Introduction of Complementary Foods to Infants

While earlier food allergy prevention strategies implemented avoidance of allergenic foods in infancy, the current paradigm is shifting from avoidance to controlled exposure. This review focuses on the outcome of recent randomized controlled trials, which have examined the early introduction of allergenic foods for allergy prevention, and discusses the implementation of results in clinical practice. In infants at high risk of allergic disease, there is now direct evidence that regular early peanut consumption will reduce the prevalence of peanut allergy, compared to avoidance. Many international infant feeding guidelines already recommend complementary foods, including allergenic foods, to be introduced from 4 to 6 months of age irrespective of family history risk. Interim guidelines from 10 International Pediatric Allergy Associations state that healthcare providers should recommend the introduction of peanut-containing products into the diets of infants at high risk of allergic disease in countries where peanut allergy is prevalent. Direct translation of the results obtained from a cohort of high-risk infants to the general population has proved difficult, and issues regarding feasibility, safety, and cost-effectiveness have been raised. Five randomized placebo-controlled trials have assessed the effects of early egg exposure in infancy with varying results. In a recent comprehensive meta-analysis, there was moderate-certainty evidence that early versus late introduction of egg was associated with a reduced egg allergy risk. Although promising, optimal timing, doses, and if the feeding regimen should be stratified according to infant allergy risk remain to be determined. The single study that assessed introduction of multiple foods from 3 months whilst breastfeeding compared with exclusive breastfeeding until 6 months of age showed no reduction in food allergy prevalence. Future research should aim at optimizing infant feeding regimens and support a tolerogenic gastrointestinal microenvironment during the period of food allergen introduction.

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Probiotics for allergy prevention

Beneficial Microbes ◽

10.3920/bm2015.0073 ◽

2016 ◽

Vol 7 (2) ◽

pp. 171-179 ◽

Cited By ~ 13

Author(s):

C.E. West

Keyword(s):

High Risk ◽

Allergic Disease ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Allergy Prevention ◽

Level Of Evidence ◽

Familial Predisposition ◽

Randomised Controlled

Probiotics, given either as a supplement or in infant foods, have been evaluated in randomised controlled trials for allergy prevention. Here, the aim is to give an overview of the results from these primary prevention studies and to discuss current strategies. In most studies, single strains or a mixture of strains of lactic acid bacteria and bifidobacteria have been used – prenatally, postnatally or perinatally. Several meta-analyses have reported a moderate benefit of probiotics for eczema prevention, and the most consistent effect has been observed with a combined perinatal intervention in infants at high risk of allergic disease due to familial predisposition. In a recent meta-analysis, the use of multi-strain probiotics appeared to be most effective for eczema prevention. No preventive effect has been shown for other allergic manifestations. As long-term follow-up data on later onset allergic conditions (asthma and allergic rhinitis) are available only from a few of the initiated studies, reports from ongoing follow-up studies that are adequately powered to examine long-term outcomes are anticipated to provide more insight. Arguably, the differences in many aspects of study design and the use of different probiotic strains and combinations have made direct comparison difficult. To date, expert bodies do not generally recommend probiotics for allergy prevention, although the World Allergy Organization (WAO) in their recently developed guidelines suggests considering using probiotics in pregnant women, during breastfeeding and/or to the infant if at high risk of developing allergic disease (based on heredity). However, in concordance with other expert bodies, the WAO guideline panel stressed the low level of evidence and the need for adequately powered randomised controlled trials and a more standardised approach before clinical recommendations on specific strains, dosages and timing can be given.

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Food allergy prevention, including early food introduction

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200007 ◽

2020 ◽

Vol 2 (1) ◽

pp. 69-74

Author(s):

Stephanie A. Leonard

Keyword(s):

Vitamin D ◽

Food Allergy ◽

Infant Feeding ◽

Peanut Allergy ◽

Diet Composition ◽

Immunoglobulin E ◽

Allergy Prevention ◽

Early Interventions ◽

Infant Feeding Practices ◽

Ige Mediated

As the prevalence of immunoglobulin E (IgE)-mediated food allergy continues to increase without an imminent cure, prevention has become an urgent need. A breakthrough study that shows that early consumption of peanut can prevent the development of peanut allergy has led for a push in early interventions. Theories associated with the increasing prevalence of food allergy lend themselves to areas of potential intervention, e.g., age at time of food introduction, infant feeding practices, microbiome influences, diet composition, vitamin D deficiency, and increasing rates of eczema. This review focused on the available data from studies that investigated early interventions to decrease the risk of food allergy.

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The Role of Hydrolyzed Formula in Allergy Prevention

Annals of Nutrition and Metabolism ◽

10.1159/000460269 ◽

2017 ◽

Vol 70 (Suppl. 2) ◽

pp. 38-45 ◽

Cited By ~ 11

Author(s):

Michael D. Cabana

Keyword(s):

Allergic Rhinitis ◽

Food Allergy ◽

Infant Formula ◽

Allergic Disease ◽

Clinical Studies ◽

Atopic Disease ◽

Allergy Prevention ◽

Preventive Effect ◽

History Of ◽

Hydrolyzed Formula

Asthma, eczema, food allergy, and allergic rhinitis are some of the most common pediatric, chronic conditions in the world. Breastfeeding is the optimal way to feed all infants. For those infants who are exposed to infant formula, some studies suggest that certain partially hydrolyzed or extensively hydrolyzed formulas may decrease the risk of allergic disease compared to nonhydrolyzed formulas for children with a family history of atopic disease. Overall, there is some evidence to suggest that partially hydrolyzed whey formulas and extensively hydrolyzed casein formulas may decrease the risk of developing eczema for infants at high risk of allergic disease. The evidence for a preventive effect of hydrolyzed formulas on allergic rhinitis, food allergy, and asthma is inconsistent and insufficient. Finally, the qualitative changes to the peptides by the method of hydrolysis, not just the degree of protein hydrolysis, may have a large influence on the preventive effect of a particular infant formula for the potential risk of allergic disease. As a result, it may be difficult to generalize findings from clinical studies using a specific infant formula to other infant formulas from different manufacturers using different methods of hydrolysis. Further clinical studies are needed to help clinicians identify which infants may benefit from early intervention, as well as which specific hydrolyzed formulas are best suited to decrease the risk of future allergic disease.

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Improved prospects for food allergy prevention

Journal of Primary Health Care ◽

10.1071/hc17042 ◽

2017 ◽

Vol 9 (4) ◽

pp. 254 ◽

Cited By ~ 1

Author(s):

Rohan Ameratunga

Keyword(s):

Food Allergy ◽

High Risk ◽

Allergy Prevention ◽

Window Of Opportunity ◽

Early Introduction ◽

The World ◽

Food Challenges ◽

High Risk Children

ABSTRACT Three recent publications from Professor Gideon Lack have fundamentally changed our understanding of how to prevent food allergy. His team has shown that early introduction of allergenic foods may prevent food allergy in most but not all high-risk children. Various allergy and paediatric societies around the world are changing their recommendations based on these three studies. It appears there is a window of opportunity to safely introduce allergenic foods to high-risk children. This has resource implications, as some of these children will need testing and food challenges.

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Dietary exposures and allergy prevention in high-risk infants

Paediatrics & Child Health ◽

10.1093/pch/pxab064 ◽

2021 ◽

Vol 26 (8) ◽

pp. 504-505

Author(s):

Elissa M Abrams ◽

Julia Orkin ◽

Carl Cummings ◽

Becky Blair ◽

Edmond S Chan

Keyword(s):

Food Allergy ◽

High Risk ◽

Food Allergies ◽

Allergy Prevention ◽

Severe Reaction ◽

Omega 3 ◽

Atopic Condition ◽

Specific Formula ◽

High Risk Infants ◽

Hydrolyzed Formula

Abstract Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow’s milk protein formula has been introduced in an infant’s diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early—at around 6 months, but not before 4 months of age—can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.

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Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

The Medical Journal of Australia ◽

10.5694/mja2.50535 ◽

2020 ◽

Vol 212 (6) ◽

pp. 256-257

Author(s):

Rachel L Peters ◽

Kirsten P Perrett

Keyword(s):

Food Allergy ◽

Infant Feeding ◽

Feeding Practices ◽

Allergy Prevention ◽

Infant Feeding Practices

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Maternal late-pregnancy serum unmetabolized folic acid concentrations are not associated with infant allergic disease - A prospective cohort study

10.1101/2020.10.29.20222588 ◽

2020 ◽

Author(s):

Karen P Best ◽

Tim J Green ◽

Dian Sulistyoningrum ◽

Thomas R Sullivan ◽

Susanne Aufreiter ◽

...

Keyword(s):

Food Allergy ◽

Folic Acid ◽

High Risk ◽

Allergic Disease ◽

Disease Risk ◽

Late Pregnancy ◽

Serum Folate ◽

Allergen Sensitization ◽

Disease Outcomes ◽

Ige Mediated

AbstractBackgroundThe increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake.ObjectiveWe aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at one year of age in a population at high risk of allergy.MethodsThe cohort consisted of 561 mother-infant pairs from Western Australia. To be eligible the infant had a first-degree relative (mother, father or sibling) with a history of medically diagnosed allergic disease. Maternal serum was collected between 36 and 40 weeks of gestation. UMFA concentrations were measured by tandem mass spectrometry using stable isotope dilution, folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization and medically diagnosed wheeze were assessed at 1 year of age.ResultsMedian (IQR) for UMFA and serum folate was 1.6 (0.6-4.7) and 53.2 (32.6-74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes.ConclusionIn this cohort of children at high risk for allergic disease there was no association between maternal UMFA or serum folate measured in late pregnancy and allergic disease outcomes at 1 year of age.

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Maternal Late-Pregnancy Serum Unmetabolized Folic Acid Concentrations Are Not Associated with Infant Allergic Disease: A Prospective Cohort Study

Journal of Nutrition ◽

10.1093/jn/nxab040 ◽

2021 ◽

Cited By ~ 1

Author(s):

Karen P Best ◽

Tim J Green ◽

Dian C Sulistyoningrum ◽

Thomas R Sullivan ◽

Susanne Aufreiter ◽

...

Keyword(s):

Food Allergy ◽

Folic Acid ◽

High Risk ◽

Allergic Disease ◽

Late Pregnancy ◽

Serum Folate ◽

Tandem Ms ◽

Microbiological Method ◽

Disease Outcomes ◽

Ige Mediated

ABSTRACT Background The increase in childhood allergic disease in recent decades has coincided with increased folic acid intakes during pregnancy. Circulating unmetabolized folic acid (UMFA) has been proposed as a biomarker of excessive folic acid intake. Objective We aimed to determine if late-pregnancy serum UMFA and total folate concentrations were associated with allergic disease risk in the offspring at 1 y of age in a population at high risk of allergy. Methods The cohort consisted of 561 mother–infant pairs from Western Australia. To be eligible the infant had to have a first-degree relative (mother, father, or sibling) with a history of medically diagnosed allergic disease. Maternal venous blood was collected between 36 and 40 wk of gestation. Serum UMFA was measured by LC–tandem MS. Serum total folate was determined using a microbiological method with chloramphenicol-resistant Lactobacillus rhamnosus as the test organism, and was collected between 36 and 40 wk of gestation. UMFA concentrations were measured by tandem MS using stable isotope dilution; folate concentrations were determined using the microbiological method with standardized kits. Infant allergic disease outcomes of medically diagnosed eczema, steroid-treated eczema, atopic eczema, IgE-mediated food allergy, allergen sensitization, and medically diagnosed wheeze were assessed at 1 y of age. Results Median (IQR) concentrations for UMFA and serum folate were 1.6 (0.6–4.7) and 53.2 (32.6–74.5) nmol/L, respectively. Of the infants, 34.6% had medically diagnosed eczema, 26.4% allergen sensitization, and 14.9% had an IgE-mediated food allergy. In both adjusted and unadjusted models there was little evidence of association between UMFA or serum folate and any of the infant allergy outcomes. Conclusions In this cohort of children at high risk of allergic disease there was no association between maternal UMFA or serum folate concentrations measured in late pregnancy and allergic disease outcomes at 1 y of age.

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