1
|
Muraro A, de Silva D, Halken S, Worm M, Khaleva E, Arasi S, Dunn-Galvin A, Nwaru BI, De Jong NW, Rodríguez Del Río P, Turner PJ, Smith P, Begin P, Angier E, Arshad H, Ballmer-Weber B, Beyer K, Bindslev-Jensen C, Cianferoni A, Demoulin C, Deschildre A, Ebisawa M, Fernandez-Rivas MM, Fiocchi A, Flokstra-de Blok B, Gerdts J, Gradman J, Grimshaw K, Jones C, Lau S, Loh R, Alvaro Lozano M, Makela M, Marchisotto MJ, Meyer R, Mills C, Nilsson C, Nowak-Wegrzyn A, Nurmatov U, Pajno G, Podestà M, Poulsen LK, Sampson HA, Sanchez A, Schnadt S, Szajewska H, Van Ree R, Venter C, Vlieg-Boerstra B, Warner A, Wong G, Wood R, Zuberbier T, Roberts G. Managing food allergy: GA 2LEN guideline 2022. World Allergy Organ J 2022; 15:100687. [PMID: 36119657 PMCID: PMC9467869 DOI: 10.1016/j.waojou.2022.100687] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 12/29/2022] Open
Abstract
Food allergy affects approximately 2-4% of children and adults. This guideline provides recommendations for managing food allergy from the Global Allergy and Asthma European Network (GA2LEN). A multidisciplinary international Task Force developed the guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We reviewed the latest available evidence as of April 2021 (161 studies) and created recommendations by balancing benefits, harms, feasibility, and patient and clinician experiences. We suggest that people diagnosed with food allergy avoid triggering allergens (low certainty evidence). We suggest that infants with cow's milk allergy who need a breastmilk alternative use either hypoallergenic extensively hydrolyzed cow's milk formula or an amino acid-based formula (moderate certainty). For selected children with peanut allergy, we recommend oral immunotherapy (high certainty), though epicutaneous immunotherapy might be considered depending on individual preferences and availability (moderate certainty). We suggest considering oral immunotherapy for children with persistent severe hen's egg or cow's milk allergy (moderate certainty). There are significant gaps in evidence about safety and effectiveness of the various strategies. Research is needed to determine the best approaches to education, how to predict the risk of severe reactions, whether immunotherapy is cost-effective and whether biological therapies are effective alone or combined with allergen immunotherapy.
Collapse
Affiliation(s)
| | | | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark
| | | | | | | | | | | | - Nicolette W. De Jong
- Internal Medicine, Allergology & Clinical Immunology, Pediatric Allergology, University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Pete Smith
- Griffith University School of Medicine, Australia
| | | | | | - Hasan Arshad
- Faculty of Medicine, University of Southampton, UK
| | - Barbara Ballmer-Weber
- Department of Dermatology, University Hospital Zürich and Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, Switzerland
| | | | | | - Antonella Cianferoni
- University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Céline Demoulin
- Association Francaise pour la Prevention des Allergies, France
| | - Antoine Deschildre
- CHU Lille, Univ.Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | | | | | | | - Bertine Flokstra-de Blok
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute Asthma and COPD (GRIAC), Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, the Netherlands
| | | | - Josefine Gradman
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Kate Grimshaw
- Dietetic Department, Salford Care Organisation, Northern Care Alliance NHS Group, UK
| | | | - Susanne Lau
- Charité - Universitätsmedizin Berlin, Germany
| | | | | | | | | | - Rosan Meyer
- Imperial College London, London, United Kingdom
| | - Clare Mills
- School of Biological Sciences, Manchester Institute of Biotechnology, University of Manchester, Manchester, M17DN, UK
| | - Caroline Nilsson
- Karolinska Institutet, Dept. of Clinical Science and Education, Södersjukhuset and Sachs’ Children and Youth Hospital, Sweden
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | | | | | | | | | - Angel Sanchez
- AEPNAA Spanish Association for People with Food and Latex Allergy, Spain
| | | | - Hania Szajewska
- Department of Paediatrics, Medical University of Warsaw, Poland
| | | | - Carina Venter
- Children's Hospital Colorado, University of Colorado, USA
| | | | | | - Gary Wong
- Chinese University of Hong Kong, Hong Kong
| | - Robert Wood
- Department of Pediatrics, John Hopkins University School of Medicine, USA
| | | | - Graham Roberts
- University of Southampton, UK
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- David Hide Asthma and Allergy Centre, St Mary’s Hospital, Isle of Wight, UK
| |
Collapse
|
2
|
Vandenplas Y, Meyer R, Chouraqui JP, Dupont C, Fiocchi A, Salvatore S, Shamir R, Szajewska H, Thapar N, Venter C, Verhasselt V. The role of milk feeds and other dietary supplementary interventions in preventing allergic disease in infants: Fact or fiction? Clin Nutr 2021; 40:358-371. [DOI: 10.1016/j.clnu.2020.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
|
3
|
Rajani PS, Seppo AE, Järvinen KM. Immunologically Active Components in Human Milk and Development of Atopic Disease, With Emphasis on Food Allergy, in the Pediatric Population. Front Pediatr 2018; 6:218. [PMID: 30131949 PMCID: PMC6090044 DOI: 10.3389/fped.2018.00218] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
Breast-feeding is currently recommended to prevent the development of allergic diseases; however, data are conflicting and mechanisms are unclear. The immunomodulatory composition of human milk is poorly characterized and varies between mothers. We and others have shown that high levels of human milk IgA and certain cytokines and human milk oligosaccharides are associated with protection against food allergy in the infant, but it is unclear whether they are responsible for or simply biomarkers of the vertical transfer of protection. Because human milk has pre- and probiotic properties, the anti-allergy protection afforded by human milk may be due to its control on the developing gut microbiome. In mice, murine milk IgA supports gut homeostasis and shapes the microbiota, which in turn diversifies the intestinal IgA repertoire that reciprocally promotes the diversity of gut microbiome; these mechanisms are poorly understood in humans. In addition, several human milk bioactives are immunostimulatory, which may in part provide protection against allergic diseases. The regulation of immunologically active components in human milk is incompletely understood, although accumulating evidence suggests that IgA and cytokines in human milk reflect maternal exposures. This review summarizes the current literature on human milk components that have been associated with protection against food allergy and related allergic disorders in early childhood and discusses the work relating to regulation of these levels in human milk and possible mechanisms of action.
Collapse
Affiliation(s)
| | | | - Kirsi M. Järvinen
- Division of Pediatric Allergy and Immunology and Center for Food Allergy, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| |
Collapse
|
4
|
Soto-Ramírez N, Kar S, Zhang H, Karmaus W. Infant feeding patterns and eczema in children in the first 6 years of life. Clin Exp Allergy 2017; 47:1285-1298. [PMID: 28815821 DOI: 10.1111/cea.12998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/10/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Modes of infant feeding such as direct and indirect breastfeeding, and formula feeding, and their combinations may play a role in child health. OBJECTIVE The aim was to investigate which feeding patterns in the first 6 months pose risks of eczema/skin allergy in children up to 6 years compared to direct breastfeeding for at least 3 months. METHODS The Infant Feeding Practices Study II in the United States and its 6-year follow-up provided data on feeding modes in infancy and doctor's diagnosed eczema/skin allergy in the first 6 years of life (1387 infants), based on parental reports. Different feeding patterns were identified. Log-linear models were used to estimate prevalence ratios (PRs) of feeding patterns for doctor's diagnosed eczema/skin allergy in the first 6 years of life, adjusting for confounders. RESULTS Compared to "direct breastfeeding for at least 3 months" (DBF3m), the combination of "direct feeding at the breast (DBF), pumping and feeding breast milk (BM), and formula (FF) in the first months" (DBF/BM/FF) showed a statistically significant higher risk of eczema/skin allergy in the first 6 years of life (PR = 1.46), adjusting for confounders. DBF combined with BM for the first 3 months followed by mixed feeding also had an increased risk (PR = 1.26), although not statistically significant. Formula feeding introduced since birth had no effect on eczema. Among the confounders, paternal eczema and race/ethnicity (Hispanic vs White) were associated with a higher risk of eczema/skin allergy. CONCLUSIONS & CLINICAL RELEVANCE Mixed infant feeding may carry a higher risk of eczema/skin allergy compared to direct feeding at the breast. The recent epidemic of pumping and feeding in the United States and the use of mixed infant feeding modes requires additional studies to provide appropriate and renewed assessments of the risks of feeding modes for the future development of allergies.
Collapse
Affiliation(s)
- N Soto-Ramírez
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - S Kar
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - H Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - W Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| |
Collapse
|
5
|
The German Infant Nutritional Intervention Study (GINI) for the preventive effect of hydrolyzed infant formulas in infants at high risk for allergic diseases. Design and selected results. Allergol Select 2017; 1:28-38. [PMID: 30402599 PMCID: PMC6039995 DOI: 10.5414/alx01462e] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/25/2011] [Indexed: 01/02/2023] Open
Abstract
In the complex interaction between certain environmental factors and genetic disposition, the early allergen exposure plays a major role in the development of allergic diseases. In aiming to reduce the allergen burden for the infant at risk during early infancy, cow's milk protein hydrolysate infant formulas (hypoallergenic infant formulas) are appropriate alternatives to breastfeeding for primary allergy prevention. The German Infant Nutritional Intervention-Program (GINI) was supported for the first 3 years by the German Ministry for Education and Research (BMBF) (FKZ 01 EE 9401-4). It is a birth cohort which was primarily scheduled until the children were 3 years old. The aim of the prospective, randomized, double-blind intervention study was to investigate the impact of different cow's milk protein hydrolysate infant formulas in the first 4 - 6 months on the development of allergic diseases in children at risk due to at least one parent or biological sibling with a history of allergic disease. The allocation to one of the 4 intervention formulas (partial whey hydrolysate, extensive whey hydrolysate, extensive casein hydrolysate or standard cow's milk formula) was randomised and stratified by family history (single/biparental) and the respective obstetric clinic. Recruitment was carried out by the three clinical centers (Research Institute Marien-Hospital Wesel, Children's Department, Ludwigs-Maximilians-University Munich and Children's Department Technical University Munich) in 18 obstetric clinics between 01.09.1995 and 30.06.1998. Along with the intervention study a non-interventional, complementary observational cohort of children with or without allergy risk was recruited and followed by annual self-reporting parental questionnaires. The GINI intervention study (GINI-I, N = 2.252) and the non-interventional observation study (GINI-NI, N = 3.739) are combined in the population-based GINIplus study (see article J. Heinrich et al. in this journal). The results of the GINI intervention study confirm that, cow's milk protein hydrolysate infant formulas have a preventive effect on allergic manifestation compared with a standard cow's milk formula, until school age. However, the dimension of the effect is different between the formulas. This effect, which is mainly driven by the effect on atopic eczema, develops in the first months of life and persists without rebound. In the formula groups the cumulative incidence of atopic eczema until school age is reduced between 26% and 45% compared with standard cow's milk formula. A beneficial effect of the hydrolysate formulas on the respiratory manifestations asthma and rhinoconjunctivitis, however, could not be shown. By comparing the GINI intervention and non-intervention arm of the GINIplus study it was demonstrated, that a family history for allergy doubles the risk for eczema in the offspring. Early intervention with cow's milk protein hydrolysate infant formulas is able to substantially compensate this risk for eczema until the age of 6 years. In contrast, by randomization to standard cow's milk formula this risk showed a trend towards a higher incidence compared with children at risk from the non-intervention group. Thus, the results of the GINIplus study have contributed to answer some of the controversially discussed questions.
Collapse
|
6
|
Santos L, Vericimo M, Teixeira G, Clemente SS, Figueiredo I. Seroreactivity to Anisakis spp. in the perinatal period. Obstet Med 2017; 10:96-98. [DOI: 10.1177/1753495x16689443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Background This study had sought to assess the seroreactivity to the fish nematode Anisakis spp. in a puerperal population, as well as to ascertain whether a correlation exists between maternal and cord blood levels. Methods Blood samples were obtained from puerperal women and cord blood to measure specific anti- Anisakis antigen IgG and IgE by ELISA. Non-parametric tests were used to compare two or more independent and related samples. Results Of the 99 maternal serum samples assessed, 21 were positive on ELISA (21.2%). There were no significant differences in the mean ranks of IgG optical density levels between women who ate fish and those who did not (p = 0.456), those who ate raw fish and those who did not (p = 0.479), or between those who had allergic complaints and those who did not (p = 0.431). Conclusion Transplacental passage of antibodies occurred, leading to moderate correlation between maternal and cord blood serum levels.
Collapse
Affiliation(s)
- Luciana Santos
- Departamento de Imunobiologia, Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
| | - Mauricio Vericimo
- Departamento de Imunobiologia, Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
| | - Gerlinde Teixeira
- Departamento de Imunobiologia, Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
| | - Sergio S Clemente
- Departamento Tecnologia de Produtos de Origem Animal, Faculdade de Veterinária, Universidade Federal Fluminense, Niterói, Brazil
| | - Israel Figueiredo
- Departamento Materno-Infantil, Faculdade de Medicina; Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil
| |
Collapse
|
7
|
du Toit G, Tsakok T, Lack S, Lack G. Prevention of food allergy. J Allergy Clin Immunol 2016; 137:998-1010. [PMID: 27059727 DOI: 10.1016/j.jaci.2016.02.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 01/21/2023]
Abstract
The past few decades have witnessed an increase in the prevalence of IgE-mediated food allergy (FA). For prevention strategies to be effective, we need to understand the causative factors underpinning this rise. Genetic factors are clearly important in the development of FA, but given the dramatic increase in prevalence over a short period of human evolution, it is unlikely that FA arises through germline genetic changes alone. A plausible hypothesis is that 1 or more environmental exposures, or lack thereof, induce epigenetic changes that result in interruption of the default immunologic state of tolerance. Strategies for the prevention of FA might include primary prevention, which seeks to prevent the onset of IgE sensitization; secondary prevention, which seeks to interrupt the development of FA in IgE-sensitized children; and tertiary prevention, which seeks to reduce the expression of end-organ allergic disease in children with established FA. This review emphasizes the prevention of IgE-mediated FA through dietary manipulation, among other strategies; in particular, we focus on recent interventional studies in this field.
Collapse
Affiliation(s)
- George du Toit
- King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and the Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Teresa Tsakok
- King's College London and St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Lack
- Imperial College London, London, United Kingdom
| | - Gideon Lack
- King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and the Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
8
|
di Mauro G, Bernardini R, Barberi S, Capuano A, Correra A, de’ Angelis GL, Iacono ID, de Martino M, Ghiglioni D, Di Mauro D, Giovannini M, Landi M, Marseglia GL, Martelli A, Miniello VL, Peroni D, Sullo LRMG, Terracciano L, Vascone C, Verduci E, Verga MC, Chiappini E. Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics. World Allergy Organ J 2016; 9:28. [PMID: 27583103 PMCID: PMC4989298 DOI: 10.1186/s40413-016-0111-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/07/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Allergic sensitization in children and allergic diseases arising therefrom are increasing for decades. Several interventions, functional foods, pro- and prebiotics, vitamins are proposed for the prevention of allergies and they can't be uncritically adopted. OBJECTIVE This Consensus document was developed by the Italian Society of Preventive and Social Paediatrics and the Italian Society of Paediatric Allergy and Immunology. The aim is to provide updated recommendations regarding allergy prevention in children. METHODS The document has been issued by a multidisciplinary expert panel and it is intended to be mainly directed to primary care paediatricians. It includes 19 questions which have been preliminarily considered relevant by the panel. Relatively to each question, a literature search has been performed, according to the Italian National Guideline Program. Methodology, and a brief summary of the available literature data, has been provided. Many topics have been analyzed including the role of mother's diet restriction, use of breast/formula/hydrolyzed milk; timing of introduction of complementary foods, role (if any) of probiotics, prebiotics, vitamins, exposure to dust mites, animals and to tobacco smoke. RESULTS Some preventive interventions have a strong level of recommendation. (e.g., the dehumidifier to reduce exposure to mite allergens). With regard to other types of intervention, such as the use of partially and extensively hydrolyzed formulas, the document underlines the lack of evidence of effectiveness. No preventive effect of dietary supplementation with polyunsaturated fatty acids, vitamins or minerals has been demonstrated. There is no preventive effect of probiotics on asthma, rhinitis and allergic diseases. It has demonstrated a modest effect, but steady, in the prevention of atopic dermatitis. CONCLUSIONS The recommendations of the Consensus are based on a careful analysis of the evidence available. The lack of evidence of efficacy does not necessarily imply that some interventions may not be effective, but currently they can't be recommended.
Collapse
Affiliation(s)
- Giuseppe di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Roberto Bernardini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Salvatore Barberi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Annalisa Capuano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Antonio Correra
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi de’ Angelis
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Iride Dello Iacono
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maurizio de Martino
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Daniele Ghiglioni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Dora Di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Marcello Giovannini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Massimo Landi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi Marseglia
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Alberto Martelli
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Vito Leonardo Miniello
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Diego Peroni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Lucilla Ricottini Maria Giuseppa Sullo
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Luigi Terracciano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Cristina Vascone
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elvira Verduci
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maria Carmen Verga
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elena Chiappini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| |
Collapse
|
9
|
Hoyt AEW, Medico T, Commins SP. Breast Milk and Food Allergy: Connections and Current Recommendations. Pediatr Clin North Am 2015; 62:1493-507. [PMID: 26456446 DOI: 10.1016/j.pcl.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Breast milk, a living source of nutrition for babies, complements a baby's immune system, supplementing undeveloped defenses with immune factors while creating the foundation for the innate and adaptive immune systems. Such immune development includes tolerance of the environment and, in the case of food allergy, a lack of tolerance. Recent research questions the previous opinion that breast milk is protective against food allergy. This article reviews the immature immune system, the immunology and nutrition of breast milk, the literature exploring breast milk and food allergy, and the current recommendations regarding breast milk and the prevention of food allergy.
Collapse
Affiliation(s)
- Alice E W Hoyt
- University of Virginia, PO Box 801355, 409 Lane Road MR-4 Building, Room 5051, Charlottesville, VA 22908, USA
| | - Tegan Medico
- University of Virginia, PO Box 801355, 409 Lane Road MR-4 Building, Room 5051, Charlottesville, VA 22908, USA
| | - Scott P Commins
- University of North Carolina School of Medicine, Department of Medicine, Division of Rheumatology, Allergy and Immunology, 3300 Thurston Building, CB 7280, Chapel Hill, NC 27599-7280, USA.
| |
Collapse
|
10
|
Definition und Design hypoallergener Nahrungsmittel. ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Rueter K, Haynes A, Prescott SL. Developing Primary Intervention Strategies to Prevent Allergic Disease. Curr Allergy Asthma Rep 2015; 15:40. [PMID: 26143389 DOI: 10.1007/s11882-015-0537-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Allergic diseases are a major cause of morbidity in the developed world, now affecting up to 40 % of the population with no evidence that this is abating. If anything, the prevalence of early onset allergic diseases such as eczema and food allergy appears to be still increasing. This is almost certainly due to the changing modern environment and lifestyle factors, acting to promote immune dysfunction through early perturbations in immune maturation, immune tolerance and regulation. This early propensity to inflammation may also have implications for the rising risk of other inflammatory non-communicable diseases (NCDs) later in life. Identifying risk factors and pathways for preventing early onset immune disease like allergy is likely to have benefits for many aspects of human health, particularly as many NCDs share similar risk factors. This review focuses on recent advances in primary intervention strategies for promoting early immune health and preventing allergic disease, highlighting the current evidence-based guidelines where applicable and areas requiring further investigation.
Collapse
Affiliation(s)
- Kristina Rueter
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | | | | |
Collapse
|
12
|
Vandenplas Y, De Greef E, Xinias I, Vrani O, Mavroudi A, Hammoud M, Al Refai F, Khalife MC, Sayad A, Noun P, Farah A, Makhoul G, Orel R, Sokhn M, L'Homme A, Mohring MP, Merhi BA, Boulos J, El Masri H, Halut C. Safety of a thickened extensive casein hydrolysate formula. Nutrition 2015; 32:206-12. [PMID: 26704966 DOI: 10.1016/j.nut.2015.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/14/2015] [Accepted: 08/08/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Cow's milk allergy (CMA) is treated in formula-fed infants with an extensive protein hydrolysate. This study aimed to evaluate the nutritional safety of a non-thickened and thickened extensively casein hydrolyzed protein formula (NT- and T-eCHF) in infants with CMA. METHODS Infants younger than 6 mo old with a positive cow milk challenge test, positive IgE, or skin prick test for cow milk were selected. Weight and length were followed during the 6 mo intervention with the NT-eCHF and T-eCHF. RESULTS A challenge was performed in 50/71 infants with suspected CMA and was positive in 34/50. All children with confirmed CMA tolerated the eCHF. The T-eCHF leads to a significant improvement of the stool consistency in the whole population and in the subpopulation of infants with proven CMA. Height and weight evolution was satisfactory throughout the 6 mo study. CONCLUSIONS The eCHF fulfills the criteria of a hypoallergenic formula and the NT- and T-eCHF reduced CMA symptoms. Growth was within normal range.
Collapse
Affiliation(s)
- Yvan Vandenplas
- UZ Brussel, Department of Pediatrics, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Elisabeth De Greef
- UZ Brussel, Department of Pediatrics, Vrije Universiteit Brussel, Brussels, Belgium
| | - I Xinias
- Department of Pediatrics, Hippocration Hospital, Thessaloniki, Greece
| | - O Vrani
- Department of Pediatrics, Hippocration Hospital, Thessaloniki, Greece
| | - A Mavroudi
- Department of Pediatrics, Hippocration Hospital, Thessaloniki, Greece
| | - M Hammoud
- Faculty of Medicine, Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - F Al Refai
- Faculty of Medicine, Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - M C Khalife
- Holy Spirit University of Kaslik, Kaslikand UH-NDS, Beyruth, Lebanon
| | - A Sayad
- Holy Spirit University of Kaslik, Kaslikand UH-NDS, Beyruth, Lebanon
| | - P Noun
- Holy Spirit University of Kaslik, Kaslikand UH-NDS, Beyruth, Lebanon
| | - A Farah
- Holy Spirit University of Kaslik, Kaslikand UH-NDS, Beyruth, Lebanon
| | | | - R Orel
- University Children's Hospital, Ljubljana, Slovenia
| | - M Sokhn
- University of Balamand, Beirut, Lebanon
| | - A L'Homme
- Department of Pediatrics, La Citadelle Regional Hospital, Liège, Belgium
| | - M P Mohring
- Department of Pediatrics, La Citadelle Regional Hospital, Liège, Belgium
| | | | - J Boulos
- Mount Lebanon Hospital, Beyruth, Lebanon
| | - H El Masri
- Bahman Hospital, Medical Director Dar Hawraa Center, Beyruth, Lebanon
| | - C Halut
- Department of Pediatrics, Regional Hospital, Namur, Belgium
| | | |
Collapse
|
13
|
Song TW, Ahn K, Lee SY. Prevention of food allergy in infants: recommendation for infant feeding and complementary food introduction. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.5.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Tae Won Song
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Environmental Health Center for Atopic diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
14
|
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, duToit G, Eigenmann P, Fernandez Rivas M, Halken S, Hickstein L, Høst A, Knol E, Lack G, Marchisotto MJ, Niggemann B, Nwaru BI, Papadopoulos NG, Poulsen LK, Santos AF, Skypala I, Schoepfer A, Van Ree R, Venter C, Worm M, Vlieg-Boerstra B, Panesar S, de Silva D, Soares-Weiser K, Sheikh A, Ballmer-Weber BK, Nilsson C, de Jong NW, Akdis CA. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008-25. [PMID: 24909706 DOI: 10.1111/all.12429] [Citation(s) in RCA: 796] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.
Collapse
|
15
|
Vandenplas Y, De Greef E. Extensive protein hydrolysate formula effectively reduces regurgitation in infants with positive and negative challenge tests for cow's milk allergy. Acta Paediatr 2014; 103:e243-50. [PMID: 24575806 PMCID: PMC4282102 DOI: 10.1111/apa.12615] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/13/2014] [Accepted: 02/24/2014] [Indexed: 01/30/2023]
Abstract
Aim Cow’s milk protein allergy (CMPA) is treated using an elimination diet with an extensive protein hydrolysate. We explored whether a thickened or nonthickened version was best for infants with suspected CMPA, which commonly causes regurgitation/vomiting. Methods Diagnosis of CMPA was based on a positive challenge test. We compared the efficacy of two casein extensive hydrolysates (eCH), a nonthickened version (NT-eCH) and a thickened version (T-eCH), using a symptom-based score covering regurgitation, crying, stool consistency, eczema, urticarial and respiratory symptoms. Results A challenge was performed in 52/72 infants with suspected CMPA and was positive in 65.4%. All confirmed CMPA cases tolerated eCH. The symptom-based score decreased significantly in all infants within a month, and the highest reduction was in those with confirmed CMPA. Regurgitation was reduced in all infants (6.4 ± 3.2–2.8 ± 2.9, p < 0.001), but fell more with the T-eCH (−4.2 ± 3.2 regurgitations/day vs. −3.0 ± 4.5, ns), especially in infants with a negative challenge (−3.9 ± 4.0 vs. −1.9 ± 3.4, ns). Conclusion eCH fulfilled the criteria for a hypoallergenic formula, and the NT-eCH and T-eCH formulas both reduced CMPA symptoms. The symptom-based score is useful for evaluating how effective dietary treatments are for CMPA.
Collapse
Affiliation(s)
- Y. Vandenplas
- Department of Paediatrics UZ Brussel Vrije Universiteit Brussel Brussels Belgium
| | - E. De Greef
- Department of Paediatrics UZ Brussel Vrije Universiteit Brussel Brussels Belgium
| | | |
Collapse
|
16
|
Muraro A, Halken S, Arshad SH, Beyer K, Dubois AEJ, Du Toit G, Eigenmann PA, Grimshaw KEC, Hoest A, Lack G, O'Mahony L, Papadopoulos NG, Panesar S, Prescott S, Roberts G, de Silva D, Venter C, Verhasselt V, Akdis AC, Sheikh A. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014; 69:590-601. [PMID: 24697491 DOI: 10.1111/all.12398] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2014] [Indexed: 12/12/2022]
Abstract
Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4-6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.
Collapse
Affiliation(s)
- A. Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region; Department of Mother and Child Health; University of Padua; Padua Italy
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - S. H. Arshad
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - K. Beyer
- Clinic for Pediatric Pneumology & Immunology; Charité Universitätsmedizin Berlin; Berlin Germany
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Paediatric Allergy; GRIAC Research Institute; University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
| | - G. Du Toit
- Department of Paediatric Allergy; Division of Asthma, Allergy and Lung Biology; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; King's College London; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - P. A. Eigenmann
- Department of Child and Adolescent; Allergy Unit; University Hospitals of Geneva; Geneva Switzerland
| | - K. E. C. Grimshaw
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - A. Hoest
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - G. Lack
- Department of Paediatric Allergy; Division of Asthma, Allergy and Lung Biology; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; King's College London; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - L. O'Mahony
- Swiss Institute of Allergy and Asthma Research; University of Zurich; Zurich Switzerland
| | - N. G. Papadopoulos
- Institute of Human Development; University of Manchester; Manchester UK
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - S. Panesar
- Evidence-Based Health Care Ltd; Edinburgh UK
| | - S. Prescott
- School of Paediatrics and Child Health Research; University of Western Australia; Perth WA Australia
| | - G. Roberts
- Clinical and Experimental Sciences Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - D. de Silva
- Evidence-Based Health Care Ltd; Edinburgh UK
| | - C. Venter
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
| | - V. Verhasselt
- Hôpital de l'Archet; Université de Nice Sophia-Antipolis EA 6302 “Tolérance Immunitaire”; Nice France
| | - A. C. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Scotland UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
| | | |
Collapse
|
17
|
Meulenbroek LAPM, Oliveira S, den Hartog Jager CF, Klemans RJB, Lebens AFM, van Baalen T, Knulst AC, Bruijnzeel-Koomen CAFM, Garssen J, Knippels LMJ, van Hoffen E. The degree of whey hydrolysis does not uniformly affectin vitrobasophil and T cell responses of cow's milk-allergic patients. Clin Exp Allergy 2014; 44:529-39. [DOI: 10.1111/cea.12254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/11/2013] [Accepted: 12/02/2013] [Indexed: 01/05/2023]
Affiliation(s)
- L. A. P. M. Meulenbroek
- Division of Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - S. Oliveira
- Division of Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Immunology; Danone Research Centre for Specialised Nutrition; Wageningen The Netherlands
| | - C. F. den Hartog Jager
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - R. J. B. Klemans
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. F. M. Lebens
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - T. van Baalen
- Department of Immunology; Danone Research Centre for Specialised Nutrition; Wageningen The Netherlands
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - J. Garssen
- Division of Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Immunology; Danone Research Centre for Specialised Nutrition; Wageningen The Netherlands
| | - L. M. J. Knippels
- Division of Pharmacology; Faculty of Science; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Department of Immunology; Danone Research Centre for Specialised Nutrition; Wageningen The Netherlands
| | - E. van Hoffen
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
18
|
Lowe AJ, Dharmage SC, Allen KJ, Tang MLK, Hill DJ. The role of partially hydrolyzed whey formula for the prevention of allergic disease: evidence and gaps. Expert Rev Clin Immunol 2014; 9:31-41. [DOI: 10.1586/eci.12.80] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
19
|
Affiliation(s)
- Andrea von Berg
- Marien-Hospital-Wesel, Department of Pediatrics, Research Institute, Wesel, Germany.
| |
Collapse
|
20
|
Diet. Curr Opin Allergy Clin Immunol 2013; 13:273-4. [DOI: 10.1097/aci.0b013e328360ee01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol 2013; 131:1565-73. [PMID: 23506844 DOI: 10.1016/j.jaci.2013.01.006] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/07/2013] [Accepted: 01/11/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND The long-term effect of nutritional intervention with hydrolysate infant formulas on allergic manifestations in high-risk children is uncertain. OBJECTIVE We sought to investigate the effect of hydrolysate infant formulas on allergic phenotypes in children with family history of allergies at school age. METHODS We analyzed data from participants of the prospective German Infant Nutritional Intervention study after 10 years of follow-up. At birth, children were randomly assigned to receive, for the first 4 months, one of 4 blinded formulas as breast milk substitute, if necessary: partially hydrolyzed whey formula (pHF-W), extensively hydrolyzed whey formula (eHF-W), extensively hydrolyzed casein formula (eHF-C), or standard cow's milk formula. Outcomes were parent-reported, physician-diagnosed allergic diseases. Log-binomial regression models were used for statistical analysis. RESULTS The relative risk for the cumulative incidence of any allergic disease in the intention-to-treat analysis (n = 2252) was 0.87 (95% CI, 0.77-0.99) for pHF-W, 0.94 (95% CI, 0.83-1.07) for eHF-W, and 0.83 (95% CI, 0.72-0.95) for eHF-C compared with standard cow's milk formula. The corresponding figures for atopic eczema/dermatits (AD) were 0.82 (95% CI, 0.68-1.00), 0.91 (95% CI, 0.76-1.10), and 0.72 (95% CI, 0.58-0.88), respectively. In the per-protocol analysis (n = 988) effects were stronger. The period prevalence of AD at 7 to 10 years was significantly reduced with eHF-C in this analysis, but there was no preventive effect on asthma or allergic rhinitis. CONCLUSION The significant preventive effect on the cumulative incidence of allergic diseases, particularly AD, with pHF-W and eHF-C persisted until 10 years without rebound, whereas eHF-W showed no significant risk reduction. There is insufficient evidence of ongoing preventive activity at 7 to 10 years of age.
Collapse
|
22
|
Dreborg S, Roberts G, Lau S, Santos AF, Halken S, Høst A. The history of pediatric allergy in Europe - from a working group to ESPACI and SP-EAACI. Pediatr Allergy Immunol 2013; 24:88-96. [PMID: 23331532 DOI: 10.1111/pai.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2012] [Indexed: 01/12/2023]
Abstract
A Working Group on Pediatric Allergology was formed in 1984, which rapidly developed to become the European Society on Pediatric Allergology and Clinical Immunology (ESPACI) in 1988 with its own journal, Pediatric Allergology and Immunology. ESPACI worked together with the European Academy of Allergology and Clinical Immunology (EAACI) to form a Section of Pediatrics within EAACI (SP-EAACI) in 1996. The ESPACI and the SP-EAACI formally merged in 2001. Within the EAACI organization, the Pediatric Section has continued to grow. The Pediatric Section is working to develop pediatric allergology across Europe, focusing on postgraduate education, facilitating the research agenda and advocating for children and adolescents with allergies.
Collapse
Affiliation(s)
- Sten Dreborg
- Department of Pediatric Allergy, Women's and Children's Health, University of Uppsala, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
23
|
Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2012; 1:29-36. [PMID: 24229819 DOI: 10.1016/j.jaip.2012.09.003] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/17/2012] [Accepted: 09/20/2012] [Indexed: 01/23/2023]
Abstract
With the rising prevalence of atopic disease, primary prevention may play a role in reducing its burden, especially in high-risk infants. With this in mind, the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology was charged with the task of developing recommendations for primary care physicians and specialists about the primary prevention of allergic disease through nutritional interventions according to current available literature and expert opinion. Recommendations that are supported by data are as follows. Avoidance diets during pregnancy and lactation are not recommended at this time, but more research is necessary for peanut. Exclusive breast-feeding for at least 4 and up to 6 months is endorsed. For high-risk infants who cannot be exclusively breast-fed, hydrolyzed formula appears to offer advantages to prevent allergic disease and cow's milk allergy. Complementary foods can be introduced between 4 and 6 months of age. Because no formal recommendations have been previously provided about how and when to introduce the main allergenic foods (cow's milk, egg, soy, wheat, peanut, tree nuts, fish, shellfish), these are now provided, and reasons to consider allergy consultation for development of a personalized plan for food introduction are also presented.
Collapse
Affiliation(s)
- David M Fleischer
- National Jewish Health, University of Colorado Denver School of Medicine, Denver, Colo.
| | | | | | | |
Collapse
|
24
|
Affiliation(s)
- Hazel A Smith
- Hazel A Smith Research Midwife University College Cork
| |
Collapse
|
25
|
Järvinen KM, Fleischer DM. Can we prevent food allergy by manipulating the timing of food exposure? Immunol Allergy Clin North Am 2011; 32:51-65. [PMID: 22244232 DOI: 10.1016/j.iac.2011.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prevention of food allergies by maternal and infant feeding practices serves as a simple, inexpensive approach to address the growing number of subjects with food allergies in comparison with any emerging interventional therapies for existing food allergies, such as oral immunotherapy. This article provides a careful evaluation of the rationale and existing data on the effect of timing of the introduction of food allergens (during pregnancy, lactation, and early childhood) on the development of specific food allergies.
Collapse
Affiliation(s)
- Kirsi M Järvinen
- Division of Allergy and Immunology and Center for Immunology and Microbial Diseases, Albany Medical College, 47 New Scotland Avenue MC # 151, Albany, NY 12208, USA.
| | | |
Collapse
|
26
|
Skypala I. Adverse Food Reactions—An Emerging Issue for Adults. ACTA ACUST UNITED AC 2011; 111:1877-91. [DOI: 10.1016/j.jada.2011.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/20/2011] [Indexed: 01/03/2023]
|
27
|
Early complementary feeding and risk of food sensitization in a birth cohort. J Allergy Clin Immunol 2011; 127:1203-10.e5. [PMID: 21458850 DOI: 10.1016/j.jaci.2011.02.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 01/17/2011] [Accepted: 02/17/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Exposure to solid food or cow's milk (complementary food) before age 4 months may confer immune protection (tolerance) or detriment (allergy). OBJECTIVE We explored the relationship between introduction of complementary food <4 months and IgE to egg, milk, and peanut allergen at 2 years in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study birth cohort of Detroit, Mich. METHODS At infant ages 1, 6, and 12 months, mothers were interviewed about feeding practices. Blood samples were collected at age 2 to 3 years to assess sensitization (IgE ≥ 0.35 IU/mL) to egg, milk, or peanut. RESULTS For the 594 maternal-infant pairs analyzed, maternal mean age was 29.7 years, and 60.6% self-reported as African American or black. Infant exposure to complementary food <4 months was reported by 39.7% of mothers. IgE ≥0.35 IU/mL for egg, milk, or peanut allergen at age 2 years was observed in 23.9% (95% CI, 20.5% to 27.6%), 30.6% (26.9% to 34.5%), and 11.4% (8.9% to 14.3%) of children, respectively. The association between early feeding and sensitization was modified by parental history of asthma or allergy. In multivariable analysis, early feeding reduced the risk of peanut sensitization among children with a parental history (adjusted odds ratio, 0.2 [95% CI, 0.1-0.7]; P = .007). The relationship also became significant for egg when a cutoff for IgE of ≥0.70 IU/mL was used (adjusted odds ratio, 0.5 [95% CI, 0.3-0.9]; P = .022). CONCLUSION In this cohort, complementary food introduced <4 months was associated with a reduced risk of peanut (and perhaps egg) sensitization by age 2 to 3 years, but only for children with a parental history of asthma or allergy.
Collapse
|
28
|
Valenta R, Ferreira F, Focke-Tejkl M, Linhart B, Niederberger V, Swoboda I, Vrtala S. From allergen genes to allergy vaccines. Annu Rev Immunol 2010; 28:211-41. [PMID: 20192803 DOI: 10.1146/annurev-immunol-030409-101218] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
IgE-mediated allergy is a hypersensitivity disease affecting more than 25% of the population. The structures of the most common allergens have been revealed through molecular cloning technology in the past two decades. On the basis of this knowledge of the sequences and three-dimensional structures of culprit allergens, investigators can now analyze the immune recognition of allergens and the mechanisms of allergic inflammation in allergic patients. Allergy vaccines have been constructed that are able to selectively target the aberrant immune responses in allergic patients via different pathways of the immune system. Here we review various types of allergy vaccines that have been developed based on allergen structures, results from their clinical application in allergic patients, and future strategies for allergen-specific immunotherapy and allergy prophylaxis.
Collapse
|
29
|
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, Bozzola M, Bradsher J, Compalati E, Ebisawa M, Guzman MA, Li H, Heine RG, Keith P, Lack G, Landi M, Martelli A, Rancé F, Sampson H, Stein A, Terracciano L, Vieths S. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. World Allergy Organ J 2010; 3:57-161. [PMID: 23268426 PMCID: PMC3488907 DOI: 10.1097/wox.0b013e3181defeb9] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
30
|
Chamlin SL, Kaulback K, Mancini AJ. What is "high risk?" a systematic review of atopy risk and implications for primary prevention. Pediatr Dermatol 2009; 26:247-56. [PMID: 19706083 DOI: 10.1111/j.1525-1470.2008.00807.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atopic diseases are common and becoming more prevalent. Efforts have focused on primary disease prevention by identifying high-risk children and applying preventative strategies. Our aim was to evaluate methods used to identify high-risk children in atopy prevention studies. A literature search for relevant articles published between 1986 and 2006 was conducted, and all abstracts were reviewed. The search yielded 1,535 publications, 133 were reviewed in detail, and 57 met inclusion criteria. High risk was defined by 30 different methods. First-degree relatives with an atopic disorder were included in all methods, but only three publications used referenced questionnaires to determine this. Less frequently included were cord blood immunoglobulin E measurements and skin prick or radioallergosorbent testing, and 16 methods relied on history alone. Family history was the most common method used to predict high risk of atopic disease in a child, but a minority of studies used a tested questionnaire to determine the presence of atopy in family members. The methods used to identify high-risk children are variable, and the development and widespread use of a validated, practical screening tool is needed.
Collapse
Affiliation(s)
- Sarah L Chamlin
- Division of Pediatric Dermatology, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
| | | | | |
Collapse
|
31
|
Maternal transfer of IgE and subsequent development of IgE responses in the horse (Equus callabus). Vet Immunol Immunopathol 2008; 127:203-11. [PMID: 19081642 DOI: 10.1016/j.vetimm.2008.10.316] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 09/24/2008] [Accepted: 10/02/2008] [Indexed: 11/24/2022]
Abstract
Immunoglobulin E (IgE) mediates the immune response to parasites, but can also cause allergies. In humans maternal IgE is not transferred to cord blood and high levels of cord blood IgE are associated with subsequent allergy. In horses, both maternal IgG and IgE are transferred via colostrum; the IgE levels in the mare's serum, the colostrum and the foal's serum are correlated but the consequences of IgE transfer to foals are not known. By about 6 weeks of age the levels of IgE in foal serum have dropped to a nadir, at 6 months of age the level of IgE has risen only very slightly and is no longer correlated with the levels seen at birth, IgE(+) B-cells could be detected in lymphoid follicles of some foals at this age. Surprisingly, the levels of total IgE detected in a foals serum at 6 months of age are significantly correlated with the level in its serum at 1, 2 and even 3 years of age suggesting that by 6 months of age the foals are synthesizing IgE and that a pattern of relatively higher or lower total serum IgE has been established. The neonatal intestinal mucosa contained connective tissue mast cells which stained for bound IgE in foals up to 9 weeks of age but not mucosal mast cells, thereafter, the intestinal mast cells were IgE negative until 6 months of age. IgE antibodies to Culicoides nubeculosus salivary antigens were detected in Swiss born foals from imported Icelandic mares allergic to Culicoides spp. yet the foals showed no signs of skin sensitization and such second generation foals are known not to have an increased risk of developing allergy to Culicoides. Overall this evidence suggests there is a minimal effector role of maternal IgE also that maternal IgE has waned prior to the onset of IgE synthesis in foals and does not support maternal priming of IgE responses in foals. Furthermore the total levels of IgE in any given foal are seen to be relatively high or low from soon after the onset of IgE synthesis, and most likely they are determined by genetic factors.
Collapse
|
32
|
Hamelmann E, Herz U, Holt P, Host A, Lauener RP, Matricardi PM, Wahn U, Wickman M. New visions for basic research and primary prevention of pediatric allergy: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19 Suppl 19:4-16. [PMID: 18665959 DOI: 10.1111/j.1399-3038.2008.00763.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hydrolyzed formula feeding, delayed introduction of solid food, indoor allergen avoidance, smoke and pollutants avoidance have been applied for several decades as primary preventive measures for allergic diseases. Unfortunately, some of these strategies have had no or modest success. Therefore, resources need to be focused on better understanding of the early allergic events and on interventional studies to investigate new strategies of primary and secondary prevention. Accordingly, this review summarizes the state-of-the-art of genetic, immunological and clinical aspects of primary prevention of allergic diseases. Studies investigating gene-by-gene and gene-by-environment interactions suggest that prevention of allergic diseases must be tailored to the individual genetic susceptibilities ('gene profiling') and environmental exposures. The expanding knowledge on new T cell populations (Th17, TSLP (thymic stromal derived lymphopoietin)-dependent 'inflammatory Th2 cells') is also inspiring new concepts on the origins of allergic diseases. The old concept of 'blocking immunoglobulin G antibodies' has been re-appraised and it is likely to generate novel preventive and therapeutic strategies. The major task for future clinical research is to clearly define the timing of optimal exposure to potential allergens. In addition, the role of microbial products such as certain bacteria, or their components, and of helminths or their larvae at different times in early life, alone or with potential allergens, definitely need to be further investigated. The benefit of efficient allergy prevention, based on focusing resources on novel and promising research lines, will be of prime importance to both affluent countries and other parts of the world where allergy is only currently emerging.
Collapse
|
33
|
Eigenmann PA, Beyer K, Wesley Burks A, Lack G, Liacouras CA, Hourihane JO, Sampson HA, Sodergren E. New visions for food allergy: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19 Suppl 19:26-39. [PMID: 18665961 DOI: 10.1111/j.1399-3038.2008.00765.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The spectrum of food allergy consists of a variety of different clinical pictures including immunoglobulin (Ig)E, and non-IgE food allergy as well as mixed, IgE and non-IgE disorders. In addition, eosinophilic diseases of the gastrointestinal (GI) tract with occasional IgE-type sensitization are increasingly recognized. As a consequence, the clinical picture of food allergy is pleomorphic and can range from chronic GI symptoms to severe anaphylaxis. The diagnosis of food allergy is mostly hampered by the lack of reliable in vitro tests for non-IgE-mediated diseases, and in most cases relies on a reoccurrence of symptoms upon re-exposure to the antigen; in general during a standardized food challenge. Currently, there is no safe and efficient treatment for food allergy and the treatment relies on avoidance diets. Priorities for research have been identified by iPAC (international Pediatric Allergy and Asthma Consortium) and outlined in this review. They include studies to better identify the pathogenesis of food allergy, including genetic aspects; studies to develop diagnostic and follow-up tests; studies for standardization of food challenges; as well as studies addressing a safe and efficient treatment of food allergy.
Collapse
|
34
|
von Berg A, Filipiak-Pittroff B, Krämer U, Link E, Bollrath C, Brockow I, Koletzko S, Grübl A, Heinrich J, Wichmann HE, Bauer CP, Reinhardt D, Berdel D. Preventive effect of hydrolyzed infant formulas persists until age 6 years: long-term results from the German Infant Nutritional Intervention Study (GINI). J Allergy Clin Immunol 2008; 121:1442-7. [PMID: 18539195 DOI: 10.1016/j.jaci.2008.04.021] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 04/18/2008] [Accepted: 04/21/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The long-term effect of nutritional intervention with hydrolyzed infant formulas on allergy development has not been sufficiently evaluated. OBJECTIVE We performed a follow-up of the German Infant Nutritional Intervention study until 6 years of life to investigate the long-term allergy-preventive effect of 3 hydrolyzed infant formulas compared with cow's milk formula (CMF) in a randomized, double-blind trial. METHODS Between 1995 and 1998, 2252 newborns with atopic heredity were randomly assigned at birth to receive one of 4 blinded formulas: partially or extensively hydrolyzed whey formula, extensively hydrolyzed casein formula, or CMF as milk substitute for the first 4 months when breast-feeding was insufficient. The cohort was followed from birth until 6 years of age with yearly questionnaires. Outcomes were physician-diagnosed allergic diseases (atopic dermatitis, food allergy, allergic urticaria, asthma, and hay fever/allergic rhinitis). Log-binomial regression modeled with generalized estimation equations was used for the statistical analysis. RESULTS In the intent-to-treat analysis the relative risk of a physician's diagnosis of allergic manifestation (AM) compared with CMF was 0.82 (95% CI, 0.70-0.96) for partially hydrolyzed whey formula, 0.90 (95% CI, 0.78-1.04) for extensively hydrolyzed whey formula, and 0.80 (95% CI, 0.69-0.93) for extensively hydrolyzed casein formula. The corresponding figures for atopic eczema were 0.79 (95% CI, 0.64-0.97), 0.92 (95% CI, 0.76-1.11), and 0.71 (95% CI, 0.58-0.88), respectively. In the per-protocol analysis all effects were stronger and significant. No significant effect on other AMs was found. CONCLUSION The data confirm a long-term allergy-preventive effect of hydrolyzed infant formulas on AM and atopic eczema until 6 years of age.
Collapse
Affiliation(s)
- Andrea von Berg
- Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3052] [Impact Index Per Article: 190.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
Collapse
Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Høst A, Halken S, Muraro A, Dreborg S, Niggemann B, Aalberse R, Arshad SH, von Berg A, Carlsen KH, Duschén K, Eigenmann PA, Hill D, Jones C, Mellon M, Oldeus G, Oranje A, Pascual C, Prescott S, Sampson H, Svartengren M, Wahn U, Warner JA, Warner JO, Vandenplas Y, Wickman M, Zeiger RS. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol 2008; 19:1-4. [PMID: 18199086 DOI: 10.1111/j.1399-3038.2007.00680.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP-EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer-reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer-reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high-risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4-6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months.
Collapse
Affiliation(s)
- Arne Høst
- Department of Pediatrics, Odense University Hospital, Odense, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Brand PLP, Vlieg-Boerstra BJ, Dubois AEJ. Dietary prevention of allergic disease in children: are current recommendations really based on good evidence? Pediatr Allergy Immunol 2007; 18:475-9. [PMID: 17561932 DOI: 10.1111/j.1399-3038.2007.00541.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to 'high risk' families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted.
Collapse
Affiliation(s)
- Paul L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
| | | | | |
Collapse
|
38
|
Kaza U, Knight AK, Bahna SL. Risk factors for the development of food allergy. Curr Allergy Asthma Rep 2007; 7:182-6. [PMID: 17448328 DOI: 10.1007/s11882-007-0019-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Both genetic and environmental factors seem to predispose to the development of food allergy. A most notable factor is diet, particularly during infancy. Possible other factors include maternal diet during pregnancy and lactation, birth by cesarean section, exposure to tobacco smoke, multivitamin supplementation, and intake of antacids. It is important to identify and control such risk factors to reduce the development of food allergy.
Collapse
Affiliation(s)
- Ujwala Kaza
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA.
| | | | | |
Collapse
|
39
|
Ward CM, Geng L, Jyonouchi H. Fetal sensitization to cow's milk protein and wheat: cow's milk protein and wheat-specific TNF-alpha production by umbilical cord blood cells and subsequent decline of TNF-alpha production by peripheral blood mononuclear cells following dietary intervention. Pediatr Allergy Immunol 2007; 18:276-80. [PMID: 17584308 DOI: 10.1111/j.1399-3038.2007.00536.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a case of fetal sensitization to cow's milk protein (CMP) and wheat, resulting in non-IgE mediated food allergy (NFA). Fetal sensitization was indicated by onset of NFA symptoms shortly after birth and CMP/wheat-specific tumor necrosis factor-alpha (TNF-alpha) production by cord blood mononuclear cells. Following dietary intervention, we observed a decline of TNF-alpha production by peripheral blood mononuclear cells with stimuli of these dietary proteins (DPs) but recurrence of reactivity was observed following viral gastroenteritis, while interleukin-10 production with these DPs persisted during his first 5 yr of life. This finding may indicate active suppressive mechanisms for maintaining oral tolerance.
Collapse
Affiliation(s)
- Carla M Ward
- Division of Allergy and Immunology, Department of Pediatrics, UMDNJ-New Jersey Medical School, Newark, NJ 07101-1709, USA
| | | | | |
Collapse
|
40
|
Tricon S, Willers S, Smit HA, Burney PG, Devereux G, Frew AJ, Halken S, Host A, Nelson M, Shaheen S, Warner JO, Calder PC. Nutrition and allergic disease. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1365-2222.2006.00114.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
41
|
Affiliation(s)
- Anders Hjern
- Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
| |
Collapse
|
42
|
Hjern A. Chapter 5.8: major public health problems - allergic disorders. Scand J Public Health 2006; 67:125-31. [PMID: 16762905 DOI: 10.1080/14034950600677139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Allergens/adverse effects
- Asthma/epidemiology
- Asthma/etiology
- Child
- Child, Preschool
- Dermatitis, Allergic Contact/epidemiology
- Dermatitis, Allergic Contact/etiology
- Environmental Exposure/adverse effects
- Female
- Humans
- Hypersensitivity/epidemiology
- Hypersensitivity/etiology
- Hypersensitivity, Immediate/epidemiology
- Hypersensitivity, Immediate/etiology
- Infant
- Male
- Middle Aged
- Occupational Exposure/adverse effects
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/etiology
- Socioeconomic Factors
- Sweden/epidemiology
Collapse
Affiliation(s)
- Anders Hjern
- Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
| |
Collapse
|
43
|
|
44
|
Penttila I. Effects of transforming growth factor-beta and formula feeding on systemic immune responses to dietary beta-lactoglobulin in allergy-prone rats. Pediatr Res 2006; 59:650-5. [PMID: 16627876 DOI: 10.1203/01.pdr.0000203149.75465.74] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Early nutritional events have the potential to affect health outcomes in later life including the development of allergy. Food allergy is usually the first manifestation of allergy. Breast-feeding has been associated with a protective effect against the development of allergy, but the evidence is contradictory and the mechanisms involved are not clear. We hypothesize that milk cytokines, such as transforming growth factor beta (TGF-beta), play a role in regulating immune responses to dietary antigens. Using a rat pup model of gastrostomy feeding, the immune response profile, at weaning and post-weaning, of allergy-prone Brown Norway rats fed formula supplementation with TGF-beta was assessed. We show that feeding formula to allergy-prone rat pups results in increased total IgE immunoglobulin, beta-lactoglobulin (BLG) IgG1 antibody, and mucosal mast cell activation, as measured by serum rat mast cell protease II (RMCPII) levels in the gut. Supplementation of formula with physiological levels of TGF-beta down-regulated the BLG IgG1 response as well as total IgE and mucosal mast cell activation. Supplementation of formula also resulted in an increase in Th1 cytokines, interleukin (IL)-18, IL-12p40, IL-12p35, and interferon gamma (IFN-gamma) and an increase in IL-10. In conclusion, TGF-beta supplementation of formula moved the immune response profile of allergy prone (Th2 type) rat pups toward a Th1 profile in the suckling period. Importantly, this immune profile persisted after weaning when TGF-beta was no longer present in the diet.
Collapse
Affiliation(s)
- Irmeli Penttila
- Child Health Research Institute, North Adelaide, South Australia, Australia 5006.
| |
Collapse
|
45
|
Salvatore S, Keymolen K, Hauser B, Vandenplas Y. Intervention during pregnancy and allergic disease in the offspring. Pediatr Allergy Immunol 2005; 16:558-66. [PMID: 16238580 DOI: 10.1111/j.1399-3038.2005.00315.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The etiology of allergy is multifactorial, with many variables contributing to the final expression of atopic disease. Three breeding grounds are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s) and environmental factors. Timing and dosing of allergen(s) are of major importance. Contact with (dietary) allergens and various agents such as tobacco smoke and infections occur not only during post-natal life, but also perinatally and even pre-natally. A critical review of published evidence regarding the impact of maternal exposure to antigens during pregnancy on later development of allergy in the offspring can only conclude that more research is urgently needed. Contact with multiple dietary allergens should be in general of benefit to the fetus to develop tolerance. Current knowledge suggests that pregnant women should have a normal diversified diet, avoiding toxic agents such as tobacco and alcohol. The role of maternal intake of poly-unsaturated fatty acids on the development of atopy in the infants needs to be further evaluated. If parental history would be insufficient to determine the fetal risk, preventive measurements would be advisable for all fetuses.
Collapse
Affiliation(s)
- S Salvatore
- Clinica Pediatrica di Varese, Università dell'Insubria, Varese, Italy
| | | | | | | |
Collapse
|
46
|
Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000168798.22110.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
47
|
Abstract
PURPOSE OF REVIEW Allergic diseases represent a major burden of health problems in industrialized countries. Though several studies have focused on possible preventive measure and strategies much controversy still exists on this topic. The aim of this review is to discuss the recent literature on primary prevention of food allergy. RECENT FINDINGS In prospective observational controlled studies of high quality of birth cohorts, exclusive breastfeeding for at least 4 months combined with introduction of solid foods after 4 months of age is associated with a reduced risk of food allergy and atopic dermatitis, particularly in high-risk infants. When breastfeeding for 4-6 months is not possible or insufficient, randomized controlled trials have shown a significant reduction in food allergy and atopic dermatitis in high-risk infants fed a documented hypoallergenic hydrolysed formula. SUMMARY Breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented hypoallergenic hydrolysed formula is recommended if exclusively breastfeeding is not possible for the first 4 months. As regards primary prevention of food allergy there is no evidence for preventive dietary intervention during neither pregnancy nor lactation. Likewise, preventive dietary restrictions after the age of 4-6 months are not scientifically documented.
Collapse
Affiliation(s)
- Arne Høst
- Department of Pediatrics, Odense University Hospital, Denmark.
| | | |
Collapse
|