Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials
- 1 October 2020
- journal article
- review article
- Published by Wiley in Pediatric Allergy and Immunology
- Vol. 31 (7), 813-826
- https://doi.org/10.1111/pai.13273
Abstract
Background This systematic review of ways to prevent immediate-onset/IgE-mediated food allergy will inform guidelines by the European Academy of Allergy and Immunology (EAACI). Methods The GRADE approach was used. Eleven databases were searched from 1946 to October 2019 for randomized controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations, and outcomes and so were summarized narratively. Results Forty-six studies examined interventions to reduce the risk of food allergy in infancy (up to 1 year) or early childhood. The following interventions for pregnant or breastfeeding women and/or infants may have little to no effect on preventing food allergy, but the evidence is very uncertain: dietary avoidance of food allergens, vitamin supplements, fish oil, probiotics, prebiotics, synbiotics, and emollients. Breastfeeding, hydrolyzed formulas, and avoiding cow's milk formula may not reduce the risk of cow's milk protein allergy; however, temporary supplementation with cow's milk formula in the first week of life may increase the risk of cow's milk allergy. Introducing well-cooked egg, but not pasteurized raw egg, from 4 to 6 months probably reduces the risk of hen's egg allergy. Introducing regular peanut consumption into the diet of an infant at increased risk beginning from 4 to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions about introducing peanut are based on moderate certainty evidence, from single trials in high-income countries. Conclusions Sixty percent of the included studies were published in the last 10 years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations.Funding Information
- European Academy of Allergy and Clinical Immunology
This publication has 71 references indexed in Scilit:
- Early regular egg exposure in infants with eczema: A randomized controlled trialJournal of Allergy and Clinical Immunology, 2013
- Prenatal Vitamin D Supplementation and Child Respiratory Health: A Randomised Controlled TrialPLOS ONE, 2013
- Postnatal Fish Oil Supplementation in High-Risk Infants to Prevent Allergy: Randomized Controlled TrialPEDIATRICS, 2012
- Optimal duration of exclusive breastfeedingEmergencias, 2012
- GRADE guidelines: 9. Rating up the quality of evidenceJournal of Clinical Epidemiology, 2011
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Ovalbumin‐specific immunoglobulins A and G levels at age 2 years are associated with the occurrence of atopic disordersClinical & Experimental Allergy, 2011
- High-Dose Docosahexaenoic Acid Supplementation of Preterm Infants: Respiratory and Allergy OutcomesPEDIATRICS, 2011
- Long-term prevention of allergic diseases by using protein hydrolysate formula in at-risk infantsThe Journal of Pediatrics, 1992