Advertisement

Primary Prevention of Food Allergy

  • Ann Marie Kumfer
  • Scott P. ComminsEmail author
Pediatric Allergy and Immunology (William Dolen, Section Editor)
  • 66 Downloads
Part of the following topical collections:
  1. Topical Collection on Pediatric Allergy and Immunology

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy.

Recent Findings

Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation.

Summary

The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

Keywords

Food allergy Specific IgE Primary prevention of food allergy Childhood food allergy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS Data Brief. 2013;(121):1–8.Google Scholar
  2. 2.
    Schwartz RH. Allergy, intolerance, and other adverse reactions to foods. Pediatr Ann. 1992;21(10):654–5 60-2, 65-74.CrossRefGoogle Scholar
  3. 3.
    Food allergy continues to increase. Child Health Alert. 2010;28:2.Google Scholar
  4. 4.
    Benede S, Blazquez AB, Chiang D, Tordesillas L, Berin MC. The rise of food allergy: environmental factors and emerging treatments. EBioMedicine. 2016;7:27–34.  https://doi.org/10.1016/j.ebiom.2016.04.012.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Nutr Res. 2011;31(1):61–75.  https://doi.org/10.1016/j.nutres.2011.01.001.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunol. 2012;129(4):906–20.  https://doi.org/10.1016/j.jaci.2012.02.001.CrossRefPubMedGoogle Scholar
  7. 7.
    Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol. 2011;127(3):594–602.  https://doi.org/10.1016/j.jaci.2010.11.044.CrossRefPubMedGoogle Scholar
  8. 8.
    Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133(2):291–307; quiz 8.  https://doi.org/10.1016/j.jaci.2013.11.020.CrossRefPubMedGoogle Scholar
  9. 9.
    Atkins D, Bock SA. Fatal anaphylaxis to foods: epidemiology, recognition, and prevention. Curr Allergy Asthma Rep. 2009;9(3):179–85.CrossRefGoogle Scholar
  10. 10.
    Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007;119(4):1016–8.  https://doi.org/10.1016/j.jaci.2006.12.622.CrossRefPubMedGoogle Scholar
  11. 11.
    Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191–3.  https://doi.org/10.1067/mai.2001.112031.CrossRefPubMedGoogle Scholar
  12. 12.
    Savage JH, Limb SL, Brereton NH, Wood RA. The natural history of peanut allergy: extending our knowledge beyond childhood. J Allergy Clin Immunol. 2007;120(3):717–9.  https://doi.org/10.1016/j.jaci.2007.07.027.CrossRefPubMedGoogle Scholar
  13. 13.
    Eichenfield LF, Hanifin JM, Beck LA, Lemanske RF Jr, Sampson HA, Weiss ST, et al. Atopic dermatitis and asthma: parallels in the evolution of treatment. Pediatrics. 2003;111(3):608–16.CrossRefGoogle Scholar
  14. 14.
    • Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803–13.  https://doi.org/10.1056/NEJMoa1414850 Important and frequently referenced LEAP study that demonstrated ‘protection’ from peanut allergy through early introduction of peanut foods to at risk infants. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fleischer DM, Sicherer S, Greenhawt M, Campbell D, Chan E, Muraro A, et al. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. J Allergy Clin Immunol. 2015;136(2):258–61.  https://doi.org/10.1016/j.jaci.2015.06.001.CrossRefPubMedGoogle Scholar
  16. 16.
    Sicherer SH, Wood RA, Stablein D, Burks AW, Liu AH, Jones SM, Fleischer DM, Leung DYM, Grishin A, Mayer L, Shreffler W, Lindblad R, Sampson HA Immunologic features of infants with milk or egg allergy enrolled in an observational study (Consortium of Food Allergy Research) of food allergy. J Allergy Clin Immunol 2010;125(5):1077–1083 e8.  https://doi.org/10.1016/j.jaci.2010.02.038.
  17. 17.
    Rowe J, Kusel M, Holt BJ, Suriyaarachchi D, Serralha M, Hollams E, et al. Prenatal versus postnatal sensitization to environmental allergens in a high-risk birth cohort. J Allergy Clin Immunol. 2007;119(5):1164–73.  https://doi.org/10.1016/j.jaci.2007.02.016.CrossRefPubMedGoogle Scholar
  18. 18.
    Zeiger RS. Food allergen avoidance in the prevention of food allergy in infants and children. Pediatrics. 2003;111(6 Pt 3):1662–71.PubMedGoogle Scholar
  19. 19.
    Burrows M, Assundani D, Celis E, Tufaro F, Tanaka A, Bradley WG. Oral administration of PPC enhances antigen-specific CD8+ T cell responses while reducing IgE levels in sensitized mice. BMC Complement Altern Med. 2009;9:49.  https://doi.org/10.1186/1472-6882-9-49.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pali-Scholl I, Renz H, Jensen-Jarolim E. Update on allergies in pregnancy, lactation, and early childhood. J Allergy Clin Immunol. 2009;123(5):1012–21.  https://doi.org/10.1016/j.jaci.2009.01.045.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Falth-Magnusson K, Kjellman NI. Development of atopic disease in babies whose mothers were receiving exclusion diet during pregnancy--a randomized study. J Allergy Clin Immunol. 1987;80(6):868–75.CrossRefGoogle Scholar
  22. 22.
    Lovegrove JA, Hampton SM, Morgan JB. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study. Br J Nutr. 1994;71(2):223–38.CrossRefGoogle Scholar
  23. 23.
    Lilja G, Dannaeus A, Falth-Magnusson K, Graff-Lonnevig V, Johansson SG, Kjellman NI, et al. Immune response of the atopic woman and foetus: effects of high- and low-dose food allergen intake during late pregnancy. Clin Allergy. 1988;18(2):131–42.CrossRefGoogle Scholar
  24. 24.
    Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. Br Med J (Clin Res Ed). 1986;293(6541):231–3.CrossRefGoogle Scholar
  25. 25.
    Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2012;9:CD000133.  https://doi.org/10.1002/14651858.CD000133.pub3.CrossRefGoogle Scholar
  26. 26.
    American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106(2 Pt 1):346–9.CrossRefGoogle Scholar
  27. 27.
    Host A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999;81(1):80–84.Google Scholar
  28. 28.
    Greer FR, Sicherer SH, Burks AW. American Academy of Pediatrics Committee on N, American Academy of Pediatrics Section on A, Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183–91.  https://doi.org/10.1542/peds.2007-3022.CrossRefPubMedGoogle Scholar
  29. 29.
    Mofidi S. Nutritional management of pediatric food hypersensitivity. Pediatrics. 2003;111(6 Pt 3):1645–53.PubMedGoogle Scholar
  30. 30.
    • Meyer R, De Koker C, Dziubak R, Godwin H, Dominguez-Ortega G, Chebar Lozinsky A, et al. The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies. Clin Transl Allergy. 2016;6:25.  https://doi.org/10.1186/s13601-016-0115-x Interesting study regarding non-IgE immunologic responses to food that showed with appropriate dietary advice growth parameters can be maintained while on hypoallergenic formulas irrespective of the type of elimination diet and the numbers of foods eliminated. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Yepes-Nunez JJ, Fiocchi A, Pawankar R, Cuello-Garcia CA, Zhang Y, Morgano GP, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D. World Allergy Organ J. 2016;9:17.  https://doi.org/10.1186/s40413-016-0108-1.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database Syst Rev. 2015;7:CD010085.  https://doi.org/10.1002/14651858.CD010085.pub2.CrossRefGoogle Scholar
  33. 33.
    Penders J, Thijs C, van den Brandt PA, Kummeling I, Snijders B, Stelma F, et al. Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study. Gut. 2007;56(5):661–7.  https://doi.org/10.1136/gut.2006.100164.CrossRefPubMedGoogle Scholar
  34. 34.
    Forsberg A, West CE, Prescott SL, Jenmalm MC. Pre- and probiotics for allergy prevention: time to revisit recommendations? Clin Exp Allergy. 2016;46(12):1506–21.  https://doi.org/10.1111/cea.12838.CrossRefPubMedGoogle Scholar
  35. 35.
    West CE. Probiotics for allergy prevention. Benef Microbes. 2016;7(2):171–9.  https://doi.org/10.3920/BM2015.0073.CrossRefPubMedGoogle Scholar
  36. 36.
    Osborn DA, Sinn JK. Prebiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev. 2007;4:CD006474.  https://doi.org/10.1002/14651858.CD006474.pub2.CrossRefGoogle Scholar
  37. 37.
    Cuello-Garcia CA, Fiocchi A, Pawankar R, Yepes-Nunez JJ, Morgano GP, Zhang Y, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): prebiotics. World Allergy Organ J. 2016;9:10.  https://doi.org/10.1186/s40413-016-0102-7.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): probiotics. World Allergy Organ J. 2015;8(1):4–13.  https://doi.org/10.1186/s40413-015-0055-2.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    •• Greenhawt MJ, Fleischer DM. Primary prevention of food allergy. Curr Allergy Asthma Rep. 2017;17(4):26.  https://doi.org/10.1007/s11882-017-0692-3 Thoughtful article reflecting data-supported interventions for primary prevention of food allergy with speculation related to potential therapeutic implications. CrossRefPubMedGoogle Scholar
  40. 40.
    Bjorksten B. The epidemiology of food allergy. Curr Opin Allergy Clin Immunol. 2001;1(3):225–7.PubMedGoogle Scholar
  41. 41.
    Rautava S, Collado MC, Salminen S, Isolauri E. Probiotics modulate host-microbe interaction in the placenta and fetal gut: a randomized, double-blind, placebo-controlled trial. Neonatology. 2012;102(3):178–84.  https://doi.org/10.1159/000339182.CrossRefPubMedGoogle Scholar
  42. 42.
    Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357(9262):1076–9.  https://doi.org/10.1016/S0140-6736(00)04259-8.CrossRefPubMedGoogle Scholar
  43. 43.
    Abrahamsson TR, Jakobsson T, Bottcher MF, Fredrikson M, Jenmalm MC, Bjorksten B, et al. Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(5):1174–80.  https://doi.org/10.1016/j.jaci.2007.01.007.CrossRefPubMedGoogle Scholar
  44. 44.
    Kukkonen K, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(1):192–8.  https://doi.org/10.1016/j.jaci.2006.09.009.CrossRefPubMedGoogle Scholar
  45. 45.
    Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. 2007;119(1):184–91.  https://doi.org/10.1016/j.jaci.2006.08.036.CrossRefPubMedGoogle Scholar
  46. 46.
    Fiocchi A, Burks W, Bahna SL, Bielory L, Boyle RJ, Cocco R, et al. Clinical use of probiotics in pediatric allergy (CUPPA): a world allergy organization position paper. World Allergy Organ J. 2012;5(11):148–67.  https://doi.org/10.1097/WOX.0b013e3182784ee0.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Donovan SM, Wang M, Li M, Friedberg I, Schwartz SL, Chapkin RS. Host-microbe interactions in the neonatal intestine: role of human milk oligosaccharides. Adv Nutr. 2012;3(3):450S–5S.  https://doi.org/10.3945/an.112.001859.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Haarman M, Knol J. Quantitative real-time PCR analysis of fecal Lactobacillus species in infants receiving a prebiotic infant formula. Appl Environ Microbiol. 2006;72(4):2359–65.  https://doi.org/10.1128/AEM.72.4.2359-2365.2006.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Scholtens PA, Alles MS, Bindels JG, van der Linde EG, Tolboom JJ, Knol J. Bifidogenic effects of solid weaning foods with added prebiotic oligosaccharides: a randomised controlled clinical trial. J Pediatr Gastroenterol Nutr. 2006;42(5):553–9.  https://doi.org/10.1097/01.mpg.0000221887.28877.c7.CrossRefPubMedGoogle Scholar
  50. 50.
    Moro G, Arslanoglu S, Stahl B, Jelinek J, Wahn U, Boehm G. A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age. Arch Dis Child. 2006;91(10):814–9.  https://doi.org/10.1136/adc.2006.098251.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Gruber C, van Stuijvenberg M, Mosca F, Moro G, Chirico G, Braegger CP, et al. Reduced occurrence of early atopic dermatitis because of immunoactive prebiotics among low-atopy-risk infants. J Allergy Clin Immunol. 2010;126(4):791–7.  https://doi.org/10.1016/j.jaci.2010.07.022.CrossRefPubMedGoogle Scholar
  52. 52.
    von Berg A, Koletzko S, Grubl A, Filipiak-Pittroff B, Wichmann HE, Bauer CP, et al. The effect of hydrolyzed cow’s milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol. 2003;111(3):533–40.CrossRefGoogle Scholar
  53. 53.
    von Berg A, Filipiak-Pittroff B, Kramer U, Hoffmann B, Link E, Beckmann C, et al. Allergies in high-risk schoolchildren after early intervention with cow’s milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol. 2013;131(6):1565–73.  https://doi.org/10.1016/j.jaci.2013.01.006.CrossRefGoogle Scholar
  54. 54.
    Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006;4:CD003664.  https://doi.org/10.1002/14651858.CD003664.pub3.CrossRefGoogle Scholar
  55. 55.
    Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422–30.  https://doi.org/10.1097/MPG.0b013e3181cea52b.CrossRefPubMedGoogle Scholar
  56. 56.
    Szajewska H, Horvath A. Meta-analysis of the evidence for a partially hydrolyzed 100% whey formula for the prevention of allergic diseases. Curr Med Res Opin. 2010;26(2):423–37.  https://doi.org/10.1185/03007990903510317.CrossRefPubMedGoogle Scholar
  57. 57.
    Boyle RJ, Ierodiakonou D, Khan T, Chivinge J, Robinson Z, Geoghegan N, et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ. 2016;352:i974.  https://doi.org/10.1136/bmj.i974.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Szajewska H, Horvath A. A partially hydrolyzed 100% whey formula and the risk of eczema and any allergy: an updated meta-analysis. World Allergy Organ J. 2017;10(1):27.  https://doi.org/10.1186/s40413-017-0158-z.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Muraro A, Halken S, Arshad SH, Beyer K, Dubois AE, Du Toit G, et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014;69(5):590–601.  https://doi.org/10.1111/all.12398.CrossRefPubMedGoogle Scholar
  60. 60.
    •• Turner PJ, Campbell DE, Boyle RJ, Levin ME. Primary prevention of food allergy: translating evidence from clinical trials to population-based recommendations. J Allergy Clin Immunol Pract. 2018;6(2):367–75.  https://doi.org/10.1016/j.jaip.2017.12.015 Excellent article that expans upon existing data related to primary prevention of food allergy and alerts the reader to upcoming studies, cohorts. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122(5):984–91.  https://doi.org/10.1016/j.jaci.2008.08.039.CrossRefPubMedGoogle Scholar
  62. 62.
    Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259–60.CrossRefGoogle Scholar
  63. 63.
    Goldring ST, Griffiths CJ, Martineau AR, Robinson S, Yu C, Poulton S, et al. Prenatal vitamin d supplementation and child respiratory health: a randomised controlled trial. PLoS One. 2013;8(6):e66627.  https://doi.org/10.1371/journal.pone.0066627.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of PediatricsUniversity of North Carolina School of MedicineChapel HillUSA
  3. 3.Division of Allergy, Immunology and RheumatologyUniversity of North CarolinaChapel HillUSA

Personalised recommendations