Primary Prevention Of Food Allergy Research Articles

Primary prevention of food allergy in children

Pediatricians and allergists have noted a recent increase in cases of food allergy and anaphylaxis to peanuts and nuts, affecting very young children with worrying consequences in terms of quality of life. Children suffering from persistent cow's milk protein allergies that do not heal spontaneously are at very high risk of a fatal accident. Based on the findings of these studies, recommendations for primary prevention are made.

A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

Background and aimsWith an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings. MethodsWe systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022. ResultsOur search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the “Scope and Purpose” and “Rigour of Development” domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the “Applicability” domain were generally low, and only 3 CPGs rated highly in the “Implementability” domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably. ConclusionThe overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders’ preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe. PROSPERO registration numberCRD42021265689.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study.

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life. Recruitment and data collection started in February 2022 and is still ongoing. The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps. DERR1-10.2196/41436.

Vitamin D and Omega-3 (Fatty Acid) Supplementation in Pregnancy for the Primary Prevention of Food Allergy in Children-Literature Review.

During the last decades the prevalence of food allergy (FA), an adverse immune response to a specific food antigen, has risen, with negative effects on the quality of life (QoL) of many children and their families. The pathogenesis of FA is complex, involving both genetic and environmental factors. SPINK5, STAT6, HLA and FOXP3 are some of the genes that are reported to be implicated in FA development. Regarding environmental factors, particular interest has been focused on modification of the dietary habits of pregnant women for the primary prevention of FA. Specifically, Vitamin D and omega-3 (Ω-3) fatty acid supplementation during pregnancy may influence the development of FA in the offspring. Vitamin D is a hormone with various actions, including mediation of the immune system, reducing the production of inflammatory cytokines and promoting tolerance. Vitamin D deficiency in pregnancy suppresses T-regulatory cells in the fetus, and Vitamin D supplementation might protect against FA development. Dietary Ω-3 fatty acids are found mainly in fish and vegetable oils. They are beneficial for human health, playing a role in the immune system as anti-inflammatory agents, and providing cell membrane stabilization with inhibition of antigen presentation. It is documented that maternal supplementation with Ω-3 during pregnancy may protect from allergic sensitization in the children. The aim of this literature review was to explore the potential preventive role of maternal supplementation during pregnancy with Vitamin D and Ω-3 in the development of FA in the offspring. With the prevalence of FA rising, all the possible protective mechanisms and measures for FA prevention need to be explored, starting with those that can be modified.

Quality and consistency of clinical practice guidelines on the prevention of food allergy and atopic dermatitis: Systematic review protocol

Background and aimsAllergy prevention strategies have gained significant traction as a means to attenuate the growing burden of allergic diseases over the past decade. As the evidence base for primary prevention of food allergy (FA) and atopic dermatitis (AD) is constantly advancing, clinical practice guideline (CPG) recommendations on interventions for FA and AD prevention vary in quality and consistency among professional organizations. We present a protocol for a systematic review of CPGs on primary prevention of FA and AD. MethodsWe will systematically review and appraise all CPGs addressing primary prevention of FA and AD and report our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases and manual website searches from January 2011 to March 2021 without language or geographical restrictions, and supplemented by author contact, will generate the list of potentially relevant CPGs to screen. Evaluation of the methodological quality, consistency, and global applicability of shortlisted CPGs will be performed by members of the Allergy Prevention Work Group of the World Allergy Organization (WAO) using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE-REX (Recommendations EXcellence). instruments. Guideline contents, consistency, and quality of the recommendations will be summarised in tabular and narrative formats. We aim to present consolidated recommendations from international guidelines of the highest methodological quality and applicability, as determined by AGREE II and AGREE-REX. DisseminationThis systematic review will provide a succinct overview of the quality and consistency of recommendations across all existing CPGs for FA and AD prevention, as well as crucial perspectives on applicability of individual recommendations in different geographical contexts. Results from this systematic review will be reported in a peer-reviewed journal. It will also inform a position statement by WAO to provide a practical framework to guide the development of future guidelines for allergy prevention worldwide. Prospero registration numberCRD42021265689.

Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial

Primary prevention of food allergy by early introduction of allergenic foods seems promising. We aimed to determine whether early food introduction or the application of regular skin emollients in infants from a general population reduced the risk of food allergy. This 2 × 2 factorial, cluster-randomised trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway, and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine 18-week ultrasound examination were cluster-randomised at birth to the following groups: (1) no intervention group; (2) the skin intervention group (skin emollients; bath additives and facial cream; from age 2 weeks to <9 months, both at least four times per week); (3) the food intervention group (early complementary feeding of peanut, cow's milk, wheat, and egg from age 3 months); or (4) combined intervention group (skin and food interventions). Participants were randomly assigned (1:1:1:1) using computer-generated randomisation based on clusters of 92 geographical areas and eight 3-month time blocks. Study personnel performing clinical assessments were masked to group allocation. The primary outcome was allergy to any interventional food at 36 months of age. The primary efficacy analysis was done by intention-to-treat analysis, which included all participants who were randomly assigned, apart from three individuals who withdrew their consent. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). This study is registered as ClinicalTrials.gov, NCT02449850. We recruited 2697 women with 2701 pregnancies, from whom 2397 newborn infants were enrolled between April 14, 2015, and April 11, 2017. Of these infants, 597 were randomly assigned to the no intervention group, 575 to the skin intervention group, 642 to the food intervention group, and 583 to the combined intervention group. One participant in each of the no intervention, food intervention, and skin intervention groups withdrew consent and were therefore not included in any analyses. Food allergy was diagnosed in 44 children; 14 (2·3%) of 596 infants in the non-intervention group, 17 (3·0%) of 574 infants in the skin intervention group, six (0·9%) of 641 infants in the food intervention group, and seven (1·2%) of 583 infants in the combined intervention group. Peanut allergy was diagnosed in 32 children, egg allergy in 12 children, and milk allergy in four children. None had allergy to wheat. Prevalence of food allergy was reduced in the food intervention group compared with the no food intervention group (risk difference -1·6% [95% CI -2·7 to -0·5]; odds ratio [OR] 0·4 [95% CI 0·2 to 0·8]), but not compared with the skin intervention group (0·4% [95% CI -0·6 to 1· 5%]; OR 1·3 [0·7 to 2·3]), with no significant interaction effect (p=1·0). Preventing food allergy in one child required early exposure to allergenic foods in 63 children. No serious adverse events were observed. Exposure to allergenic foods from 3 months of age reduced food allergy at 36 months in a general population. Our results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy. Full funding sources listed at end of paper (see Acknowledgments).

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Systematic Food Allergy Educational Resource Evaluation by Caregivers of Children with Food Allergy

Food allergy (FA) management impacts the daily life of children and their caregivers. Parental FA knowledge is poor at diagnosis, and current available educational resources have not been systematically evaluated for quality amongst families. We assessed available FA educational resources in print form in order to formulate an efficient packet of materials for the newly diagnosed FA family. Seven caregivers of children with FA who served as mentors in a tertiary pediatric allergy clinic evaluated a binder of 52 commonly used FA resources via the Patient Education Materials Assessment Tool for Printable Materials [PEMAT-P]. Resources fell into 9 categories, ranging from FA basics to managing allergic reactions to the psychosocial impact of FAs. The PEMAT-P is a 26-item measure that has two subscales: understandability and actionability. Items are rated as ‘yes=1’ or ‘no=0’; each subscale score is summed with higher scores indicating greater understandability/actionability. Understandability scores ranged from 62% to 100% (M=88%; SD=10%). Actionability scores ranged from 0% to 100% (M=76%; SD=19%). Five resources, including anaphylaxis emergency care, received perfect PEMAT-P scores. Four resources scored below 70% for understandability, and 14 scored below 70% for actionability. The lowest ratings were given to resources about primary prevention of FA. This study used parent mentors to evaluate currently available FA resources and found inconsistent quality among resource topics. Resources in domains such as emergency anaphylactic care are well understood and can be acted upon, but understandable and actionable resources regarding the primary prevention of FA need to be developed.

A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology

Recently published data from high-impact randomized controlled trials indicate the strong potential of strategies to prevent the development of food allergy in high-risk individuals, but guidance in the United States at present is limited to a policy for only the prevention of peanut allergy, despite other data being available and several other countries advocating early egg and peanut introduction. Eczema is considered the highest risk factor for developing IgE-mediated food allergy, but children without risk factors still develop food allergy. To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months. Screening before introduction is not required, but may be preferred by some families. Other allergens should be introduced around this time as well. Upon introducing complementary foods, infants should be fed a diverse diet, because this may help foster prevention of food allergy. There is no protective benefit from the use of hydrolyzed formula in the first year of life against food allergy or food sensitization. Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended. Although exclusive breast-feeding is universally recommended for all mothers, there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy.

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population

Primary Prevention of Food Allergy.

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy. Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation. The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

Primary Prevention of Food Allergy: Translating Evidence from Clinical Trials to Population-Based Recommendations

Given the prevalence and impact of childhood food allergy, there is increasing interest in interventions targeting disease prevention. Although interventions such as early introduction of dietary peanut have demonstrated efficacy in a small number of well-conducted randomized clinical trials, evidence for broader effectiveness and successful implementation at a population level is still lacking, although epidemiological data suggest that such strategies are likely to be successful, at least for peanut. In this commentary, we explore the issues of translating evidence of efficacy studies (performed under optimal conditions) to make policy recommendations at a population level, and highlight potential benefits, harms, and unintended consequences of making population-based recommendations on the basis of randomized controlled trials. We discuss the complexity and barriers to effective primary and secondary prevention intervention implementation in resource-poor settings.

CME Exam: Primary Prevention of Food Allergy: Translating Evidence from Clinical Trials to Population-Based Recommendation

CME Exam: Primary Prevention of Food Allergy: Translating Evidence from Clinical Trials to Population-Based Recommendation

The past, present, and future of the research on food allergy in Korean children

Food allergy is an immune-mediated adverse reaction that occurs mainly by consumption of food. Some of the children with food allergies have mild symptoms like urticaria and pruritus, while others manifest fatal symptoms like anaphylaxis. Many cases develop in infants and children, and disappear spontaneously over time. The prevalence of food allergy is known to be up to 6% of children and 3%-4% of adults. Growing concern is that prevalence of food allergy seems to be increasing. The prevalence, common aller gens and natural course of food allergy vary according to the race, age, eating habits, and unknown factors. In Korea, many re searchers have reported regional data on food allergy for comparison with those of foreign countries. Awareness is increasing and food labelling is being established to help people avoid allergenic foods. In the future, monitoring of prevalence and common food allergens at regular intervals is needed to make appropriate policies for children with food allergy. There are still lack of data on pathogenesis, natural course and clinical trials of immunotherapy in Korean children. In addition, it is necessary to form a consensus on primary prevention of food allergy by early exposure to allergenic foods. Further regional studies should be performed to ex pand our understanding of food allergy and to lead to proper management for Korean children with food allergy. (Allergy Asthma Respir Dis 2018;6 Suppl 1:S44-51)

Primary Prevention of Food Allergy.

This article summarises recent developments on the prevention of food allergy in terms of the 5 D's of the development of food allergy: dry skin, diet, dogs, dribble, and vitamin D. While several advances have improved our understanding of the development of food allergy, few preventive strategies have been implemented beyond changes in infant feeding guidelines. These now state that the introduction of allergenic solids such as peanuts should occur in the first year of life. Results from randomised controlled trials on other allergenic solids, vitamin D supplementation, BCG immunisation at birth and eczema prevention are eagerly anticipated in order to inform further preventative strategies.

Primary Prevention of Food Allergy

Food allergy is estimated to affect approximately 8% of children in the USA. This is a disease without any known treatment or cure and, for some, a disease that can be quite severe, even life-threatening. While recent advances in potential treatment have made remarkable strides, with two food-targeted immunotherapy products now in phase III trials, perhaps the biggest gains in the field have come in the advent of potential preventative strategies to avoid the development of food allergy in high-risk individuals. There have been multiple, randomized, controlled trials (RCTs) performed in the past 5 years that have demonstrated significant risk reduction from early allergen introduction. These include two trials for early peanut introduction and five trials for early egg introduction in the first year of life. The results indicate that primary prevention of food allergy through early allergen introduction may represent a strategy that could potentially avert tens of thousands of children from becoming food allergic. In support of the data for peanut, the National Institute of Allergy and Infectious Diseases recently sponsored an addendum to the 2010 food allergy guidelines, specifically recommending peanut be introduced in both high- and standard-risk infants to reduce the risk of developing peanut allergy. To date, no formal recommendations have been made for egg, however. This review will focus on the latest evidence supporting early introduction as a strategy to prevent food allergy, as well as on practical aspects for its successful implementation.

Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial

Evidence is accumulating that early consumption is more beneficial than is delayed introduction as a strategy for primary prevention of food allergy. However, allergic reactions caused by early introduction of such solid foods have been a problematic issue. We investigated whether or not early stepwise introduction of eggs to infants with eczema combined with optimal eczema treatment would prevent egg allergy at 1 year of age. In this randomised, double-blind, placebo-controlled trial, we enrolled infants 4-5 months of age with eczema from two centres in Japan. Exclusion criteria were being born before 37 weeks of gestational age, experience of ingestion of hen's eggs or egg products, history of immediate allergic reaction to hen's eggs, history of non-immediate allergic reaction to a particular type of food, and complications of any severe disease. Infants were randomly assigned (block size of four; stratified by institution and sex) to early introduction of egg or placebo (1:1). Participants in the egg group consumed orally 50 mg of heated egg powder per day from 6 months to 9 months of age and 250 mg per day thereafter until 12 months of age. We aggressively treated participants' eczema at entry and maintained control without exacerbations throughout the intervention period. Participants and physicians were masked to assignment, and allocation was concealed. The primary outcome was the proportion of participants with hen's egg allergy confirmed by open oral food challenges at 12 months of age, assessed blindly by standardised methods, in all randomly allocated participants who received the intervention. This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry, number UMIN000008673. Between Sept 18, 2012, and Feb 13, 2015, we randomly allocated 147 participants (73 [50%] to the egg group and 74 [50%] to the placebo group). This trial was terminated on the basis of the results of the scheduled interim analysis of 100 participants, which showed a significant difference between the two groups (four [9%] of 47 participants had an egg allergy in the egg group vs 18 [38%] of 47 in the placebo group; risk ratio 0·222 [95% CI 0·081-0·607]; p=0·0012). In the primary analysis population, five (8%) of 60 participants had an egg allergy in the egg group compared with 23 (38%) of 61 in the placebo group (risk ratio 0·221 [0·090-0·543]; p=0·0001). The only difference in adverse events between groups was admissions to hospital (six [10%] of 60 in the egg group vs none in the placebo group; p=0·022). 19 acute events occurred in nine (15%) participants in the egg group versus 14 events in 11 (18%) participants in the placebo group after intake of the trial powder. Introduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen's egg allergy in high-risk infants. In this study, we developed a practical approach to overcome the second wave of the allergic epidemic caused by food allergy. Ministry of Health, Labour and Welfare, and National Centre for Child Health and Development, Japan.

Taking the leap earlier

The paradigm for the primary prevention of peanut allergy was, until recently, strict avoidance of peanut during pregnancy, infancy, and early childhood. However, in countries that had these dietary guidelines, the prevalence of peanut allergy greatly increased in contrast to low prevalence rates of peanut allergy in countries where infant diets included peanut at an early age, suggesting the hypothesis that early introduction of peanut is superior to delayed introduction of peanut as a strategy for the primary prevention of food allergy. This review examines recent high-quality studies that support this hypothesis. Publication of the Learning Early about Allergy to Peanut interventional trial showed that 17% of children avoiding peanut until 5 years of age developed peanut allergy compared with 3% of children who started eating peanut at ages of 4-11 months. Two birth cohort studies demonstrated that high maternal consumption of peanut during the pregnancy period reduced the risk of peanut allergy in offspring by 50-75%. Recent studies indicate that early introduction of peanut enhances the development of tolerance to peanut, reducing the risk of childhood peanut allergy.

Prevention of food allergy in infants: recommendation for infant feeding and complementary food introduction

Food allergy is common with the prevalence of 5%-7% in Korean children. The development of food allergy is likely to reflect interactions between genetic factors and environmental exposure. To prevent food allergy, early exposure to food allergens through maternal and infant diet have been investigated. Recently, guidelines for primary prevention of food allergy have been updated, and consensus communication on early peanut introduction has been demonstrated. For the first 4-6 months after birth, exclusive breast-feeding is recommended, and if impossible, extensively or partially hydrolyzed infant formula can be recommended in high-risk infants. Introducing complementary foods is recommended between 4 and 6 months of age, even in case of potentially allergenic foods such as egg, milk, and wheat. For the prevention of peanut allergy, early peanut introduction could be better than late peanut introduction in selected high-risk infants. However, infants who developed food allergy should avoid ingestion of specific offending foods. (Allergy Asthma Respir Dis 2015;3:320-325)

Primary prevention of food allergy in children and adults: systematic review.

D de Silva, M Geromi, S Halken; EAACI Food Allergy and Anaphylaxis Guidelines Group. Allergy. 2014;69(5):581–589 The goal of this study was to systematically review the literature on how to prevent the development of food allergy. A systematic review was performed on articles published through September 2012. Meta-analyses, randomized controlled trials, and prospective cohort studies designed to prevent food sensitization and/or the development of food allergy were identified from Medline, Embase, Cochrane, CINAHL, Web of Science, TRIP Database, …