Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis

Voorheis, Paula; Bell, Sadie; Cornelsen, Laura; Quaife, Matthew; Logan, Kirsty; Marrs, Tom; Radulović, Suzana; Craven, Joanna; Flohr, Carsten; Lack, Gideon; Perkin, Michael R.; Young, Louise; Offord, Victoria; DeSousa, Mary; Cullen, Jason; Taylor, Katherine; Tseng, Anna; Raji, Bunmi; Byrom, Sarah; Regis, Gillian; Bigwood, Charlie; Stedman, Charlotte; Tonner, Sharon; Banks, Emily; Kahnum, Yasmin; Babic, Rachel; Stockwell, Ben; Thompson, Erin; Wheatley, Lorna; Patkunam, Devi; Richards, Kerry; Pietraszewicz, Ewa; Stephens, Alick; Sudra, Asha; Turcanu, Victor

doi:10.1016/j.jaci.2019.09.004

Cited by 23 publications

(17 citation statements)

References 20 publications

(32 reference statements)

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“…7,8 However, the probiotic literature may suffer from issues of selective reporting and early introduction of multiple allergenic foods has proved to be a challenging recommendation to comply with. 9 Thus, simple, achievable, safe and effective ways of preventing eczema or food allergy are still needed.…”

Section: Introductionmentioning

confidence: 99%

“…Systematic reviews found some evidence that probiotics in late pregnancy may decrease eczema risk and that early introduction of allergenic foods may decrease risk of allergy to the same foods 7,8 . However, the probiotic literature may suffer from issues of selective reporting and early introduction of multiple allergenic foods has proved to be a challenging recommendation to comply with 9 . Thus, simple, achievable, safe and effective ways of preventing eczema or food allergy are still needed.…”

Section: Introductionmentioning

confidence: 99%

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Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis

Kelleher

Cro

Vogt

et al. 2021

Clin Experimental Allergy

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Objective Eczema and food allergy start in infancy and have shared genetic risk factors that affect skin barrier. We aimed to evaluate whether skincare interventions can prevent eczema or food allergy. Design A prospectively planned individual participant data meta‐analysis was carried out within a Cochrane systematic review to determine whether skincare interventions in term infants prevent eczema or food allergy. Data sources Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to July 2020. Eligibility criteria for selected studies Included studies were randomized controlled trials of infants <1 year with healthy skin comparing a skin intervention with a control, for prevention of eczema and food allergy outcomes between 1 and 3 years. Results Of the 33 identified trials, 17 trials (5823 participants) had relevant outcome data and 10 (5154 participants) contributed to IPD meta‐analysis. Three of seven trials contributing to primary eczema analysis were at low risk of bias, and the single trial contributing to primary food allergy analysis was at high risk of bias. Interventions were mainly emollients, applied for the first 3–12 months. Skincare interventions probably do not change risk of eczema by age 1–3 years (RR 1.03, 95% CI 0.81, 1.31; I2=41%; moderate certainty; 3075 participants, 7 trials). Sensitivity analysis found heterogeneity was explained by increased eczema in a trial of daily bathing as part of the intervention. It is unclear whether skincare interventions increase risk of food allergy by age 1–3 years (RR 2.53, 95% CI 0.99 to 6.47; very low certainty; 996 participants, 1 trial), but they probably increase risk of local skin infections (RR 1.34, 95% CI 1.02, 1.77; I2=0%; moderate certainty; 2728 participants, 6 trials). Conclusion Regular emollients during infancy probably do not prevent eczema and probably increase local skin infections.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis

Kelleher

Cro

Vogt

et al. 2021

Clin Experimental Allergy

View full text Add to dashboard Cite

show abstract

“…However, non-adherence rate in the intervention group was substantial (68.1%) and may lead to bias in the per-protocol analysis ( 51 ). It also indicated the difficulty for parents to introduce so many allergens at such an early age ( 33 ). Of note, the lowest adherence rate was reported for the introduction of egg (43.1%).…”

Section: Introduction Of Solid Foods In the First Year Of Lifementioning

confidence: 99%

The Role of Diet Diversity and Diet Indices on Allergy Outcomes

et al. 2020

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Nutrients in foods are not eaten in isolation and food intake interacts in a complex manner, affecting health and disease outcomes. For this reason, focusing on the whole "pattern" of dietary intake instead of the single nutrients or groups of nutrients when studying diseases outcomes is increasingly appealing and growing. Diet diversity refers to the variety of foods being eaten, and the terms, diversity or variety, are often used interchangeably. When the overall diet is characterized by healthy foods, diet diversity will reflect a diversity/variety of healthy foods eaten over a period of time. The introduction of solid foods in the 1st year of life is considered a measure of increased diet diversity. Consuming a diverse range of foods and food allergens in the first year of life may increase intake of important nutrients and positively affect the gut microbiome structure and function. Intake of omega-3 fatty acids and fibers/prebiotics may be particularly important but more information is required about dose and which individuals are most likely to benefit. Increased diet diversity in the first year of life is also associated with reduced food allergy outcomes. In addition to diet diversity, diet indices are considered measures of overall diet quality and can be used as a simple assessment of dietary intake. The focus of this paper is to review and critically address the current knowledge of the association between diet diversity and diet indices and allergy outcomes. Based on the current evidence, we recommend the introduction of solid foods, including common allergenic solids, during the 1st year of life, according to the infant's neuro-developmental abilities and familial or cultural habits. For infants with severe AD and/or FA, medical assessment may be advisable before introducing common food allergens into the diet. Limited evidence exist about the role of diet indices in pregnancy and allergic disease in the offspring, and the most promising results indicate a reduction in childhood wheeze and/or asthma intake.

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“…This, in conjunction with current understanding of skin barrier defects as a route of atopic sensitization has led to the Dual-Allergen-Exposure hypothesis, which states that exposure to food allergens through the skin can lead to allergy, while consumption of these foods at an early age may actually result in tolerance. However, induction of tolerance through early introduction of food allergens presents a number of challenges [ 47 , 48 ]. The protective effects of early food protein allergen exposure appear to be allergen-specific suggesting that early introduction of one food protein allergen does not prevent the development of FA to other allergens and that multiple food introductions in early life are necessary to prevent all FA.…”

Section: Oral Tolerance: Early Introduction Of Allergic Foodsmentioning

confidence: 99%

Early intervention of atopic dermatitis as a preventive strategy for progression of food allergy

Sweeney

Sampath

Nadeau

2021

Allergy Asthma Clin Immunol

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Background Atopic diseases, such as atopic dermatitis (AD) and food allergy (FA), have increased in prevalence in industrialized countries during the past few decades and pose a significant health burden. They appear to have a common underlying mechanism and a natural disease progression. AD is generally the first atopic disease to manifest followed by other atopic diseases, such as FA, allergic rhinitis, or allergic asthma suggesting that they are likely different manifestations of the same disease. Body Evidence suggests that allergic sensitization occurs through an impaired skin barrier, while consumption of these foods at an early age may actually result in tolerance. This has been termed the Dual-Allergen-Exposure hypothesis. Loss of barrier integrity has been hypothesized to enable penetration of allergens, pollutants, and microbes and initiation of an inflammatory immune cascade of events leading to sensitization. The immune dysfunction is thought to further exacerbate the impaired skin barrier to form a vicious cycle. There is much interest in preventing or protecting the skin barrier from developing a proinflammatory atopic state, which may potentially lead to the development of AD and subsequently, FA. Conclusion Research on preventing or treating skin barrier dysfunction is ongoing. A number of studies have evaluated the efficacy of emollients in preventing AD and FA with mixed results. Studies have differed in the study design, population characteristics, emollients type, and frequency, duration, and area of application. Emollient type has varied widely from oils, creams, petrolatum-based lotions, and trilipid creams. Current research is directed towards the use of trilipid emollients that are similar to the skin’s natural lipid composition with a 3:1:1 ratio of ceramides, cholesterol and free fatty acids and a pH that is similar to that of skin to determine their effectiveness for skin barrier repair and prevention of AD and FA.

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Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis

Cited by 23 publications

References 20 publications

Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis

Skincare interventions in infants for preventing eczema and food allergy: A cochrane systematic review and individual participant data meta‐analysis

The Role of Diet Diversity and Diet Indices on Allergy Outcomes

Early intervention of atopic dermatitis as a preventive strategy for progression of food allergy

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