Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art?
Abstract
:1. Introduction
1.1. Food Allergy Immuno-Pathogenesis
1.2. Digestion and Mucosal Barrier
1.3. Microbiota and Food Allergies
2. Method
3. Studies
3.1. Studies Performed in High-Risk Populations
3.1.1. Egg Proteins
3.1.2. Cow’s Milk, Peanut, Hard-Boiled Hen’s Egg, Sesame, Whitefish (Cod) and Wheat
3.1.3. Rusk-like Biscuit Powder
3.1.4. Peanut
3.2. Studies Performed in Low-Risk Populations
3.2.1. Egg Proteins
3.2.2. Cow’s Milk, Peanut, Hard-Boiled Hen’s Egg, Sesame, Whitefish (Cod) and Wheat
3.3. Studies Performed in Both High-Risk and Low-Risk Populations
Cow’s Milk Proteins
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author, Year, Country, Trial | Study Design | Sample Size | Population | Inclusion Criteria | Allergen | Outcome | Main Results |
---|---|---|---|---|---|---|---|
Snijders et al., 2008 Netherlands KOALA [60] | Prospective birth cohort study | 2558 infants | General population | Pregnant women with diverse lifestyles | Cow’s milk products and other solid products. | Questionnaires at 7, 12, 24 months; Specific IgE >0.3 UI/mL against eggs, cow’s milk at age 2 | Delayed introduction of CMP and other food products associated with higher risk for eczema (p = 0.01 and 0.02 for trend, respectively); no association between delayed introduction of CMP and AD; delayed introduction of other food associated with higher risk for AD (p = 0.00 trend) and increased risk of atopy development at the age of 2 years |
Palmer et al., 2013 Australia STAR [61] | RDBPCT | 86 infants: 49 SG 37 CG | High risk | 4 months of age singleton term infants with moderate-to-severe eczema no prior egg or solid food ingestion | Hen’s egg (0.9 g/day) | OFC and SPT at 12 months | At 12 months 33% SG, 51% CG were diagnosed IgE-mediated egg allergy (relative risk, 0.65; 95% CI, 0.38–1.11; p = 0.11) |
Du Toit et al., 2015 England LEAP [62] | RCT | 640 infants: 319 SG 321 CG | Infants 4 to 11 months of age with severe eczema, egg allergy, or both | High risk | Peanut (6 g/week) | Open OFC or DBPCFC at 12, 30 and 60 months | In the intention-to-treat population: 13.7% in the CG and 1.9% in the SG who had negative SPT developed peanut allergy (p < 0.001) |
Perkin et al., 2016 England EAT [63] | RCT | 1303 infants: 652 SG 651 CG | Exclusively breastfed infants for ≥4–5 months, regardless of atopic status or family history of allergy | General population | Cow’s milk, peanut, hard-boiled Hen’s egg, sesame, whitefish (cod) and wheat at 3 and 6 months of age (4 g/week) | OFC at 1 and 3 years of age after allergenic food introduction | Among infants with sensitization to 1 or more foods at enrollment, EIG infants developed significantly less FA than SIG infants Intention to treat: SIG, 7.1%; EIG, 5.6% p = 0.32 Per protocol: SIG, 7.3% EIG, 2.4% p = 0.01 |
Bellach et al., 2017 Germany HEAP [64] | RDBPCT | 383 infants: 184 SG 199 CG | GA ≥ 34 weeks and birth weight ≥ 2.5 kg Specific IgE to egg <0.35 kU/L | General population 4–6 months | Hens’ egg 2.5 g 3 times/week from 4–6 to 12 months | OFC and specific IgE ≥0.35 KU/L at 12 months after hen’s egg introduction | Sensitized to hen’s egg at age 12 months: 5.6% (6/124) in SG 2.6% (4/152) in CG (p = 0.35); allergy to hen’s egg 2.1% in SG 0.6% in CG (relative risk,3.30;95%CI, 0.35–31.32; p = 0.35); no prevention in hen’s egg sensitization nor egg allergy |
Tan et al., 2017 Australia BEAT [65] | RDBCT | 319 infants: SG 165 CG 154 | Infants with at least 1 first-degree relative with allergic disease and SPT < 2 mm | High risk | Hens’ egg 350 mg from 4–8 months | EW SPT response of 3 mm or greater OFC to whole egg at age 12 months. | Sensitization to EW at 12 months: 20% in CG 11% in SG; allergy to EW at 12 months: 10.5% in CG 6.2% in SG (odds ratio, 0.46;95% CI, 0.22–0.95; p = 0.03) |
Natsume et al., 2017 Japan PETIT [66] | RDBPCT | 147 infants | 4–5 months of age with eczema | High risk | Eggs 50 mg/die (3–9 months) 250 mg/die (9–12 months) | Open OFC at 12 months of age | Five (8%) of 60 participants had an egg allergy in the SG compared to 23 (38%) of 61 in the CG (risk ratio 0.221;95% CI, 0.090–0.543; p = 0.0001) |
Palmer et al., 2017 Australia STEP [67] | RCT | 820 infants: SG 165 CG 154 | Singleton infants with atopic mothers, recruited before age 6.5 months No prior egg ingestion and allergic disease | High risk | Hens’ egg pasteurized raw whole egg powder (SG = 407) or a rice powder (CG = 413) from 6 to 10 months; introduction of egg at 10 months | OFC to egg at 12 months and SPT positive | At 12 months: IgE-mediated food allergy: SG 7.0% vs. CG 10.3% (RR(95%CI) 0.75 (0.48–1.17) p = 0.20) |
Nishimura et al., 2022 Japan SEED [68] | RCT | 163 children: 83 SG 80 CG | 3–4 months old with atopic dermatitis | High risk | Egg, milk, wheat, soybean, buckwheat, and peanuts. Amount of powder increased at 2, 4 and 12 week. | The occurrence of FA at 18 months old | Incidence of FA episodes by 18 months: SG 7/83 vs. CG 19/80; (risk ratio 0.301 [95% CI 0.116–0.784]; p = 0.0066). Egg allergies were reduced in the SG group |
Kalb et al., 2022 German TEFFA [69]. | RCT | 150 infants with atopic eczema at 4–8 months randomized in a 2:1 manner into an SG and CG | 4–8-month-old infants with eczema | High risk | Rusk-like biscuit powder with HE, CM, PN, HN 2 mg for 6–8 months | After 6 months of intervention they will check sensitization against hen’s egg, cow’s milk, hazelnut and peanut | At 12 months egg allergy: SG 2.1% CG 0.6% (3.30;95% CI, 0.31–3132 p = 0.35) |
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Gravina, A.; Olivero, F.; Brindisi, G.; Comerci, A.F.; Ranucci, C.; Fiorentini, C.; Sculco, E.; Figliozzi, E.; Tudini, L.; Matys, V.; et al. Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art? Int. J. Mol. Sci. 2024, 25, 2769. https://doi.org/10.3390/ijms25052769
Gravina A, Olivero F, Brindisi G, Comerci AF, Ranucci C, Fiorentini C, Sculco E, Figliozzi E, Tudini L, Matys V, et al. Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art? International Journal of Molecular Sciences. 2024; 25(5):2769. https://doi.org/10.3390/ijms25052769
Chicago/Turabian StyleGravina, Alessandro, Francesca Olivero, Giulia Brindisi, Antonia Fortunata Comerci, Chiara Ranucci, Cinzia Fiorentini, Eleonora Sculco, Ethel Figliozzi, Laura Tudini, Viviana Matys, and et al. 2024. "Dietary Intervention during Weaning and Development of Food Allergy: What Is the State of the Art?" International Journal of Molecular Sciences 25, no. 5: 2769. https://doi.org/10.3390/ijms25052769