Allergy Prevention Guidelines Research Articles

Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians

ObjectiveTo characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce Study designPediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines. ResultsA total of 250 pediatricians, 250 family physicians, 504 advanced practice practitioners (APPs), and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis. ConclusionsAlthough pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices.

Midwives as influencers in skin care for newborns at risk of atopic diseases : Survey of midwives' current recommendations

The prevalence of atopic diseases remains high. Initial studies suggest that primary prevention with regular basic care may influence the incidence of atopic dermatitis in infants; however, data are unclear. Midwives play an important role in the care of women in the peripartum period and therefore also in providing advice on topics such as skin care, breastfeeding and nutrition of the newborn and young infant. The aim of this study was to determine the care recommendations for newborns by midwives. We conducted across-sectional survey among German midwives using questionnaires on the topic of newborn skin care. A total of 128 questionnaires were analyzed. The most common recommendations were oil-based herbal topicals (34.9%) and plain water (34.0%). Approximately 70% of midwives reported recommending various options when there was aknown family history of atopic diathesis. It was remarkable that most of the midwives' recommendations were identical regardless of the presence of an atopic diathesis. Essential care products are only used "when necessary". Training programs for midwives on the topic of "care and strengthening of the skin barrier", taking into account the current guidelines for allergy prevention, should be implemented.

Early Peanut Immunotherapy in Children (EPIC) trial: protocol for a pragmatic randomised controlled trial of peanut oral immunotherapy in children under 5 years of age

IntroductionFood allergy is a major public health challenge in Australia. Despite widespread uptake of infant feeding and allergy prevention guidelines the incidence of peanut allergy in infants has not fallen,...

Making a SmartStart for peanut introduction to support food allergy prevention guidelines for infants.

Food allergy affects up to 10% of Australian infants. It was hypothesized that if parents follow the Australasian Society of Clinical Immunology and Allergy guidelines, Australian food allergy rates may stabilize or decline. This project aimed to determine whether SmartStartAllergy influenced parental introduction of peanut by age 12 months, including in high-risk infants. SmartStartAllergy integrates with general practice management software to send text messages to parents via participating general practices. The intervention group participants were sent text messages when their child was aged 6, 9, and 12 months; the control group participants were parents of 12-month-old infants. When their child was aged 12 months, all participants completed a questionnaire regarding eczema and family history of atopy. Infants with severe eczema and/or a family history of atopy were considered high-risk. Between 21 September 2018 and 26 April 2022, a total of 29,092 parents were enrolled in SmartStartAllergy as intervention (n= 18,090) and control (n= 11,002) group members The intervention group was more likely to introduce peanut by 12 months (crude odds ratio= 5.18; P< .0001; 95% CI= 4.35-6.16). After adjustment for the infants' level of risk and family history of atopy and food allergy, the intervention group was more likely to introduce peanut by 12 months of age (adjusted odds ratio= 5.34; P< .01; 95% CI= 4.48-6.37). SmartStartAllergy appears to be an effective tool for encouraging parental introduction of peanut. The ability to provide parents with credible allergy prevention information, along with the capacity to collect simple responses via text along with additional information via an online questionnaire, make this a useful public health tool.

Complementary feeding practices are related to the risk of food allergy in the ELFE cohort.

Conflicting results have been obtained when analyzing the relationship between complementary feeding (CF) practices and allergic diseases in childhood. This study aims to further explore the association between allergic diseases in early childhood (10.1016/j.jaci.2012.02.036) and the age at CF introduction (10.1016/S0140-6736(15)00149-X), food diversity in the first year of life (10.1016/j.ijporl.2019.109759) and the delayed introduction of major allergenic foods. This analysis focused on 6662 children from the French nationwide ELFE cohort. Data on feeding practices were collected monthly from 3 to 10 months old. Their age at CF introduction was calculated alongside a diversity score, and the number of major allergenic foods (out of eggs, fish, wheat, and dairy products) not introduced at 8 and 10 months. Their associations with parent-reported allergy-related health events between 1 and 5.5 years were assessed using logistic regressions adjusted for confounding factors. A sensitivity analysis excluding early allergic cases (occurring between 2 months and 1 or 2 years) was conducted. Late CF (>6 months) was related to a higher risk of food allergy (OR [95% CI] = 1.35 [1.02; 1.78]), a low diversity score at 8 months to a higher risk of asthma (OR [95% CI] = 1.22 [1.01; 1.48]), and two allergenic foods or more not being introduced at 10 months to a higher risk of rhinoconjunctivitis (OR [95% CI] = 1.20 [1.00; 1.44]) and food allergy (OR [95% CI] = 2.46 [1.77; 3.42]). Only this last association remained significant after the exclusion of early cases. The delayed introduction of major allergenic foods is related to a higher risk of food allergy, which supports the updated guidelines for allergy prevention.

Australian Infant Food Allergy Emergency Presentations Following Updated Early Food Introduction Guidelines

The Australasian Society of Clinical Immunology and Allergy food allergy prevention guidelines were updated in 2016 to recommend home introduction of allergenic foods actively in the first year of life, including to infants at high risk of allergy. An important consideration for parents and providers is whether this practice increases food allergy reactions or anaphylaxis. We aimed to determine whether the 2016 update of food allergy prevention guidelines was associated with an increase in food allergy or anaphylaxis emergency department (ED) presentations. We obtained hospital electronic medical records for infants aged 4 to 12 months who attended the Royal Children's Hospital Melbourne ED in 2015 or in 2018 with a presenting problem or an encounter diagnosis of food allergy or anaphylaxis. Emergency department presentations owing to food allergy increased from 1.0% (95% CI, 0.85-1.23) in 2015 to 1.4% (95% CI, 1.22-1.67) in 2018 (P= .006). There was no increase in the number of anaphylaxis presentations (28 in 2015 and 22 in 2018) or peanut anaphylaxis presentations (three in 2015 and three in 2018). Overall, the proportion of food allergy presentations attributed to IgE-mediated food allergy was similar (82.1% in 2015 and 84.1% in 2018), whereas peanut allergy presentations increased slightly, although not statically significantly, from 14.6% to 21.2% (P= .09). Food protein-induced enterocolitis syndrome ED presentations were five in 2015 (4.3%) and 12 in 2018(7.6%), although not statistically significant (P= .25). Changes to food allergy prevention guidelines recommending the earlier introduction of allergenic food may have led to a small increase in ED presentations for food allergy but not anaphylaxis.

A Survey of Canadian Dietitians on Identification of Infants at High Risk of Food Allergy and Frequency of Allergenic Food Consumption.

Purpose: To assess knowledge of Canadian dietitians on the topics of food allergy and food allergy prevention guidelines, including introduction of allergenic solids to infants at risk of food allergy.Methods: An online survey was distributed via email listservs targeting Canadian dietitians.Results: In total, 144 of 261 dietitians completed the survey (60.5%). Respondents recommend introduction of peanut (89.5%) and allergenic solids (91.2%) within the recommended age of 4-6 months for infants at high risk of food allergy, but only 26.2% recommend offering peanut three times per week once it has been introduced. In identifying what constitutes an infant at high risk of developing peanut allergy, dietitians expressed lower comfort levels and lower number of correct responses.Conclusions: Dietitians demonstrated they are up to date regarding the timing of introduction of allergenic solids, but not the frequency of consumption once introduced, for infants at high risk of food allergy. They also expressed low comfort level identifying risk factors for peanut allergy. There are opportunities for further education of dietitians, as well as potential to further utilize dietitian services for the benefit of patients with food allergy or who are at risk for food allergy.

Needs Assessment for Interactive Curriculum on Peanut Allergy Prevention Guidelines

The increasing impact of food allergy has produced corresponding interest in food allergy prevention and education. In 2017, the National Institute for Allergy and Infectious Disease (NIAID) published the Prevention of Peanut Allergy (PPA) Guidelines. Supporting clinicians to apply these guidelines through innovative methods of education is needed.

Nip allergies in the Bub: a qualitative study for a public health approach to infant feeding for allergy prevention

Objective:To identify a brand, key messages and resources to underpin a public health approach to food allergy prevention. Methods:A focus group design was used to explore perceptions and opinions of potential brands, infant feeding messages and resources for providing standardised food allergy prevention information. Focus groups were conducted in February 2018 using interview guides and were transcribed verbatim. A content analysis of the transcripts was undertaken using thematic analysis software. The University of Western Australia provided ethics approval: RA/4/20/4280. Results:Seven focus groups with 39 participants were conducted. Four slogans and styles of imagery were considered. ‘Nip Allergies in the Bub’ was the most favoured slogan and images of babies with food were most favoured. Participant feedback was sought regarding messages and supporting messages were considered important. Participants were consulted about useful resources and a website was identified. Conclusions:Conducting focus groups assisted the selection of a brand, messages and resources to underpin a public health approach to implementing allergy prevention guidelines. Implications for public health:This is the first focus group research undertaken for food allergy prevention. Identification of a meaningful brand, key messages and resources will support a public health approach to implementing allergy prevention guidelines.

Infant feeding patterns before and after changes to food allergy prevention guidelines in Australia

Food allergy is an important public health problem in Australia. Randomised controlled trials have provided evidence that introducing infants to peanut and egg early reduces the risk of developing allergies to these foods.1 The Australian Infant Feeding Summit was therefore held in 2015 to review infant feeding recommendations.2 Based on a consensus among expert stakeholders (state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health), and with the aim of providing clear guideline advice to the public while balancing the need for food allergy prevention and other nutritional priorities, including the known benefits of breastfeeding, three recommendations were made: to introduce solid foods at about six months (but not before four months) of age; to introduce peanut and egg during the first twelve months of life; and to no longer use hydrolysed infant formula for preventing allergy.2 These recommendations were incorporated into the infant feeding guidelines of the Australasian Society of Clinical Immunology and Allergy in 2016.3 We have previously reported that introducing peanut during the first year of life increased in Melbourne after the new guidelines were introduced, from 28% of infants during 2007–11 to more than 88% during 2017–19.4 In this article, we report our assessment of breastfeeding rates, the introduction of solid foods, and the use of partially hydrolysed formula before and after the new Australian guidelines were published. We analysed data from two population-based studies we had undertaken using the same recruitment methods and sampling frame.4 Twelve-month-old infants were recruited at local council vaccination sessions in Melbourne, for the HealthNuts study during 2007–11, and for EarlyNuts during 2017–19. Their parents completed questionnaires including items on infant feeding practices (Box 1), with similar response rates (HealthNuts, 74%; EarlyNuts, 76%). The Royal Children’s Hospital Human Research Ethics Committee approved each study (HealthNuts, #27047; EarlyNuts, #36160). The proportion of infants breastfed for at least twelve months was larger during 2017–2019 than 2007–2011 (52.7%; 95% confidence interval [CI], 50.3–55.0% v 35.9%; 95% CI, 34.5–37.2%), and the proportion of those who received formula slightly smaller (76.0%; 95% CI, 74.0–77.9% v 80.1%; 95% CI, 79.0–81.2%); changes in the proportions of infants ever breastfed or who received partially hydrolysed formula were not statistically significant. The proportion of infants introduced to solid foods at four months increased (31.9%; 95% CI, 29.7–34.1% v 19.2%; 95% CI, 18.2–20.4%), but not that of those introduced very early (before four months) (Box 2). Breastfeeding rates were higher in the Melbourne EarlyNuts study than in the 2017–18 National Health Survey5 — breastfeeding ever, 95% v 93%; at least twelve months, 53% v 41% — but a smaller proportion had been introduced to solid food at six months or later (39% v 48%). As EarlyNuts was a food allergy study, rates of breastfeeding and the adoption of guideline recommendations among its participants may have been higher than for the general population. Our findings suggest that introducing common food allergens early is not associated with a decline in breastfeeding. They do not establish a causal relationship between the new allergy guidelines and changes in infant feeding outcomes, but it is reassuring that the proportion of breastfed infants did not decline after their publication. Timely introduction of allergens can be recommended without concern that it might curtail breastfeeding or increase extremely early introduction to solid foods. We recommend ongoing monitoring of breastfeeding, timing of the introduction of solid and allergenic foods, and the incidence of food allergy in Australia. The EarlyNuts study was supported by the National Health and Medical Research Council (NHMRC; GNT1146769) and the Murdoch Children's Research Institute. Research at the Murdoch Children's Research Institute is supported by the Victorian Government Operational Infrastructure Program. Victoria Soriano is supported by a PhD scholarship from the NHMRC-funded Centre for Food and Allergy Research (GNT1134812). Jennifer Koplin (GNT1158699), Merryn Netting (GNT1156518), and Rachel Peters (GNT1160779) are supported by NHMRC fellowships. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. No relevant disclosures.

Does Parental Food Allergy History Matter? —Assessing Awareness of NIAID-Sponsored Peanut Allergy Prevention Guidelines and Infant Feeding Practices in a Representative Sample of US Parents

NIAID-sponsored Guidelines for Prevention of Peanut Allergy (PPA) recommend introduction of peanut-containing foods during the first year of life for most infants. However little is known regarding PPA guidelines awareness and current infant feeding practices regarding common food allergens—particularly among parents with food allergy.

Changes in Australian food anaphylaxis admission rates following introduction of updated allergy prevention guidelines

Food anaphylaxis admission rates have increased steadily in recent decades. Global food allergy prevention guidelines recommending early introduction of allergenic foods were introduced in 2015-2016. Australian guidelines to not delay the introduction of allergenic foods were introduced in 2007-2008. Our aim was to examine whether introduction of Australian guidelines (2007-2008) and global allergy prevention guidelines (2015-2016) were associated with reductions in food anaphylaxis admission rates. We compared food anaphylaxis admission rates across 3 periods: 1998-1999 to 2006-2007, 2007-2008 to 2014-2015, and 2015-2016 to 2018-2019. Annual food anaphylaxis admission rates increased 9-fold between 1998-1999 and 2018-2019, from 2.0 per 105 population to 18.2 per 105 population; the highest absolute rates were in those younger than 1 year. When year-on-year rates of change were examined across the 3 time periods, the annual rate of increase slowed after 2007-2008 in those aged 1 to 4 years (17.6%, 6.2%, and 3.9% per year, respectively) and those aged 5 to 9 years (22%, 13.9%, and -2.4%, respectively), and after 2015-2016, in those aged 10 to 14 years (17.5%, 18.0%, and 10.8%, respectively). By contrast, the year-on-year rate of increase accelerated in those younger than 1 year (5.2%, 8.0%, and 18.0%, respectively) and in all age groups older than 15 years. Although food anaphylaxis continues to increase overall, there is preliminary evidence indicating a slowing in the year-on-year rate of increase among those aged 1 to 4, 5 to 9, and 10 to 14 years, coinciding with introduction of updated infant feeding and allergy prevention guidelines in 2007-2008 and 2015-2016. Changes to the guidelines may have contributed to an attenuated rate of increase in food anaphylaxis in these age groups, as well as to increased rates in those younger than 1 year.

Practical Challenges and Considerations for Early Introduction of Potential Food Allergens for Prevention of Food Allergy

Recent randomized controlled trials aimed at the prevention of food allergy have led to sweeping changes in food allergy prevention guidelines. Emphasis is now on the introduction of potential food allergens, particularly peanut and egg, rather than avoidance. Although guidelines recommend against delaying the introduction of other potential allergens, there remains little or no evidence of the benefit of their early introduction. Parents and physicians alike report a need for greater guidance and resources on early potential allergen introduction in the complementary feeding period. A thorough understanding of early introduction literature, current prevention guidelines, and infant nutrition will empower physicians to address patient needs and concerns both when advice is established as effective and where uncertainty remains. We discuss the state of the science, compare recommendations between guidelines, and provide practical options to introduce allergenic foods, alongside other complementary foods, within the first year of life. We include a review of the available literature, including review and suggestions of potential doses of food allergens, and the first published comparison of commercially available products and homemade early introduction foods to help clinicians support their patients. We address the nutritional, dietary, and practical considerations of introducing food allergens in the first year of life while adhering to infant feeding guidelines. Finally, given the limitations of existing guidelines, we review the need for shared decision-making between physicians and parents regarding early allergen introduction.

Removing risk stratification in food allergy prevention guidelines

There is now level one evidence based on randomized controlled trials that early ingestion of allergenic solids in infancy has a preventive effect against food allergy development. As a result, guidelines now recommend early ingestion of allergenic solids as a means of food allergy prevention. However, guidelines in Canada currently focus this intervention specifically on infants at risk, defined currently as an infant who has a history of atopy such as eczema or food allergy, or who has an immediate family history of atopy. However, this definition fails to account for studies supporting early ingestion as a preventive measure within the broader population. Not all of these risk factors (such as immediate family history of atopy) are consistently supported by the literature to date. Finally, a more universal approach to food allergy prevention simplifies the message, decreases stigmatization, and reduces medicalization of infant feeding. It also has the potential to reduce reticence to feed in infancy. The goal of this commentary is to argue that food allergy prevention guidelines should focus their interventions on the broader population and not just those defined as athigher risk.

Effectiveness of Clinical Decision Support Tools on Pediatrician Adherence to Peanut Allergy Prevention Guidelines

Effectiveness of Clinical Decision Support Tools on Pediatrician Adherence to Peanut Allergy Prevention Guidelines

Implementation, Practices, and Barriers to the 2017 Peanut Allergy Prevention Guidelines Among Pediatricians

Implementation, Practices, and Barriers to the 2017 Peanut Allergy Prevention Guidelines Among Pediatricians

The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines.

The Australasian Society of Clinical Immunology and Allergy, the peak professional body for clinical immunology and allergy in Australia and New Zealand, develops and provides information on a wide range of immune-mediated disorders, including advice about infant feeding and allergy prevention for health professionals and families. Guidelines for infant feeding and early onset allergy prevention were published in 2016, with additional guidance published in 2017 and 2018, based on emerging evidence. When the infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods. (This is not a strict window of introduction but rather a recommendation not to delay the introduction of solid foods beyond 12 months.) Introduce peanut and egg in the first year of life in all infants, regardless of their allergy risk factors. Hydrolysed (partially and extensively) formula is no longer recommended for the prevention of allergic disease. The guidelines specifically recommend introducing solid foods at around 6 months of age and introducing peanut and egg in the first year of life in all infants to prevent allergy development. Hydrolysed formula is no longer recommended for prevention of allergic disease. A new document outlining the reasons for and the method of peanut introduction to high risk infants is available for health professionals.

Life after LEAP: How to implement advice on introducing peanuts in early infancy.

The increase in food allergies worldwide has led to mounting concern among healthcare providers, families, schools, and the food industry. Of particular interest is the growing prevalence of peanut allergy. The Learning Early About Peanut Allergy (LEAP) study confirms that the early introduction of peanut significantly decreases the risk of developing peanut allergy among high-risk children. However, a number of issues, such as a unified definition of high risk and whether or not to screen patients before peanut introduction, remain. This article will review the LEAP findings and the new peanut allergy prevention guidelines, and then briefly discuss recommendations on the introduction of other allergenic foods based on results from other food allergy prevention randomised controlled trials.

The Epidemiology of Food Allergy

The past few years have seen an exponential increase in publications on the topic of IgE-mediated food allergy. Recent publications have greatly advanced our understanding of the global prevalence of food allergy, and have revealed new insights into risk factors for food allergy. In this article, we will review these recent developments, summarise the current state of knowledge of the epidemiology of IgE-mediated food allergy, and outline areas of ongoing research where gaps in evidence remain. Recent publications reveal substantial differences in food allergy prevalence between countries. Data show that the incidence of food-induced anaphylaxis in developed countries continues to rise, particularly in children, although it remains unclear to what extent this is due to an increase in food allergy prevalence, or an increase in severe reactions among allergic individuals, or both. There has been considerable progress in understanding risk factors for food allergy. In particular, there is now good evidence that delayed introduction of peanut increases the risk of developing peanut allergy in infants with pre-existing risk factors for peanut allergy. A shift towards earlier introduction of peanut in these infants, now starting to be recommended in allergy prevention guidelines, may help to prevent peanut allergy in future generations. Recent studies have defined the prevalence of food allergy in different regions of the world. These studies provide strong baseline data to measure the extent to which new food allergy prevention strategies, including recommending timely peanut introduction for high-risk infants, change the prevalence of childhood food allergy.

Probiotics, Prebiotics &amp; Food allergy Prevention

ABSTRACTPurpose of review:there are accruing evidences on the role of the intestinal microbiota in the development of allergic diseases among infants. Elaborating on this theoretical basis, studies did assess the possibilities to prevent allergic diseases in infancy through manipulation of the intestinal microbiota. We review here such studies.Recent findings:interventional studies led to conflicting conclusions on the possible role of probiotics and prebiotics in allergy prevention. Two metanalyses published in 2015 did reconcile all data. Guidelines have been predicated on such studies using the GRADE methodology.Summary:the guidelines for allergy prevention suggest for the first time the use of probiotics and prebiotics. The existing evidences stand for a use of such supplementation in particular for the prevention of eczema. As there is no evidence so far of superiority of one probiotic strand over the others, they should be considered as class and not as individual products.