm may tolerate and benefit from early peanut exposure. Given the potential long-term benefits of tolerating peanut, we sought to offer peanut OFCs to a wider population of sensitized infants.

Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis

BackgroundThe early introduction group participants of the Enquiring About Tolerance study were asked to undertake a proscriptive regimen of early introduction and sustained consumption of 6 allergenic foods. It was envisaged that this might be challenging, and early introduction group families were presented with an open-text question to express any problems they were experiencing with the regimen in recurring online questionnaires.ObjectiveWe sought to analyze these open-text questionnaire responses with the aim of identifying challenges associated with the introduction and regular consumption of allergenic foods.MethodsThree combinations of interim questionnaire responses were selected for analysis, representing the early period (4, 5, and 6 months), middle period (8 and 12 months), and late period (24 and 36 months) of participation in the Enquiring About Tolerance study. Responses were assigned a code to describe their content and subsequently grouped into themes to portray key messages. A thematic content analysis allowed for conversion of qualitative codes into quantitative summaries.ResultsThree main challenges to allergenic food consumption were identified. First, some children refused the allergenic food, causing a sense of defeat among caregivers. Second, caregivers were concerned that allergenic foods might be causing a reaction, triggering a need for reassurance. Third, practical problems associated with the regimen compromised caregivers' capacity to persist.ConclusionUnderstanding the challenges experienced with allergenic food introduction and sustained consumption is the necessary precursor to developing specific communication and support strategies that could be used by caregivers, practitioners, policymakers, and key stakeholders to address these problems.

Association Between the Age of Solid Food Introduction and Eczema: A Systematic Review and a Meta-analysis

To review all available literature to determine if the timing of solid food introduction influences the risk of atopic eczema. Cow’s milk was purposely excluded in this review because it is not given as a solid food.Children enrolled in 11 cohort studies, 2 case controls, 1 cross-sectional study, and 2 randomized controlled trials were included.PubMed and Embase databases were searched using the key words solid food, complementary and allergenic food introduction, and eczema, with the final literature search performed on February 18, 2017. Two authors independently assessed all applicable English-language human studies and performed data extraction. Cohort studies, case-controlled studies, cross-sectional studies, and randomized controlled trials containing original data were included in this review.A total of 1414 articles were initially identified; after removal of duplicates, 1092 articles underwent title and abstract screening, with 987 articles being excluded. The remaining 105 articles underwent full text review, and 89 articles were excluded. A total of 17 articles met the inclusion criteria: 11 were cohort studies (1 cohort study generated 2 publications), 2 were case controls, 1 was a cross-sectional study, and 2 were randomized controlled trials. In the 2 randomized controlled trials, researchers examined early egg introduction; in 1 of these studies, researchers showed that early egg introduction (between 4 and 6 months) may reduce the risk of atopic eczema, whereas researchers in the other trial failed to demonstrate this response. Because of heterogeneity between the studies, a limited meta-analysis was performed; this did not show an association between the age of solid food introduction and risk of eczema.No strong evidence was found that early solid food introduction was associated with less risk of atopic eczema.Every day, parents ask health care providers, when should my infant start solid foods? How early is early? Can this help prevent eczema? The takeaway from this study is that early solid food introduction has little bearing on an infant’s risk of eczema development. On the basis of recommendations from many national and international health organizations, solid food introduction should occur around 6 months of age and not before 4 months of age.

Caregiver and Expecting Caregiver Support for Early Peanut Introduction Guidelines

To assess current opinions and preferences of new and expecting caregivers regarding early allergenic solid food introduction and how such introduction may be accomplished by surveying a sample of expecting and recently delivered caregivers.The population included US residents 18 to 55 years of age that identified as expecting caregivers or caregivers of newborns 12 months or younger.One thousand expecting caregivers and 1000 caregivers of infants <12 months of age were surveyed during a 3-week period in April 2017 (3 months after the release of the National Institute of Allergy and Infectious Diseases guidelines on early peanut introduction and 26 months after publication of the LEAP Study). The survey contained 32 questions on knowledge, attitude, and preference regarding timing of solid food introduction, concern and knowledge for the potential development of food allergy, attitudes regarding office-based recommendations for the introduction of potentially allergenic solids, and in-office procedures for assessment of food allergies.Two thousand of 2196 respondents completed the survey. A family history of food allergy was significantly associated with a better awareness of the guidelines (odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.02–1.49; P = .03, nonsignificant after adjustment for multiple comparisons), concern for their child developing a food allergy (OR: 2.5; 95% CI: 1.8–3.5; P < .001), and belief in the timing of introduction in developing food allergy (OR: 1.2; 95% CI: 1.03–1.46; P = .02, nonsignificant after adjustment for multiple comparisons). Only 31% of respondents reported willingness to introduce peanut before or around 6 months of age, with nearly 40% willing to introduce only after 11 months of age. An exception was egg, in which 60% reported willingness to introduce before 8 months of age. Fifty-one percent were unwilling to allow skin testing before 11 months of age, and 56.8% were unwilling to allow an oral food challenge before 11 months of age. Overall, 58% of the combined sample indicated that they would support medicalization of early introduction of potentially allergenic solids foods with in-office risk assessment, 28.1% would not support, and 13.6% reported they would do what their physician recommended. The preference for early introduction and willingness to allow in-office assessment was greater among expecting caregivers than those recently delivered.Recently delivered and expecting caregivers surveyed in this study expressed considerable hesitancy regarding readiness to introduce peanut and other potentially allergenic solid foods early and hesitancy regarding in-office assessments to help mitigate potential risk of such introduction.There have been many efforts to disseminate LEAP Study results and subsequent updated National Institute of Allergy and Infectious Diseases guidelines. Implementation of the new guidelines is equally important and requires that health care providers have discussions with parents and identify barriers to change. This study sheds light on the hesitancy that expecting and recently delivered caregivers may have regarding these guidelines.

Factors influencing adherence in a trial of early introduction of allergenic food

BackgroundThe Enquiring About Tolerance (EAT) study examined whether the early introduction of 6 allergenic foods from 3 months of age in exclusively breastfed infants prevented the development of food allergy. The intervention was effective in the per-protocol analysis for allergy to 1 or more foods and for egg and peanut individually, but only 42% of early introduction group (EIG) children met the per-protocol criteria.ObjectiveWe sought to identify which factors were responsible for nonadherence in the EAT study.MethodsFactors influencing adherence within the key early introduction period in the EIG (up to 6 months of age) were divided into enrollment and postenrollment factors, and their association with nonadherence was explored.ResultsIn an adjusted analysis, at enrollment, increased maternal age, nonwhite ethnicity, and lower maternal quality of life were independently and significantly associated with overall nonadherence in the EIG. Enrollment eczema and enrollment serum allergen-specific IgE sensitization to 1 or more foods (≥0.1 kU/L) were not related to overall nonadherence. After enrollment, 2 factors were significantly related to EIG overall nonadherence: parent-reported IgE-type symptoms with infant allergenic food consumption by 6 months of age and reported feeding difficulties by 4 months of age.ConclusionIf early introduction of allergenic foods were to be considered a strategy to prevent food allergy, families of nonwhite ethnicity, those with older mothers, and those with infants with reported feeding difficulties or early-onset eczema would benefit from support to promote early and sustained consumption.

A Synopsis of the Synopses, 2018 to 2019

With this Synopsis Book, we provide reviews on a range of observations and advances that will increase understanding of allergic and immunologic disorders impacting children. These findings can influence clinical practice now and in the near future. Reviewers have selected notable articles that will help improve patient care through optimizing diagnosis and management and raising awareness of modifiable risk factors and novel therapeutic targets. There continues to be tremendous interest in identifying potential risk factors for the development of allergic disorders, with much attention on the role of the microbiome as well as other modifiable risks, such as antioxidants, vitamin D, and ultraviolet radiation exposure. Although associations are reported in some studies, significant shifts in allergy risk have not been demonstrated in interventional studies. Multiple factors are likely in play with complex interactions; therefore, further exploration in these realms is required to determine if these or other risk factors can be modified to mitigate allergy risk. The role of diet in the development of allergic disease remains an area of significant interest. Early introduction of peanut for allergy prevention is supported by national guidelines, and efforts have focused on dissemination …

Prevention of food allergy.

Primary prevention and secondary prevention in the context of food allergy refer to prevention of the development of sensitization (i.e., the presence of food-specific immunoglobulin E (IgE) as measured by skin-prick testing and/or laboratory testing) and sensitization plus the clinical manifestations of food allergy, respectively. Until recently, interventions that target the prevention of food allergy have been limited. Although exclusive breast-feeding for the first 6 months of life has been a long-standing recommendation due to associated health benefits, recommendations regarding complementary feeding in infancy have significantly changed over the past 20 years. There now is evidence to support early introduction of peanut into the diet of infants with egg allergy, severe atopic dermatitis, or both diagnoses, defined as high risk for peanut allergy, to try to prevent development of peanut allergy. Although guideline-based recommendations are not available for early introduction of additional allergenic foods, this topic is being actively studied. There is no evidence to support additional dietary modification of the maternal or infant diet for the prevention of food allergy. Similarly, there is no conclusive evidence to support maternal avoidance diets for the prevention of food allergy.

Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies.

This review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.