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Venter C, Pickett-Nairne K, Leung D, Fleischer D, O'Mahony L, Glueck DH, Dabelea D. Maternal allergy-preventive diet index, offspring infant diet diversity, and childhood allergic diseases. Allergy 2024. [PMID: 39192779 DOI: 10.1111/all.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/21/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Studies of childhood diet diversity and allergic disease have not examined additional associations with an offspring allergy-linked maternal diet index during pregnancy. We studied both associations in a pre-birth cohort. METHODS Offspring allergic disease diagnoses were obtained from electronic medical records. Maternal and infant diet were self-reported. Adjusted parametric Weibull time-to-event models assessed associations between maternal diet index, infant diet diversity and time to development of allergic rhinitis, atopic dermatitis, asthma, wheeze, IgE-mediated food allergy, and a combined outcome of any allergic disease except for wheeze. RESULTS Infant diet diversity at 1 year was associated with the risk of the combined outcome between 1 and 4 years of age (p = .002). While both maternal diet index and infant diet diversity at 1 year were associated with the risk of the combined outcome between 1 and 4 years of age (both p < .05), infant diet diversity at 1 year did not modify the association between maternal diet index and the risk of the combined outcome between 1 and 4 years of age (p = .5). The group with the lowest risk of the combined allergy outcome had higher maternal diet index and higher infant diet diversity. CONCLUSIONS The novel finding that both maternal diet index during pregnancy and infant diet diversity at 12 months are associated with the risk of a combined allergic disease outcome points to two targets for preventive interventions: maternal diet index scores during pregnancy and offspring diet diversity during infancy.
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Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kaci Pickett-Nairne
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Donald Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - David Fleischer
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Liam O'Mahony
- Department of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Deborah H Glueck
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Wang S, Yin P, Yu L, Tian F, Chen W, Zhai Q. Effects of Early Diet on the Prevalence of Allergic Disease in Children: A Systematic Review and Meta-Analysis. Adv Nutr 2024; 15:100128. [PMID: 37827490 PMCID: PMC10831899 DOI: 10.1016/j.advnut.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
Recent evidence suggests that the timing of introduction, types, and amounts of complementary foods/allergenic foods may influence the risk of allergic disease. However, the evidence has not been updated and comprehensively synthesized. The Cochrane Library, EMBASE, Web of Science, and PubMed databases were searched from the inception of each database up to 31 May 2023 (articles prior to 2000 were excluded manually). Statistical analyses were performed using RevMan 5. The GRADE approach was followed to rate the certainty of evidence. Compared with >6 mo, early introduction of eggs (≤6 mo of age) might reduce the risk of food allergies in preschoolers aged <6 y (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53, 0.81), but had no effect on asthma or atopic dermatitis (AD). Consumption of fish at 6-12 mo might reduce the risk of asthma in children (aged 5-17 y) compared with late introduction after 12 mo (OR, 0.61; 95% CI: 0.52, 0.72). Introduction of allergenic foods for ≤6 mo of age, compared with >6 mos, was a protective factor for the future risk (children aged ≤10 y) of AD (OR, 0.93; 95% CI: 0.89, 0.97). Probiotic intervention for infants at high risk of allergic disease significantly reduced the risk of food allergy at ages 0-3 y (OR, 0.72; 95% CI: 0.56, 0.94), asthma at 6-12 y (OR, 0.61; 95% CI: 0.41, 0.90), and AD at aged <6 y (3-6 y: OR, 0.70; 95% CI: 0.52, 0.94; 0-3 y: OR, 0.73; 95% CI: 0.59, 0.91). Early introduction of complementary foods or the high-dose vitamin D supplementation in infancy was not associated with the risk of developing food allergies, asthma, or AD during childhood. Early introduction to potential allergen foods for normal infants or probiotics for infants at high risk of allergies may protect against development of allergic disease. This study was registered at PROSPERO as CRD42022379264.
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Affiliation(s)
- Shumin Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Pingping Yin
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Leilei Yu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Fengwei Tian
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China; National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, Jiangsu, China
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Venter C. Immunonutrition: Diet Diversity, Gut Microbiome and Prevention of Allergic Diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:545-561. [PMID: 37827976 PMCID: PMC10570780 DOI: 10.4168/aair.2023.15.5.545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
Allergic diseases are increasing both in morbidity and mortality. Genetic, environmental, and dietary factors may all be involved in this increase. Nutrition during pregnancy, breastfeeding, and early life may play a particularly important role in preventing allergic diseases. Based on current systematic reviews, the intake of specific nutrients has failed to prevent allergic disease. Prevention strategies have shifted their focus to the overall diet which can be described using diet diversity. Infant and maternal diet diversity in pregnancy has been associated with reduced allergy outcomes in childhood. Overall, diet also seems to have a marked effect on the microbiome compared to single foods. Factors that may negate the allergy-preventative effect of overall diet diversity include the addition of emulsifiers, advanced glycation end-product content, and overuse of commercial baby foods. There is a need to perform randomized controlled trials using overall dietary intake to support international food allergy guidelines. These studies should ideally be conducted by multi-professional teams.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Feng H, Chen Y, Xiong X, Xu Q, Zhang Z, Xi Q, Wu Y, Lu Y. Association of nutrients intake during pregnancy with the risk of allergic disease in offspring: a meta-analysis of prospective cohort studies. FOOD SCIENCE AND HUMAN WELLNESS 2023. [DOI: 10.1016/j.fshw.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Venter C, Palumbo MP, Glueck DH, Sauder KA, Perng W, O'Mahony L, Pickett K, Greenhawt M, Fleischer DM, Dabelea D. Comparing the Diagnostic Accuracy of Measures of Maternal Diet During Pregnancy for Offspring Allergy Outcomes: The Healthy Start Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:255-263.e1. [PMID: 36150675 PMCID: PMC10898920 DOI: 10.1016/j.jaip.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/18/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Allergic diseases in children are increasing. Although maternal diet quality in pregnancy may be protective, it is unclear which measure of maternal diet best predicts offspring diseases. OBJECTIVE To examine the associations between multiple diet measures and allergy outcomes, and to compare the diagnostic accuracy of the measures for the prediction of allergy outcomes. METHODS Maternal diet during pregnancy was measured using a validated instrument, and scored using 5 measures: the maternal diet index (MDI), Healthy Eating Index, total diet diversity, healthy diet diversity, and unhealthy diet diversity. Unadjusted and adjusted logistic regression models assessed associations between maternal diet measures and offspring allergy outcomes up to age 4 years. The diagnostic accuracy of the diet measures was compared. RESULTS There were significant associations between MDI (odds ratio [OR], 0.78; 95% CI, 0.70-0.87), Healthy Eating Index (OR, 0.98; 95% CI, 0.97-0.99), and healthy diet diversity scores (OR, 0.91; 95% CI, 0.85-0.98) during pregnancy and the primary combined outcome "any allergy excluding wheeze" in children up to age 4 years. Neither maternal total diet diversity (OR, 0.99; 95% CI, 0.95-1.03) nor unhealthy diet diversity scores (OR, 1.05; 95% CI, 0.98-1.13) were associated with the "any allergy excluding wheeze" outcome. For all outcomes studied, except for food allergy, there was a significant difference in the diagnostic accuracy between the 5 measures of maternal diet. The area under the curve for MDI was highest for every disease outcome, although not always significantly higher. CONCLUSIONS Better quality and higher diversity of a woman's diet during pregnancy, measured in various ways, is associated with offspring allergy outcomes, with healthy foods associated with decreased risk, and unhealthy foods associated with a higher risk. The MDI, which appropriately weighted both healthy and unhealthy foods, best predicted childhood allergic disease.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colo.
| | - Michaela P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colo
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colo
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colo
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colo; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Mich
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
| | - Kaci Pickett
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colo
| | - Matthew Greenhawt
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colo
| | - David M Fleischer
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colo
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colo; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colo
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Moustaki M, Loukou I, Tsabouri S, Douros K. The links between allergen exposure and sensitization in children and adolescents: an overview for the clinician. Expert Rev Clin Immunol 2022; 18:581-590. [PMID: 35502686 DOI: 10.1080/1744666x.2022.2072297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The links between allergen exposure and sensitization are complex and depend not only on the type of allergen but on various genetic and environmental factors. AREAS COVERED This review discusses the link between allergen exposure and atopic sensitization for different types of allergens and the factors that mediate or affect this link. For the purposes of this review search of PubMed was undertaken to identify English language articles using the terms 'sensitization' and 'allergen exposure' and 'children/or adolescents.' EXPERT OPINION Regarding food sensitization, the available data for peanuts and eggs suggest that there is a window period between 4 and 6 months of age when the introduction of these foods may limit sensitization and clinically overt allergy to the respective foods. As far as it concerns aeroallergens, it seems that there is a complex and variable relationship between mite exposure and specific sensitization especially if the exposure occurs early in life. Early exposure to dog allergens does not seem to be associated with specific sensitization; regarding cats, the results are still inconsistent. Several factors may mediate the relationship between early exposure to allergens and the development of sensitization or clinical allergy.
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Affiliation(s)
- Maria Moustaki
- Cystic Fibrosis Department, Agia Sofia Children's Hospital, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Department, Agia Sofia Children's Hospital, Athens, Greece
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Pediatric Department, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lee J, Shin M, Lee B. Influence of age at complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. Clin Exp Pediatr 2021; 64:408-414. [PMID: 33147910 PMCID: PMC8342876 DOI: 10.3345/cep.2020.01382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/12/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Complementary food in infancy is necessary for human growth, neurodevelopment, and health. However, the role of allergen consumption in early infancy and its effects on the development of food allergy or tolerance remain unclear. PURPOSE To investigate the influence of age at the time of complementary food introduction on the development of asthma and atopic dermatitis in Korean children aged 1-3 years. METHODS We combined data from the Korea National Health and Nutrition Examination Survey collected from 2010 to 2014 and analyzed 1619 children aged 1-3 years who were included in the survey. Multivariate regression analysis was used to identify associations among type of feeding, age at the time of complementary food introduction, and doctor-diagnosed atopic dermatitis and asthma. RESULTS Age at the time of complementary food introduction was not significantly associated with doctor-diagnosed atopic dermatitis and asthma in children aged 1-3 years. In the univariate analysis, children with asthma showed higher water and sodium intake levels than nonasthmatic children. However, this relationship was not significant in the multivariate regression analysis. CONCLUSION The present study revealed no statistically significant relationship between age at the time of complementary food introduction and the risk of atopic dermatitis and asthma in young Korean children. A national prospective study is needed to clarify the influence of age at the time of complementary food introduction on the development of allergic diseases.
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Affiliation(s)
- Jihyun Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Bora Lee
- Institute of Health & Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
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Pierau M, Arra A, Brunner-Weinzierl MC. Preventing Atopic Diseases During Childhood - Early Exposure Matters. Front Immunol 2021; 12:617731. [PMID: 33717110 PMCID: PMC7946845 DOI: 10.3389/fimmu.2021.617731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Atopic diseases in childhood are a major burden worldwide and there is still a lack of knowledge about treatable causes. In industrialized countries such as Germany, almost every second child is sensitized to at least one common allergen. Recent studies show that although the predisposition to allergies is inherited, the adaptive immune system of neonates and infants follows a developmental trajectory and whether an allergy actually occurs depends also on timing of allergen exposure including diet as well as environmental factors. New recommendations are far from being rigid of allergen avoidance; it is rather moving toward conditions that stand for more biodiversity. The observation that introduction of peanuts or eggs early in life significantly reduced the development of a later allergy will change our recommendations for the introduction of complementary foods. This is consistent with the hygiene hypothesis that early provocation shapes the developing immune system so that it reacts appropriately. Therefore, promoting the development of tolerance is at the heart of sensible allergy prevention - and this begins with the last trimester of pregnancy. In light of this concept, actual recommendations are discussed.
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Venter C, Greenhawt M, Meyer RW, Agostoni C, Reese I, Toit G, Feeney M, Maslin K, Nwaru BI, Roduit C, Untersmayr E, Vlieg‐Boerstra B, Pali‐Schöll I, Roberts GC, Smith P, Akdis CA, Agache I, Ben‐Adallah M, Bischoff S, Frei R, Garn H, Grimshaw K, Hoffmann‐Sommergruber K, Lunjani N, Muraro A, Poulsen LK, Renz H, Sokolowska M, Stanton C, O'Mahony L. EAACI position paper on diet diversity in pregnancy, infancy and childhood: Novel concepts and implications for studies in allergy and asthma. Allergy 2020; 75:497-523. [PMID: 31520486 DOI: 10.1111/all.14051] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
To fully understand the role of diet diversity on allergy outcomes and to set standards for conducting research in this field, the European Academy of Allergy and Clinical Immunology Task Force on Diet and Immunomodulation has systematically explored the association between diet diversity and allergy outcomes. In addition, a detailed narrative review of information on diet quality and diet patterns as they pertain to allergic outcomes is presented. Overall, we recommend that infants of any risk category for allergic disease should have a diverse diet, given no evidence of harm and some potential association of benefit in the prevention of particular allergic outcomes. In order to harmonize methods for future data collection and reporting, the task force members propose relevant definitions and important factors for consideration, when measuring diet diversity in the context of allergy. Consensus was achieved on practice points through the Delphi method. It is hoped that the definitions and considerations described herein will also enable better comparison of future studies and improve mechanistic studies and pathway analysis to understand how diet diversity modulates allergic outcomes.
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Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology Children's Hospital Colorado University of Colorado Denver School of Medicine Aurora CO USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology Children's Hospital Colorado University of Colorado Denver School of Medicine Aurora CO USA
| | | | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda ‐ Ospedale Maggiore Policlinico Milano Italy
- Dipartimento di Scienze Cliniche e di Comunita Universita' degli Studi Milano Italy
| | - Imke Reese
- Dietary Counseling and Nutrition Therapy Centre Munich Germany
| | - George Toit
- Department of Paediatric Allergy Division of Asthma, Allergy and Lung Biology King's College London London UK
- Guy's & St Thomas' Hospital London UK
| | - Mary Feeney
- Department of Paediatric Allergy Division of Asthma, Allergy and Lung Biology King's College London London UK
- Guy's & St Thomas' Hospital London UK
| | | | - Bright I. Nwaru
- Institute of Medicine Krefting Research Centre University of Gothenburg Gothenburg Sweden
| | - Caroline Roduit
- University Children's Hospital Zurich Zurich Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Eva Untersmayr
- Institute for Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | | | - Isabella Pali‐Schöll
- Department of Nutrition and Dietetics Hanze University of Applied Sciences Groningen The Netherlands
- Comparative Medicine Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University Vienna Vienna Austria
| | - Graham C. Roberts
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Newport UK
- NIHR Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- Faculty of Medicine Clinical and Experimental Sciences Human Development in Health Academic Units University of Southampton Southampton UK
| | - Peter Smith
- School of Medicine Griffith University Southport QLD Australia
| | - Cezmi A. Akdis
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | | | - Miriam Ben‐Adallah
- Section of Allergy and Immunology Children's Hospital Colorado University of Colorado Denver School of Medicine Aurora CO USA
| | - Stephan Bischoff
- Institute of Nutritional Medicine University of Hohenheim Stuttgart Germany
| | - Remo Frei
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Holger Garn
- Philipps University of Marburg - Medical Faculty Institute of Laboratory Medicine and Pathobiochemistry Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Marburg Germany
| | - Kate Grimshaw
- Faculty of Medicine Experimental Sciences & Human Development in Health Academic Units University of Southampton Southampton UK
- Department of Dietetics Salford Royal Foundation Trust Salford UK
| | - Karin Hoffmann‐Sommergruber
- Institute for Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Nonhlanhla Lunjani
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- University of Cape Town Cape Town South Africa
| | - Antonella Muraro
- Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera Università di Padova Padova Italy
| | - Lars K. Poulsen
- Department of Skin and Allergy Diseases Allergy Clinic Copenhagen University Hospital at Gentofte Copenhagen Denmark
| | - Harald Renz
- Institute of Laboratory Medicine Universities of Giessen and Marburg Lung Center (UGMLC) German Center for Lung Research (DZL) Philipps Universität Marburg Marburg Germany
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | | | - Liam O'Mahony
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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D'Auria E, Peroni DG, Sartorio MUA, Verduci E, Zuccotti GV, Venter C. The Role of Diet Diversity and Diet Indices on Allergy Outcomes. Front Pediatr 2020; 8:545. [PMID: 33042906 PMCID: PMC7522364 DOI: 10.3389/fped.2020.00545] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Nutrients in foods are not eaten in isolation and food intake interacts in a complex manner, affecting health and disease outcomes. For this reason, focusing on the whole "pattern" of dietary intake instead of the single nutrients or groups of nutrients when studying diseases outcomes is increasingly appealing and growing. Diet diversity refers to the variety of foods being eaten, and the terms, diversity or variety, are often used interchangeably. When the overall diet is characterized by healthy foods, diet diversity will reflect a diversity/variety of healthy foods eaten over a period of time. The introduction of solid foods in the 1st year of life is considered a measure of increased diet diversity. Consuming a diverse range of foods and food allergens in the first year of life may increase intake of important nutrients and positively affect the gut microbiome structure and function. Intake of omega-3 fatty acids and fibers/prebiotics may be particularly important but more information is required about dose and which individuals are most likely to benefit. Increased diet diversity in the first year of life is also associated with reduced food allergy outcomes. In addition to diet diversity, diet indices are considered measures of overall diet quality and can be used as a simple assessment of dietary intake. The focus of this paper is to review and critically address the current knowledge of the association between diet diversity and diet indices and allergy outcomes. Based on the current evidence, we recommend the introduction of solid foods, including common allergenic solids, during the 1st year of life, according to the infant's neuro-developmental abilities and familial or cultural habits. For infants with severe AD and/or FA, medical assessment may be advisable before introducing common food allergens into the diet. Limited evidence exist about the role of diet indices in pregnancy and allergic disease in the offspring, and the most promising results indicate a reduction in childhood wheeze and/or asthma intake.
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Affiliation(s)
- Enza D'Auria
- Pediatric Department, Vittore Buzzi Children's Hospital, Universitá degli Studi di Milano, Milan, Italy
| | - Diego G Peroni
- Clinical and Experimental Medicine Department, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Marco Ugo Andrea Sartorio
- Pediatric Department, Vittore Buzzi Children's Hospital, Universitá degli Studi di Milano, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Vittore Buzzi Children's Hospital, Universitá degli Studi di Milano, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Pediatric Department, Vittore Buzzi Children's Hospital, Universitá degli Studi di Milano, Milan, Italy
| | - Carina Venter
- Section of Allergy and Immunology, Children Hospital Colorado, University of Colorado, Denver, CO, United States
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13
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Timing of Food Introduction and the Risk of Food Allergy. Nutrients 2019; 11:nu11051131. [PMID: 31117223 PMCID: PMC6567868 DOI: 10.3390/nu11051131] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 01/14/2023] Open
Abstract
Given that the prevalence of pediatric IgE-mediated food allergies (FA) has followed a substantive increase in recent decades, nowadays, a research challenge is to establish whether the weaning strategy can have a role in FA prevention. In recent decades, several studies have demonstrated that delayed exposure to allergenic foods did not reduce the risk of FA, leading to the publication of recent guidelines which recommend against delaying the introduction of solid foods after 4–6 months of age, both in high- and low-risk infants, in order to prevent food allergy. In the present review, focusing on cow’s milk protein, hen’s eggs, peanuts, soy, wheat and fish, we describe the current scientific evidence on the relationship between timing of these foods’ introduction in infants’ diet and allergy development.
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Al-Tamemi S, Naseem SUR, Tufail-Alrahman M, Al-Kindi M, Alshekaili J. Food Allergen Sensitisation Patterns in Omani Patients with Allergic Manifestations. Sultan Qaboos Univ Med J 2019; 18:e483-e488. [PMID: 30988967 DOI: 10.18295/squmj.2018.18.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/16/2018] [Accepted: 10/04/2018] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aimed to evaluate the relationship between food allergen sensitisation patterns and allergic manifestations in Omani patients and highlight the importance of specific immunoglobulin E (IgE) testing. Methods This retrospective study included all patients referred due to allergic manifestations to the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, from November 2012 to November 2016. Specific IgE blood testing was performed to determine sensitisation to common foods known to cause allergic reactions. Results A total of 164 patients were referred to SQUH over the study period, with 35.4% presenting with one allergic manifestation, 48.8% with 2-3 and 15.9% presenting with more than three manifestations. There was a family history of allergies in 70.7% of patients. Eosinophil counts and total and specific IgE levels were elevated in 18.9%, 54.9% and 73.2% of patients, respectively. Patients demonstrated sensitisation to cow milk (47.6%), wheat (41.5%), chicken eggs (34.8%), mixed tree nuts (34.1%), lentils (33.5%), peanuts (32.9%), soy (32.3%), shrimp (23.2%) and fish (15.2%). Overall, 19.5% were sensitised to a single allergen, 14% were sensitised to 2-3 and 39.6% were sensitised to more than three allergens. Almost one-third (29.3%) of patients suffered from food-induced anaphylaxis, of which 85.4% were prescribed self-injectable adrenaline. Conclusion To the best of the authors' knowledge, this study is the first to describe food allergen sensitisation patterns among Omani patients with allergic manifestations. In conjunction with clinical symptoms, the correct interpretation of specific IgE levels is important to diagnose food allergies and make safe decisions about reintroducing foods.
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Affiliation(s)
- Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Mahmood Al-Kindi
- Department of Microbiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Jalila Alshekaili
- Department of Microbiology, Sultan Qaboos University Hospital, Muscat, Oman
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15
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Tham EH, Lee BW, Chan YH, Loo EXL, Toh JY, Goh A, Teoh OH, Yap F, Tan KH, Godfrey KM, Chong MFF, Van Bever HPS, Chong YS, Shek LPC. Low Food Allergy Prevalence Despite Delayed Introduction of Allergenic Foods-Data from the GUSTO Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:466-475.e1. [PMID: 28734861 DOI: 10.1016/j.jaip.2017.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/18/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is mounting evidence that early introduction of allergenic food decreases the risk of food allergy development, especially in high-risk infants with eczema. However, there is a lack of data to suggest whether this association holds true in Asian populations. OBJECTIVE To investigate the relationship between the timing of introduction of allergenic foods and food allergy outcomes in infants in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. METHODS The GUSTO cohort recruited 1152 mothers of Chinese, Malay, and Indian ethnicity who had singleton, naturally conceived pregnancies and followed their offspring prospectively. Information on demographic characteristics, child health, infant feeding practices, and a convincing history of IgE-mediated food allergy was obtained from interviewer-administered questionnaires at multiple time points. Corroborative skin prick tests to food allergens were performed at 18 and 36 months. RESULTS Most of the infants were introduced to egg (49.6%), peanut (88.7%), and shellfish (90.2%) after age 10 months. Food allergy prevalence was, however, very low between age 12 and 48 months: egg, 0.35% to 1.8%; peanut allergy, 0.1% to 0.3%; and shellfish, 0.2% to 0.9%. There were no significant associations between the timing of introduction of allergenic foods and the development of food allergy, adjusted for confounders including breast-feeding and eczema. CONCLUSIONS Food allergy rates in Singapore are low despite delayed introduction of allergenic foods. Early introduction of allergenic foods may thus not be necessary in populations in which overall food allergy prevalence is low, and thus infant feeding recommendations should be carefully tailored to individual populations.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Respiratory Service Medicine, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Fabian Yap
- Department of Endocrinology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Keith M Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Mary Foong Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Hugo P S Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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16
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Vahdaninia M, Mackenzie H, Helps S, Dean T. Prenatal Intake of Vitamins and Allergic Outcomes in the Offspring: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:771-778.e5. [PMID: 27888033 DOI: 10.1016/j.jaip.2016.09.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Allergic diseases have seen a rise worldwide, with children suffering the highest burden. Thus, early prevention of allergic diseases is a public health priority. OBJECTIVE To synthesize the evidence from randomized controlled trials (RCTs) assessing the effect of vitamin interventions during pregnancy on developing allergic diseases in offspring. METHODS We searched CENTRAL, MEDLINE, SCOPUS, World Health Organization's International Clinical Trials Registration, E-theses, and Web of Science. Study quality was evaluated using Cochrane's risk of bias tool. Included RCTs had a minimum of 1-month follow-up postgestation. RESULTS A total of 5 RCTs met the inclusion criteria, including 2456 children who used vitamins C + E (1 study), vitamin C (1 study), and vitamin D (3 studies) compared with placebo/control. Two studies were judged to have a high risk of bias for performance bias or a high rate of loss to follow-up. All were rated as low risk of bias for blinding of outcome assessment. We did not perform meta-analysis with vitamin C or vitamin C + E studies due to high heterogeneity between the 2 included studies. However, we did conduct a meta-analysis with trials on vitamin D (including 1493 children) and the results showed an association between the prenatal intake of vitamin D and the risk of developing recurrent wheeze in offspring (relative risk (RR), 0.812; 95% CI, 0.67-0.98). CONCLUSIONS The current evidence suggests that prenatal supplementation of vitamin D might have a beneficial effect on recurrent wheezing in children. Longer-term follow-up of these studies is needed to ascertain whether this observed effect is sustained. There is lack of evidence on the effect of other vitamins for the prevention of respiratory and/or allergic outcomes.
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Affiliation(s)
- Mariam Vahdaninia
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Heather Mackenzie
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Suzannah Helps
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Taraneh Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom; Research, Enterprise, and Social Partnership, University of Brighton, Brighton, United Kingdom.
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Abstract
BACKGROUND A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. FOR THE OFFSPRING Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. FOR THE MOTHER Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. CONCLUSIONS Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus.
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Affiliation(s)
- Richard I. Lowensohn
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
| | - Diane D. Stadler
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
| | - Christie Naze
- *Adjunct Associate Professor, Obstetrics & Gynecology and Medical Informatics & Clinical Epidemiology, †Assistant Professor of Medicine, and ‡Clinical Dietitian Specialist, Center for Women’s Health, Oregon Health & Science University, Portland, OR
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18
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McGowan EC, Peng R, Salo PM, Zeldin DC, Keet CA. Changes in Food-Specific IgE Over Time in the National Health and Nutrition Examination Survey (NHANES). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:713-20. [PMID: 27133095 PMCID: PMC4939113 DOI: 10.1016/j.jaip.2016.01.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/06/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Food allergy prevalence appears to have recently risen, with larger increases among non-Hispanic blacks. However, it is unclear whether these trends represent shifts in recognition of food allergy or in sensitization. OBJECTIVE The objective of this study was to determine whether sensitization to common food allergens increased in US children from 1988-1994 to 2005-2006 and whether these trends differed by race and/or ethnicity. METHODS Food-specific immunoglobulin E (IgE; to peanut, milk, egg, and shrimp) was measured by ImmunoCAP in stored sera from subjects aged 6-19 in the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and was compared with NHANES 2005-2006. Sensitization to foods was defined as overall (IgE ≥ 0.35 kU/L), moderate level (IgE ≥ 2 kU/L), and high level (IgE ≥ commonly used 95% predictive values). Sensitization to individual and combined foods was compared between surveys, with analyses further stratified by race and/or ethnicity. RESULTS A total of 7896 subjects (NHANES III: n = 4995, NHANES 2005-2006: n = 2901) were included. In NHANES III, the prevalence of food sensitization was 24.3% (95% confidence interval [CI]: 22.1-26.5) compared with 21.6% (95% CI: 19.5-23.7) in NHANES 2005-2006. There were no significant changes in the prevalence of any level of milk, egg, or peanut sensitization, but shrimp sensitization at all levels decreased markedly; overall sensitization NHANES III: 11.2% (95% CI: 10.0-12.5) versus NHANES 2005-2006: 6.1% (95% CI: 4.5-7.7). There was a trend toward the increased prevalence of moderate- and high-level sensitization to the combination of milk, egg, and peanut among non-Hispanic blacks but not other groups. CONCLUSIONS In contrast to our expectations, sensitization to common food allergens did not increase between the late 1980s/early 1990s and the mid-2000s among US 6-19 year olds, and in fact decreased to shrimp.
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Affiliation(s)
- Emily C. McGowan
- Johns Hopkins University School of Medicine, Division of Allergy and Clinical Immunology, and Graduate Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Roger Peng
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD
| | - Päivi M. Salo
- The Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Darryl C. Zeldin
- The Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Corinne A. Keet
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology
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Early life nutrition and the opportunity to influence long-term health: an Australasian perspective. J Dev Orig Health Dis 2016; 7:440-448. [PMID: 26810498 DOI: 10.1017/s2040174415007989] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are now significant data to support the hypothesis that early life nutrition in the fetus, infant and young child can have profound effects on long-term health. This review considers some of this evidence with specific reference to the current burden of disease in Australia and New Zealand. As the findings of further research become available, recommendations on optimizing early life nutrition should be formulated and made widely available as part of the preventative health policy agenda in both Australia and New Zealand.
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20
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Abstract
OBJECTIVE To review the evidence for the association of breast feeding, breastfeeding duration or the timing of gluten introduction and the later development of celiac disease (CD). DESIGN Systematic review. METHODS We searched MEDLINE, via PubMed, EMBASE and Web of Science, for studies published up to 31 August 2015 investigating the association of breastfeeding duration, breast feeding at the moment of gluten introduction or the timing of gluten introduction and the later development of CD. Prospective studies had to enrol infants/children at high risk of CD. For retrospective studies, participants had to be children or adults with CD. The paper quality was assessed by means of a GRADE score and the bias risk was assessed by the Newcastle-Ottawa Scale (for observational cohort studies) and Cochrane Collaboration's tool (for randomised trials). RESULTS Out of 149 retrieved papers, 48 were considered in depth and 16 were included in this review (9 were prospective and 2 were interventional). We found that neither duration of breastfeeding nor breastfeeding at time of gluten introduction nor the delayed introduction of gluten during weaning were effective in preventing later development of CD. CONCLUSIONS Currently, there is no evidence on the optimal breastfeeding duration or the effects of avoiding early (<4 months of age) or late (≥ 6 or even at 12 months) gluten introduction in children at risk of CD. Accordingly, no specific general recommendations about gluten introduction or optimal breastfeeding duration can be presently provided on evidence-based criteria in order to prevent CD.
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Affiliation(s)
- Marco Silano
- Unit of Human Nutrition and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Carlo Agostoni
- Pediatric Clinic, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Yolanda Sanz
- Department of Microbial Ecology, Nutrition & Health Research Group, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Valencia, Spain
| | - Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
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Schäfer T. Primär- und Sekundärprävention. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cepeda AM, Del Giacco SR, Villalba S, Tapias E, Jaller R, Segura AM, Reyes G, Potts J, Garcia-Larsen V. A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children. Nutrients 2015; 7:5098-110. [PMID: 26121530 PMCID: PMC4516989 DOI: 10.3390/nu7075098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/04/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Diet might influence the risk of allergic diseases. Evidence from developing countries with high prevalence of childhood asthma is scant. Methods: Information on wheeze, rhinitis, and eczema was collected from 3209 children aged 6–7 years in 2005, who were taking part in the International Study on Asthma and Allergy in Children (ISAAC) in Colombia. Intake frequency of twelve food groups was assessed. Associations between each food group and current wheeze, rhino-conjunctivitis, and eczema were investigated with multiple logistic regressions, adjusting for potential confounders. Simes’ procedure was used to test for multiple comparisons. Results: 14.9% of children reported wheeze in the last 12 months, 16% rhino-conjunctivitis, and 22% eczema. Eczema was negatively associated with consumption of fresh fruits and pulses three or more times per week (adjusted Odds ratio (aOR): 0.64; 95% Confidence Interval (CI): 0.49 to 0.83; p value = 0.004; and aOR: 0.62, 95% CI: 0.47 to 0.80; p value < 0.001, respectively). Current wheeze was negatively associated with intake of potatoes (aOR: 0.44, 95% CI: 0.31 to 0.62, p value = 0.005), whilst this outcome was positively associated with consumption of fast food (aOR: 1.76, 95% CI: 1.32 to 2.35, p value = 0.001). These associations remained statistically significant after controlling for multiple comparisons. Conclusions: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk.
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Affiliation(s)
- Alfonso M Cepeda
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | | | - Sara Villalba
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | - Elmy Tapias
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | - Rodolfo Jaller
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | - Ana María Segura
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | - Gloria Reyes
- Fundación Hospital Universitario Metropolitano de Barranquilla, Barranquilla KRA 42F No. 75B-18, Colombia.
| | - James Potts
- Respiratory Epidemiology and Public Health Group, National Heart & Lung Institute, Imperial College London, London SW3 6LR, UK.
| | - Vanessa Garcia-Larsen
- Respiratory Epidemiology and Public Health Group, National Heart & Lung Institute, Imperial College London, London SW3 6LR, UK.
- Royal Brompton Hospital and Harefield NHS Foundation Trust, London SW3 6NP, UK.
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Schäfer T, Bauer CP, Beyer K, Bufe A, Friedrichs F, Gieler U, Gronke G, Hamelmann E, Hellermann M, Kleinheinz A, Klimek L, Koletzko S, Kopp M, Lau S, Müsken H, Reese I, Schmidt S, Schnadt S, Sitter H, Strömer K, Vagts J, Vogelberg C, Wahn U, Werfel T, Worm M, Muche-Borowski C. S3-Guideline on allergy prevention: 2014 update: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Society for Pediatric and Adolescent Medicine (DGKJ). ACTA ACUST UNITED AC 2014; 23:186-199. [PMID: 26120530 PMCID: PMC4479452 DOI: 10.1007/s40629-014-0022-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The continued high prevalence of allergic diseases in Western industrialized nations combined with the limited options for causal therapy make evidence-based primary prevention necessary. The recommendations last published in the S3-guideline on allergy prevention in 2009 have been revised and a consensus reached on the basis of an up-to-date systematic literature search. Evidence was sought for the period between May 2008 and May 2013 in the Cochrane and MEDLINE electronic databases, as well as in the reference lists of recent review articles. In addition, experts were surveyed for their opinions. The relevance of retrieved literature was checked by means of two filter processes: firstly according to title and abstract, and secondly based on the full text of the articles. Included studies were given an evidence grade, and a bias potential (low/high) was specified for study quality. A formal consensus on the revised recommendations was reached by representatives of the relevant specialist societies and (self-help) organizations (nominal group process). Of 3,284 hits, 165 studies (one meta-analysis, 15 systematic reviews, 31 randomized controlled trials, 65 cohort studies, 12 case-control studies and 41 cross-sectional studies) were included and evaluated. Recommendations on the following remain largely unaltered: full breastfeeding for 4 months as a means of allergy prevention (hypoallergenic infant formula in the case of infants at risk); avoidance of overweight; fish consumption (during pregnancy/lactation and in the introduction of solid foods for infants); vaccination according to the recommendations of the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO); avoidance of air pollutants and tobacco exposure and avoidance of indoor conditions conducive to the development of mold. The assertion that a reduction in house-dust mite allergen content as a primary preventive measure is not recommended also remains unchanged. The introduction of solid foods into infant diet should not be delayed. In the case of children at risk cats should not be acquired as domestic pets. Keeping dogs is not associated with an increased risk of allergy. The updated guideline includes a new recommendation to consider the increased risk of asthma following delivery by cesarean section. Additional statements have been formulated on pre- and probiotic agents, psychosocial factors, medications, and various nutritional components. Revising the guideline by using an extensive evidence base has resulted not only in an endorsement of the existing recommendations, but also in modifications and in the addition of new recommendations. The updated guideline enables evidence-based and up-to-date recommendations to be made on allergy prevention.
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Affiliation(s)
| | | | - Kirsten Beyer
- Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany
| | - Albrecht Bufe
- Department of Experimental Pneumology, Ruhr University Bochum, Bochum, Germany
| | | | - Uwe Gieler
- Dermatological Clinic, Gießen and Marburg University Clinic, Gießen site, Gießen, Germany
| | | | - Eckard Hamelmann
- Clinic for Pediatric Medicine, Ruhr University Bochum, Bochum, Germany
| | | | | | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Sibylle Koletzko
- Dr. von Haunersches Children's Hospital, Pediatric Clinic and Pediatric Polyclinic of the Ludwig Maximilian University, Munich, Germany
| | - Matthias Kopp
- Clinic for Pediatric Medicine, Schleswig-Holstein University Clinic, Lübeck Campus, Lübeck, Germany
| | - Susanne Lau
- Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany
| | | | - Imke Reese
- Nutrition Counseling and Therapy with Special Focus on Allergology, Munich, Germany
| | | | - Sabine Schnadt
- German Allergy and Asthma Association, Monchengladbach, Germany
| | - Helmut Sitter
- Institute for Theoretical Surgery, Marburg University, Marburg, Germany
| | - Klaus Strömer
- Professional Association of German Dermatologists, Mönchengladbach, Germany
| | - Jennifer Vagts
- Dermatological Center, Elbe Clinics Stade/Buxtehude, Buxtehude, Germany
| | - Christian Vogelberg
- Clinic and Polyclinic for Pediatric Medicine, Carl Gustav Carus University Clinic, Dresden, Germany
| | - Ulrich Wahn
- Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany
| | - Thomas Werfel
- Clinic and Polyclinic for Dermatology and Venereology, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Charité Allergy Center, Clinic for Dermatology, Venereology, and Allergology, Charité University Hospital, Charité Campus Mitte, Berlin, Germany
| | - Cathleen Muche-Borowski
- German Association of the Scientific Medical Societies, Marburg, Germany ; Institute for General Medicine, Hamburg-Eppendorf University Clinic, Germany, Germany
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Food Allergy and the Oral Immunotherapy Approach. Arch Immunol Ther Exp (Warsz) 2014; 63:31-9. [DOI: 10.1007/s00005-014-0304-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/15/2014] [Indexed: 12/17/2022]
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Heinrich J, Koletzko B, Koletzko S. Timing and diversity of complementary food introduction for prevention of allergic diseases. How early and how much? Expert Rev Clin Immunol 2014; 10:701-4. [DOI: 10.1586/1744666x.2014.917049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Silva D, Geromi M, Halken S, Host A, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Cardona V, Dubois AEJ, Poulsen LK, Van Ree R, Vlieg-Boerstra B, Agache I, Grimshaw K, O'Mahony L, Venter C, Arshad SH, Sheikh A. Primary prevention of food allergy in children and adults: systematic review. Allergy 2014; 69:581-9. [PMID: 24433563 DOI: 10.1111/all.12334] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food allergies can have serious physical, social, and financial consequences. This systematic review examined ways to prevent the development of food allergy in children and adults. METHODS Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after studies, interrupted time series studies, and prospective cohort studies. Experts were consulted for additional studies. There were no language or geographic restrictions. Two reviewers appraised the studies using appropriate tools. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesized. RESULTS Seventy-four studies were included, one-third of which were of high quality. There was no good evidence to recommend that pregnant or breastfeeding women should change their diet or take supplements to prevent allergies in infants at high or normal risk. There were mixed findings about the preventive benefits of breastfeeding for infants at high or normal risk, but there was evidence to recommend avoiding cow's milk and substituting with extensively or partially hydrolyzed whey or casein formulas for infants at high risk for the first 4 months. Soy milk and delaying the introduction of solid foods beyond 4 months did not have preventive benefits in those at high or normal risk. There was very little evidence about strategies for preventing food allergy in older children or adults. CONCLUSIONS There is much to learn about preventing food allergy, and this is a priority given the high societal and healthcare costs involved.
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Affiliation(s)
| | | | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - A. Host
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - S. S. Panesar
- Primary Care Research & Development; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment; University of Padua; Padua Italy
| | - T. Werfel
- Hanover Medical School; Hanover Germany
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | | | - A. E. J. Dubois
- Division of Paediatric Pulmonology and Paediatric Allergy; Department of Paediatrics; University Medical; Centre Groningen; University of Groningen; RB Groningen the Netherlands
| | - L. K. Poulsen
- Allergy Clinic; Laboratory of Medical Allergology; Copenhagen University Hospital; Hellerup Denmark
| | - R. Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. Vlieg-Boerstra
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam the Netherlands
| | - I. Agache
- Transylvania University; Brasov Romania
| | - K. Grimshaw
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - L. O'Mahony
- Swiss Institute of Allergy and Asthma Research; University of Zurich; Davos Platz Switzerland
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
| | - S. H. Arshad
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
| | - A. Sheikh
- Primary Care Research & Development; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
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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.
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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
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Niinivirta K, Isolauri E, Nermes M, Laitinen K. Timing of complementary feeding and the risk of atopic eczema. Acta Paediatr 2014; 103:168-73. [PMID: 24117686 DOI: 10.1111/apa.12458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/15/2013] [Accepted: 10/07/2013] [Indexed: 12/01/2022]
Abstract
AIM To find out whether there was an association between when complementary feeding was introduced and the appearance of atopic eczema in children with a family history of allergy. METHODS This prospective study followed 256 mother and child pairs until the child was four-years-old. Repeated skin prick testing was performed and a clinical diagnosis of eczema made by a physician. The mothers kept a continuous diary about the introduction of complementary feeding. To control the possible reverse causation of delaying complementary food introduction due to presumed child allergy, parental suspicions of allergic reactions were recorded. RESULTS The introduction of cereals and fish after seven-months-of-age was associated with an increased risk of atopic eczema. However, when the parents' suspicions that their child might be exhibiting symptoms of allergic disease were taken into account, this effect was no longer significant. CONCLUSION We found no evidence that the timing of the introduction of complementary feeding increased the risk of atopic eczema in a high-risk cohort, when parental suspicions were taken into account. Therefore, it seems that families with a history of allergy can safely comply with current feeding recommendations, although confirmation in further studies is warranted.
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Affiliation(s)
- Katri Niinivirta
- Department of Clinical Sciences; University of Turku; Turku Finland
- Department of Paediatrics; Turku University Hospital; Turku Finland
- Functional Foods Forum; University of Turku; Turku Finland
| | - Erika Isolauri
- Department of Clinical Sciences; University of Turku; Turku Finland
- Department of Paediatrics; Turku University Hospital; Turku Finland
- Functional Foods Forum; University of Turku; Turku Finland
| | - Merja Nermes
- Department of Clinical Sciences; University of Turku; Turku Finland
- Department of Paediatrics; Turku University Hospital; Turku Finland
| | - Kirsi Laitinen
- Functional Foods Forum; University of Turku; Turku Finland
- Institute of Biomedicine; University of Turku; Turku Finland
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Timing of introduction of solid food and risk of allergic disease development: understanding the evidence. Allergol Immunopathol (Madr) 2013; 41:337-45. [PMID: 23287585 DOI: 10.1016/j.aller.2012.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/28/2012] [Indexed: 01/09/2023]
Abstract
Strategies to prevent or reduce the risk of allergic diseases are needed. The time of exclusive breastfeeding and introduction of solid foods is a key factor that may influence the development of allergy. For this reason, the aim of this review was to examine the association between exposure to solid foods in the infant's diet and the development of allergic diseases in children. Classical prophylactic feeding guidelines recommended a delayed introduction of solids for the prevention of atopic diseases. Is it really true that a delayed introduction of solids (after the 4th or 6th month) is protective against the development of eczema, asthma, allergic rhinitis and food or inhalant sensitisation? In recent years, many authors have found that there is no statistically significant association between delayed introduction of solids and protection for the development of allergic diseases. Furthermore, late introduction of solid foods could be associated with increased risk of allergic sensitisation to foods, inhalant allergens and celiac disease in children. Tolerance may be driven by the contact of the mucosal immune system with the allergen at the right time of life; the protective effects seem to be enhanced by the practice of the breastfeeding at the same time when weaning is started. Therefore, recent guidelines propose a "window" approach for weaning practice starting at the 17th week and introducing almost all foods within the 27th week of life to reduce the risk of chronic diseases such as allergic ones and the celiac disease. Guidelines emphasize the role of breastfeeding during the weaning practice.
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Ben-Shoshan M, Turnbull E, Clarke A. Food allergy: temporal trends and determinants. Curr Allergy Asthma Rep 2013; 12:346-72. [PMID: 22723032 DOI: 10.1007/s11882-012-0274-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This review summarizes studies discussing temporal trends in the prevalence of food allergy as well as potential factors associated with the development of food allergy. In addition, we will address the potential hypotheses accounting for the apparent increase in food allergy prevalence. Studies suggest increased prevalence of food allergy. However, relatively little is known about its pathogenesis. This review aims to assess temporal trends in the prevalence of food allergy and discuss potential genetic, environmental, and demographic determinants. The search strategy examined the medical literature database MEDLINE (using PubMed) for the time period of January 1, 2002 to January 31, 2012. In recent decades, the prevalence of food allergy in general has increased by 0.60 % [95 % confidence interval (CI), 0.59 %-0.61 %] and the prevalence of peanut allergy by 0.027 % (95 % CI, 0.026 %-0.028 %), but it has now likely stabilized in developed countries. Genes, the environment, and demographic characteristics play a role in the pathogenesis of food allergy. Numerous environmental and demographic factors as well as gene-environment interactions may account for this increase in prevalence, but further studies are required to tease out their relative contribution.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
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Lee S, Ahn K, Paik HY, Chung SJ. Serum immunoglobulin E (IgE) levels and dietary intake of Korean infants and young children with atopic dermatitis. Nutr Res Pract 2012. [PMID: 23198022 PMCID: PMC3506874 DOI: 10.4162/nrp.2012.6.5.429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Atopic dermatitis (AD) has become a serious epidemic in Korean children. We aimed to investigate the association between vitamin C, E and other nutrients, and serum total IgE/specific IgE levels in children with AD. A total of 119 children (0-24 mo) diagnosed with AD were recruited for this cross-sectional study from a medical center in Seoul. A 24 h recall was used to assess dietary intakes. Serum total and six food-allergen specific IgE levels were measured by CAP-FEIA. Serum vitamin E was also measured but only in 25 out of the total 119 participants. Multiple linear regression analysis was performed to estimate the coefficients between serum IgE levels and dietary intake as well as serum vitamin E. Serum vitamin E levels showed a significantly inverse association with serum total IgE and all specific IgE levels (P < 0.05). Fat intake was inversely related with specific-IgEs for egg whites, milk, buck wheat, soy, and peanuts (P < 0.05). Positive associations were found between carbohydrate (CHO) intake and total IgE and specific IgEs to egg whites, milk, soy, and peanuts (P < 0.05). Vitamin C, E and n-3/n-6 fatty acids were not related with serum total IgE and specific IgE levels except for the association between buck wheat and vitamin E. In addition, there were no significant differences between males and females in dietary intake and serum IgE levels by student's t-test. Although dietary vitamin E showed no association with serum IgE levels, serum vitamin E drew a significant inverse relationship with serum IgE levels. The evidence seems to suggest that vitamin E may possibly lower total and specific-IgEs in children with AD, and that it is important to maintain a relatively high serum vitamin E level in children with AD.
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Affiliation(s)
- Sangeun Lee
- Department of Foods and Nutrition, Kookmin University, 861-1, Jeongneung-dong, Seongbuk-gu, Seoul 136-702, Korea. ; Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea
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Different implications of paternal and maternal atopy for perinatal IgE production and asthma development. Clin Dev Immunol 2012; 2012:132142. [PMID: 22272211 PMCID: PMC3261469 DOI: 10.1155/2012/132142] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/03/2011] [Indexed: 12/16/2022]
Abstract
Asthma is a hereditary disease associated with IgE-mediated reaction. Whether maternal atopy and paternal atopy have different impacts on perinatal IgE production and asthma development remains unclear. This paper reviews and summarizes the effects of maternal and paternal atopy on the developmental aspects of IgE production and asthma. Maternal atopy affects both pre- and postnatal IgE production, whereas paternal atopy mainly affects the latter. Maternally transmitted genes GSTP1 and FceRI-beta are associated with lung function and allergic sensitization, respectively. In IgE production and asthma development, the maternal influence on gene-environment interaction is greater than paternal influence. Maternal, paternal, and/or postnatal environmental modulation of allergic responses have been linked to epigenetic mechanisms, which may be good targets for early prevention of asthma.
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