Food Allergy Prevention: Early Versus Late Introduction of Food Allergens in Children

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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Food allergy: is a disease or condition? The concept of coexistence human and food allergens

Shidnoevropejskij zurnal vnutrisnoi ta simejnoi medicini ◽

10.15407/internalmed2016.02.020 ◽

2016 ◽

Vol 2016 (2) ◽

pp. 20-27

Author(s):

L.M. Pasiyeshvili ◽

◽

N.M. Zheleznyakova ◽

T.M. Pasiyeshvili ◽

◽

...

Keyword(s):

Food Allergy ◽

Food Allergens

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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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A Review on Identified Major Food Allergens: Characteristics and Role in Food Allergy

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2017.54.3.11626 ◽

2017 ◽

Vol 54 (3) ◽

pp. 346

Author(s):

Chhavi Arya ◽

Chetna Jantwal

Keyword(s):

Food Allergy ◽

Food Allergies ◽

Allergic Reactions ◽

Food Allergens ◽

Food Groups ◽

Consumer Protection Act ◽

Major Food ◽

Life Threatening ◽

Major Allergens ◽

Allergen Labeling

Food allergens are the substances present in food that cause food allergy. Human body reactions to food allergens range from mild to severe life threatening anaphylactic shock. At least seventy different foods have been reported to cause allergic reactions and several other foods have been identified which have the potential to provoke allergic reactions. Majority of the identified food allergens are proteins. The Food Allergen Labeling and Consumer Protection Act (FALCPA) identifies eight major food groups i.e. milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans as major allergy causing foods. These eight foods are believed to account for 90 per cent of food allergies and are responsible for most serious reactions to foods. Several studies have been done which identify the major allergens in various foods. The present paper attempts to review the major allergens present in various food.

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Common food allergens and cross-reactivity

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200020 ◽

2020 ◽

Vol 2 (1) ◽

pp. 17-21

Author(s):

Olivia L. Francis ◽

Kathleen Y. Wang ◽

Edwin H. Kim ◽

Timothy P. Moran

Keyword(s):

Food Allergy ◽

Protein Stability ◽

Cross Reactivity ◽

Molecular Characteristics ◽

Food Allergens ◽

Tree Nuts ◽

Heat Stable ◽

Systemic Reactions ◽

Hen’S Egg ◽

Fish And Shellfish

The most clinically relevant food allergens are cow’s milk, hen’s egg, peanut, tree nuts, wheat, soy, fish, shellfish, and seeds. Heat-stable food allergens have molecular characteristics that enhance protein stability and gastrointestinal absorption and thus are more likely to cause systemic reactions on ingestion. In contrast, heat-labile food allergens lack these characteristics and do not typically elicit reactions if sufficiently altered by heat or acid. Immunologic cross-sensitization between food allergens is more common than clinical cross-reactivity. However, certain groups of food allergens, such as tree nuts, fish, and shellfish, are associated with high rates of clinical cross-reactivity. Knowing the rates of clinical cross-reactivity is important when providing guidance to patients with food allergy and families on what foods can be safely added to the diet and what foods should be avoided.

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Determination of allergenicity of different food allergens in a rat model of food allergy

Journal of Allergy and Clinical Immunology ◽

10.1016/s0091-6749(03)80893-x ◽

2003 ◽

Vol 111 (2) ◽

pp. S251

Author(s):

B. Ahrens ◽

D. Quarcoo ◽

A. Meeuw ◽

J. Zagon ◽

G. Reese ◽

...

Keyword(s):

Food Allergy ◽

Rat Model ◽

Food Allergens

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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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