Abrams, E.M. et al. The Journal of Pediatrics | Published online: 3 March 2017
Food allergy is estimated to affect 2%-10% of the population worldwide.1 The US Centers for Disease Control and Prevention reported an increase in food allergy prevalence in the US from 3.4% to 5.1% between 1997 and 2011.2 As a result, the focus in food allergy research has shifted from treatment to prevention
Grimshaw, K. et al. (2017) Archives of Disease in Childhood. 102:179-186
Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals.
The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4–6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic.
Summary for Parents and Caregivers | National Institute of Allergy and Infectious Diseases
Recent scientific research has shown that peanut allergy can be prevented by introducing peanut-containing foods into the diet early in life. Researchers conducted a clinical trial called Learning Early About Peanut Allergy (LEAP) with more than 600 infants considered to be at high risk of developing peanut allergy because they had severe eczema, egg allergy, or both. The scientists randomly divided the babies into two groups. One group was given peanut-containing foods to eat regularly, and the other group was told to avoid peanut-containing foods. They did this until they reached 5 years of age. By comparing the two groups, researchers found that regular consumption of peanut-containing foods beginning early in life reduced the risk of developing peanut allergy by 81 percent.
Marrs, T. Pediatric Infectious Disease Journal. 35(11) pp.1258–1261
Eczema (syn. “atopic eczema” or “atopic dermatitis”) affects at least one-fifth of the pediatric population in industrialized nations, often arises in early infancy and raises the risk of developing subsequent sensitization, food allergy and asthma. Pedigree studies of families carrying filaggrin loss-of-function mutations demonstrate a semi-dominant inheritance pattern for eczema.Filaggrin loss-of-function variants impair keratinocyte differentiation and reduce the ability of the skin to retain water, leading to poor skin barrier function and dry skin.However, it is not known what instigates the cutaneous inflammation associated with eczema, although bacterial pathogens and changes in the diversity of the cutaneous microbiota may play a role. Staphylococcus aureus is, for instance, commonly found on the skin of eczema sufferers, especially with more severe disease. However, it remains uncertain whether bacterial dysbiosis (microbial imbalance associated with reduced diversity and prominence of pathogenic strains) on the skin plays a causal role in the development of eczema and disease flares, or whether the observed expansion of S. aureus and reduction in bacterial diversity are primarily an epiphenomenon resulting from an impaired and inflamed skin barrier.
Luyt, D. et al. Paediatrics and Child Health. Available online: 17 March 2016.
Food allergy (FA) in children is common, affecting about 6% of children in the UK, and is thought to be increasing in prevalence.
Presentation varies widely with age, causative food, type of FA (IgE-mediated or non-IgE mediated) and severity. Assessment of suspected FA includes a detailed clinical history and dietary history and appropriate confirmatory allergy testing.
The traditional management of complete dietary exclusion of the causative and related foods is evolving to one of limiting exclusion and early reintroduction. Novel treatments under investigation are mechanisms to prevent FA and oral desensitisation in selected cases in an attempt to cure FA.
This article aims to give advice to the generalist about how to assess and initiate appropriate investigation a child presenting with possible food allergy.