Primary Prevention of Food Allergy

Abstract

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.

Partially hydrolyzed formula in non-exclusively breastfed infants: A systematic review and expert consensus

“…4,5 The role of family atopic history as a risk factor for the development of food allergy remains unclear, in light of recent studies of peanut and egg allergy. 6 Partially hydrolyzed formulas (pHFs) were originally developed to have enhanced tolerability and reduced allergenicity, compared with intact cows' milk protein (CMP) formula, and may therefore potentially have benefit in decreasing the occurrence of atopic diseases. 2,7 pHFs are used worldwide in healthy infants, and in certain countries, as indicated for the potential prevention of eczema through age 2 years in infants who may be at high-risk of allergy.…”

The health and economic benefits of approaches for peanut introduction in infants with a peanut allergic sibling

“…1,2 Despite new potential for both PA prevention and desensitization treatments, there are still unknowns regarding who is at risk of developing PA. 3,4 Newer studies have focused on egg allergy and/ or severe eczema as a specific risk for developing PA, whereas older studies highlighted a parental or family history of atopic disease as a risk factor. [4][5][6] There has been speculation that PA has a potential genetic inheritance pattern and that PA in a primary relative (especially a sibling) may impart risk to other family members, prompting questions if younger siblings of peanut allergic individuals should be screened prior to peanut introduction. 1,7,8 To better understand the potential health and economic benefits of screening younger siblings of PA children prior to peanut introduction (Figure S1), we…”