Removing risk stratification in food allergy prevention guidelines

Background: Food allergies are common, affecting 1 in 13 school children in the United States and their prevalence is increasing. Many misconceptions exist with regards to food allergy prevention, diagnosis and management. Objective: The main objective of this review is to address misconceptions with regards to food allergies and discuss the optimal, evidence-based approach for patients who carry this diagnosis. Observations: Common misconceptions in terms of food allergy prevention include beliefs that breastfeeding and delayed introduction of allergenic foods prevent the development of food allergies. In terms of diagnosis, statements such as ‘larger skin prick tests or/and higher levels of food-specific IgE can predict the severity of food-induced allergic reactions’, or ‘Tryptase is always elevated in food-induced anaphylaxis’ are inaccurate. Additionally, egg allergy is not a contraindication for receiving the influenza vaccine, food-allergy related fatalities are rare and peanut oral immunotherapy, despite reported benefits, is not a cure for food allergies. Finally, not all infants with eczema will develop food allergies and epinephrine auto-injectors may unfortunately be both unavailable and underused in food-triggered anaphylaxis. Conclusions and relevance: Healthcare professionals must be familiar with recent evidence in the food allergy field and avoid common misunderstandings that may negatively affect prevention, diagnosis and management of this chronic disease.

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Early Solid Food Introduction: Role in Food Allergy Prevention and Implications for Breastfeeding

The Journal of Pediatrics ◽

10.1016/j.jpeds.2017.01.053 ◽

2017 ◽

Vol 184 ◽

pp. 13-18 ◽

Cited By ~ 18

Author(s):

Elissa M. Abrams ◽

Matthew Greenhawt ◽

David M. Fleischer ◽

Edmond S. Chan

Keyword(s):

Food Allergy ◽

Solid Food ◽

Allergy Prevention ◽

Solid Food Introduction

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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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Translating Science Into Meaningful Strategies That Improve Quality Of Life In Food Allergy: An Investigation Of Defined Thresholds And Risk Stratification In Consumers, Clinicians And Food Producers

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2011.12.252 ◽

2012 ◽

Vol 129 (2) ◽

pp. AB184

Author(s):

A. DunnGalvin ◽

J.O.B. Hourihane ◽

S. Taylor

Keyword(s):

Quality Of Life ◽

Food Allergy ◽

Risk Stratification ◽

Improve Quality

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Food Allergy Prevention and Treatment by Targeted Nutrition

Annals of Nutrition and Metabolism ◽

10.1159/000487380 ◽

2018 ◽

Vol 72 (Suppl. 3) ◽

pp. 33-45 ◽

Cited By ~ 8

Author(s):

Ralf G. Heine

Keyword(s):

Vitamin D ◽

Food Allergy ◽

Food Allergen ◽

Population Level ◽

Food Allergies ◽

Allergy Prevention ◽

Prevention Strategies ◽

Allergen Avoidance ◽

Effective Prevention ◽

Young Infants

In view of the dramatic rise in the prevalence of food allergy globally, effective prevention strategies have become a public health priority. Several models have emerged around the etiology of food allergy, including the hygiene hypothesis, dual allergen exposure hypothesis, and vitamin D hypothesis. These form the basis for current and potential prevention strategies. Breastfeeding remains a key pillar of primary allergy prevention. Other nutritional interventions, including the use of whey-based, partially hydrolyzed formula in non-breastfed infants, also play an important role. In recent years, there has been a shift away from prolonged food allergen avoidance to the proactive allergen introduction from 4 months of age. This approach is supported by 2 pivotal randomized clinical trials showing that the early introduction of peanut and other food allergens significantly reduces the risk of food allergy. However, the implementation of this strategy at the population level still raises significant logistic problems, including patient selection and development of suitable food formats for young infants. Other prevention strategies, including vitamin D supplementation, are currently under evaluation. Maternal elimination diets during pregnancy and lactation are not recommended for allergy prevention. The treatment of food allergies has also seen major transformations. While strict allergen avoidance is still the key treatment principle, there is a greater focus on desensitization and tolerance induction by oral and epicutaneous immunotherapy. In addition, specialized hypoallergenic infant formulas for the treatment of infants with cow’s milk allergy have undergone reformulation, including the addition of lactose and probiotics in order to modulate the gut microbiome and early immune responses. Further research is needed to inform the most effective food allergy prevention strategies at the population level. In addition, the wider application of food allergen immunotherapy may provide better health outcomes and improved quality of life for families affected by food allergies.

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