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

Abstract

Background: Food allergies can have serious physical, social, and financial consequences. This systematic review examined ways to prevent the development of food allergy in children and adults. Methods: Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasirandomized controlled trials, controlled clinical trials, controlled before-and-after studies, interrupted time series studies, and prospective cohort studies. Experts were consulted for additional studies. There were no language or geographic restrictions. Two reviewers appraised the studies using appropriate tools. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesized. Results: Seventy-four studies were included, one-third of which were of high quality. There was no good evidence to recommend that pregnant or breastfeeding women should change their diet or take supplements to prevent allergies in infants at high or normal risk. There were mixed findings about the preventive benefits of breastfeeding for infants at high or normal risk, but there was evidence to recommend avoiding cow's milk and substituting with extensively or partially hydrolyzed whey or casein formulas for infants at high risk for the first 4 months. Soy milk and delaying the introduction of solid foods beyond 4 months did not have preventive benefits in those at high or normal risk. There was very little evidence about strategies for preventing food allergy in older children or adults. Conclusions: There is much to learn about preventing food allergy, and this is a priority given the high societal and healthcare costs involved.

Prebiotic‐supplemented partially hydrolysed cow's milk formula for the prevention of eczema in high‐risk infants: a randomized controlled trial

“…There is inconsistent evidence that partially hydrolysed formula reduces eczema risk compared with intact cow's milk formula in high‐risk infants 7, 8, 9. However, current dietary prevention guidance includes the use of partially or extensively hydrolysed formula for infants at an increased allergic disease risk where formula is introduced before 6 months 9, 10. Importantly, previous clinical studies have not evaluated markers of immune regulation, which may be important underlying mechanisms for preventing allergic disease.…”

Doing the Food Allergy Diagnosis

“…They are the first line to determine the presence of IgE antibodies specific for a food allergen [28]. The skin prick test (SPT), which utilizes commercial extracts, is usually performed using a skin prick test device on the back or the volar surface of the forearm.…”

Food allergies. Recommendations on supplementary feeding introduction in patients with food allergies and risk group children: what and when?

“…There is evidence that the introduction of supplementary foods at the age of 4 months increases the risk of atopic dermatitis in infants of the risk group (by a factor of 2.5 compared with children to whom supplementary foods were introduced at a later age) [26,27]. At the same time there is no evidence that delayed introduction of supplementary foods (4-6 months later) can reduce the risk of atopic disease in the future [27][28][29][30]. At present, the consensus of all the leading scientific community pediatricians and allergists is reached on the optimum timing of the supplementary foods introduction as part of an "early window" of forming food tolerance at the age of 4-6 months [2,3].…”

“…Whole cow milk should be avoided until the child reaches 12 months of age. These highly allergenic products may only be introduced in the diet provided that the infant tolerates other supplementary foods well [2,3,24,25,30].…”