Primary prevention of food allergy in 2021: Update and proposals of French-speaking pediatric allergists

Sabouraud-Leclerc, D.; Bradatan, E.; Moraly, T.; Payot, F.; Larue, Caroline; Chabbert, A.; Nemni, A.; Pontcharraud, R.; Juchet, A.; Divaret‐Chauveau, Amandine; Morisset, M.

doi:10.1016/j.arcped.2021.11.009

Cited by 17 publications

(3 citation statements)

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“…Or hard boiled?). Contrary to our objection, other position papers of very authoritative scientific societies 6–10 substantially agree with recommendation 3.1.2 of the EAACI Task Force 1 . However, even in these documents, the supporting evidence does not seem sufficient.…”

contrasting

confidence: 58%

Comment on Halken et al.

Sopo

Sinatti

Mastellone

et al. 2022

Pediatric Allergy Immunology

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To the Editor,We read with great interest the European Academy of Allergy and Clinical Immunology (EAACI) guideline on prevention of food allergy (FA). 1 In particular, recommendation 3.1.2 states "The EAACI Task Force suggests introducing well-cooked hen's egg, but not raw egg or uncooked pasteurized egg, into the infant diet as part of complementary feeding to prevent egg allergy in infants." The authors declare in advance that only intention-to-treat (ITT) analyses were considered and they cite, in support of the aforementioned recommendation, four studies. [2][3][4][5] However, according to the ITT analysis, the first two studies 2,3 find no evidence that consumption of hen's egg prevents hen's egg allergy. The third study 4 reports an efficacy in this regard, but the authors (a) enrolled children with eczema, and therefore, a category at increased risk of developing FA; (b) have associated aggressive eczema treatment, and it is not possible to establish the weight of one and the other treatment on the final outcome; (c) excluded from the final analysis of the data about 18% of randomized patients, and it is difficult for statistical significance to be maintained if the worst-case scenario analysis was applied. Moreover, we consider technically difficult for a parent to be able to weigh 50 mg of cooked egg powder to be given to their child, as Natsume et al. 4 suggest. At the end, the authors 4 evaluated the effectiveness of their preventive strategy with an oral food challenge with 7 g of heated whole-egg powder, and therefore, the study in question cannot tell us anything about the possible effectiveness in the prevention of allergy to raw or undercooked egg. The fourth study 5 cited by the EAACI Task Force 1 is based on a subgroup analysis that did not benefit from a specific randomization. The previously unplanned subgroup analysis, in the absence of specific randomization, is well used for formulating hypotheses to be tested with a specifically planned study, but is less adequate to support a recommendation contained in a guideline.In short, it seems to us that recommendation 3.1.2 1 cannot be issued. Moreover, no times and doses are indicated to start the possible administration of well-cooked egg, and even this definition seems a bit vague ("well cooked" means baked? Or hard boiled?). Contrary to our objection, other position papers of very authoritative scientific societies 6-10 substantially agree with recommendation 3.1.2 of the EAACI Task Force. 1 However, even in these documents, the supporting evidence does not seem sufficient. In particular, table IV by Fleischer et al, 7 which effectively summarizes the evidence available until 2021 on this topic, is very clear in this regard. Examining it, in fact, it is clear that we do not have the availability of methodologically valid studies that allow us to argue that the introduction of cooked egg during the complementary feeding, as the only intervention, reduces the likelihood of hen's egg allergy, neither in infants at increased risk of developing FA...

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contrasting

confidence: 58%

Comment on Halken et al.

Sopo

Sinatti

Mastellone

et al. 2022

Pediatric Allergy Immunology

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“…Pre-and postnatal vitamin D supplements have also been proposed for the prevention of FA; however, at this time, the data from these studies are mixed and a clear conclusion has yet to be reached. [67][68][69][70][71][72][73][74][75]…”

Section: Preventionmentioning

confidence: 99%

“…Further investigation is needed to determine optimal strategies across a multitude of topical agents that vary significantly in composition. Pre‐ and postnatal vitamin D supplements have also been proposed for the prevention of FA; however, at this time, the data from these studies are mixed and a clear conclusion has yet to be reached 67‐75 …”

Section: Diagnosis and Endotypingmentioning

confidence: 99%

Food allergy, mechanisms, diagnosis and treatment: Innovation through a multi‐targeted approach

Sindher

Long

Chin

et al. 2022

Allergy

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The incidence of food allergy (FA) has continued to rise over the last several decades, posing significant burdens on health and quality of life. Significant strides into the advancement of FA diagnosis, prevention, and treatment have been made in recent years. In an effort to lower reliance on resource‐intensive food challenges, the field has continued work toward the development of highly sensitive and specific assays capable of high‐throughput analysis to assist in the diagnosis FA. In looking toward early infancy as a critical period in the development of allergy or acquisition of tolerance, evidence has increasingly suggested that early intervention via the early introduction of food allergens and maintenance of skin barrier function may decrease the risk of FA. As such, large‐scale investigations are underway evaluating infant feeding and the impact of emollient and steroid use in infants with dry skin for the prevention of allergy. On the other end of the spectrum, the past few years have been witness to an explosive increase in clinical trials of novel and innovative therapeutic strategies aimed at the treatment of FA in those whom the disease has already manifested. A milestone in the field, 2020 marked the approval of the first drug, oral peanut allergen, for the indication of peanut allergy. With a foundation of promising data supporting the safety and efficacy of single‐ and multi‐allergen oral immunotherapy, current efforts have turned toward the use of probiotics, biologic agents, and modified allergens to optimize and improve upon existing paradigms. Through these advancements, the field hopes to gain footing in the ongoing battle against FA.

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