Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease

Ierodiakonou, Despo; García-Larsen, Vanessa; Logan, Andrew; Groome, Annabel; Cunha, Sérgio Souza da; Chivinge, Jennifer; Robinson, Zoë; Geoghegan, Natalie; Jarrold, Katharine; Reeves, Tim; Tagiyeva, Nara; Nurmatov, Ulugbek; Trivella, Marialena; Leonardi‐Bee, Jo; Boyle, Robert

doi:10.1001/jama.2016.12623

Cited by 357 publications

(385 citation statements)

References 39 publications

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“…These recommendations have been modified after studies failed to show a correlation between maternal diet and development of atopic disease [42] . In contrast to past recommendations, more recent studies have shown a protective effect of high allergen consumption during pregnancy [43] . High consumption of peanuts and tree nuts during pregnancy was found to be associated with lower rates of food allergy in children [44] .…”

Section: Allergic Sensitizationmentioning

confidence: 70%

Mechanisms of Tolerance Induction

Nowak‐Węgrzyn¹,

Chatchatee²

2017

Ann Nutr Metab

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Food allergy results from failure in oral tolerance that usually occurs in infancy or early childhood. Exposure to peanut and hen's egg via the inflamed and disrupted epithelial barrier in children with severe atopic dermatitis is a risk factor for the development of allergy to these foods and supports the hypothesis that epicutaneous exposure in the absence of oral feeding is an important pathway of allergic IgE sensitization in infants. In recent years, the collective evidence has pointed toward the protective effect of an early feeding with peanut and egg in children with eczema, taking advantage of the pathways underlying oral tolerance to counteract epicutaneous exposure. An addendum to the NIAID food allergy guidelines recommends introduction of peanut into the diet of 4- to 6-month-old infants with severe eczema or egg allergy as an effective strategy to prevent peanut allergy. Strategies aimed at restoring the skin barrier are currently explored as an alternative approach of prevention of eczema and allergic sensitization. Manipulation of the diet via supplementation with probiotics and prebiotics to restore the healthy gut microbiota represents another potential pathway to induction of tolerance in the gut. Oral, epicutaneous, and sublingual routes of food immunotherapy are promising and induce desensitization in the majority of the treated subjects with food allergy but are not proven to restore permanent oral tolerance. Rigorous multicenter randomized clinical trials are necessary to elucidate the optimal timing, dose, duration, as well as the preventive and therapeutic effects of these diverse approaches.

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Section: Allergic Sensitizationmentioning

confidence: 70%

Mechanisms of Tolerance Induction

Nowak‐Węgrzyn¹,

Chatchatee²

2017

Ann Nutr Metab

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“…Koplin et al [7] found similar results; introducing egg into the diet between 10 and 12 months was associated with a lower risk of developing egg allergy (odds ratio, OR 1.6, 95% CI 1.0–2.6) than egg introduction after 12 months (OR 3.4, 95% CI 1.8–6.5). This finding was supported by randomized controlled trials (RCTs) of peanut exposure [9, 10] and a single meta-analysis [11]. By intention to treat analysis, Perkin et al [10] found no difference in the decrease in egg allergy in UK infants fed with egg from 3 months of age compared to only breast-fed infants (3.7 vs. 5.4%, respectively), representing a 31% lower relative risk (RR).…”

Section: Introductionmentioning

confidence: 81%

Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

Al‐Saud

Sigurdardottir

2018

Int Arch Allergy Immunol

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Background: The timing of the introduction of egg to an infant’s diet is of current interest, as new evidence raises questions regarding the benefit of delaying egg introduction. The objective of this study was to systematically review the existing literature regarding the effect of the early introduction of egg on the development of egg allergy. Methods: Literature searches were conducted in MEDLINE, EMBASE, and CENTRAL, and trial protocols were searched in Meta Register and OpenGREY. Only randomized controlled trials (RCTs) comparing early (between 3 and 6 months of age) egg introduction to no early introduction were included. The primary outcome was the development of egg allergy. Results: Of the 416 articles identified and screened, 6 RCTs met the eligibility criteria for data extraction. Allergic outcomes were evaluated in a total of 3,032 participants. A low to moderate level of evidence showed a benefit of the early introduction of egg (relative risk, RR 0.60, 95% CI 0.44–0.82, p = 0.002, mild heterogeneity, I² = 23%). The absolute risk reduction for a population with an incidence of egg allergy of 9.3% was 37 fewer cases (95% CI 17–52) per 1,000 people. Consumption of < 4,000 mg/week of egg protein had a greater preventive effect than a higher dose. Conclusion: This systematic review and meta-analysis showed an association between the early introduction of egg and a lower risk of egg allergy. Furthermore, the nature and dose of egg protein exposure may play a role. These findings should be addressed in the context of primary studies.

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“…Согласно рандомизированным исследованиям и данным метаанализа (1915 участников), полу-чены доказательства умеренной силы, что раннее введение яиц на сроке 4-6 мес жизни ассоци-ировано с более низким риском развития аллергии на яйцо в будущем в группах без риска, высокого риска и очень высокого риска развития аллергии (RR 0,56 [95% CI 0,36-0,87], р=0,009) [25]. В двух исследованиях сообщалось, что у младенцев, впер-вые употребивших яйца в сырой пастеризованной форме, могут развиться тяжелые аллергические реакции из-за предшествующей сенсибилизации, но таких эффектов не наблюдалось в испытаниях с употреблением приготовленного или подвергше-гося тепловой обработке яйца.…”

Section: оригинальные статьи в помощь практическому врачуunclassified

“…По данным метанализа [25], раннее введение рыбы в рацион ассоциировано с уменьшением частоты развития аллергической гиперчувстви-тельности и аллергического ринита. Ассоциаций с другими аллергическими и аутоиммунными за-болеваниями не обнаружено.…”

Section: оригинальные статьи в помощь практическому врачуunclassified

Updated European Recommendations on the Introduction of Complementary Food in Children – Subject for Thought

Камалова¹

2017

Ross. vestn. perinatol. pediatr.

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Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease

Cited by 357 publications

References 39 publications

Mechanisms of Tolerance Induction

Mechanisms of Tolerance Induction

Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

Updated European Recommendations on the Introduction of Complementary Food in Children – Subject for Thought

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