Primary Prevention of Food Allergy
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Food allergy is estimated to affect approximately 8% of children in the USA. This is a disease without any known treatment or cure and, for some, a disease that can be quite severe, even life-threatening. While recent advances in potential treatment have made remarkable strides, with two food-targeted immunotherapy products now in phase III trials, perhaps the biggest gains in the field have come in the advent of potential preventative strategies to avoid the development of food allergy in high-risk individuals. There have been multiple, randomized, controlled trials (RCTs) performed in the past 5 years that have demonstrated significant risk reduction from early allergen introduction. These include two trials for early peanut introduction and five trials for early egg introduction in the first year of life. The results indicate that primary prevention of food allergy through early allergen introduction may represent a strategy that could potentially avert tens of thousands of children from becoming food allergic. In support of the data for peanut, the National Institute of Allergy and Infectious Diseases recently sponsored an addendum to the 2010 food allergy guidelines, specifically recommending peanut be introduced in both high- and standard-risk infants to reduce the risk of developing peanut allergy. To date, no formal recommendations have been made for egg, however. This review will focus on the latest evidence supporting early introduction as a strategy to prevent food allergy, as well as on practical aspects for its successful implementation.
KeywordsFood allergy Peanut allergy Allergy treatment Immunotherapy Food allergy guidelines
Randomized controlled trials
Randomized, placebo-controlled trial
Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood
Oral food challenge
Learning Early About Peanut Study
Relative risk reduction
Absolute risk reduction
Number needed to treat
Enquiring About Tolerance
Solids Timing for Allergy Reduction
Starting Time for Egg Protection
Beating Egg Allergy Study
Hen’s Egg Allergy Prevention
Prevention of Egg Allergy with Tiny Amount Intake
American Academy of Pediatrics
National Institute of Allergy and Infectious Diseases
American Academy of Allergy, Asthma and Immunology
Skin prick test
Compliance with Ethical Standards
Conflict of Interest
Matthew Greenhawt is supported by grant 1K08HS024599-01 from the Agency for Healthcare Quality and Research; was an Expert Panel member of the NIAID-sponsored Guidelines for Peanut Allergy Prevention; represented the American College of Allergy, Asthma and Immunology in the formation of the Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-Risk Infants; has served as a consultant for the Canadian Transportation Agency and Aimmune Therapeutics; is a member of physician/medical advisory boards for Aimmune, Nutricia, Kaleo Pharmaceutical, Nestle, and Monsanto; is a member of the scientific advisory boards for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, ReachMD, and the Kentucky/Pennsylvania/Aspen/New York allergy societies, the ACAAI, the EAACI, and UCLA/Harbor Medical Center; and is a member of the Joint Taskforce on Allergy Practice Parameters.
David Fleischer is a member of the scientific advisory council for the National Peanut Board, represented the American Academy of Allergy, Asthma and Immunology in the formation of the Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-Risk Infants; was a Coordinating Committee and Expert Panel member of the NIAID-sponsored Guidelines for Peanut Allergy Prevention; is a member of physician/medical advisory boards for Aimmune, Kaleo Pharmaceutical, Nestle, and Monsanto; and received grant support from Nestle, Monsanto, DBV Technologies, and Aimmune Therapeutics.
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.
Sources of Support
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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