Overview of Evidence in Prevention and Aetiology of Food Allergy: A Review of Systematic Reviews

Abstract

The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis from good quality systematic reviews is needed. We performed an overview of systematic reviews concerning the prevention and aetiology of food allergy, retrieving 14 systematic reviews, which covered three broad topics: formula (hydrolysed or soy) for the prevention of food allergy or food sensitization; maternal and infant diet and dietary supplements for the prevention of food allergy or food sensitization and hygiene hypothesis-related interventions. Using the AMSTAR criteria for assessment of methodological quality, we found five reviews to be of high quality, seven of medium quality and two of low quality. Overall we found no compelling evidence that any of the interventions that had been systematically reviewed were related to the risk of food allergy. Updating of existing reviews, and production of new systematic reviews, are needed in areas where evidence is emerging for interventions and environmental associations. Furthermore, additional primary studies, with greater numbers of participants and objective food allergy definitions are urgently required.

The skin as a target for prevention of the atopic march

“…Many approaches have been tried to prevent allergic diseases. 11,12 Although controversy remains about the effects of many of these strategies, there is growing evidence that early introduction of allergenic foods during infancy provides allergen-specific protection against food allergy. If the dual-allergen exposure hypothesis 17 is correct, then a combined strategy of early allergenic food exposure and barrier improvement strategies could be the optimal means to decrease the incidence of these conditions.…”

“…To date, most research into strategies for the prevention of allergic disease has been disappointing. Reviews covering these studies are already available for food allergy 11 and AD. 12 There is growing awareness of the role of epithelial barrier dysfunction in the pathogenesis of allergic disease, 13 and there is mounting evidence that impaired skin barrier and inflammation associated with AD could be a precursor to allergic sensitization and other forms of allergic disease.…”

In utero Programming of Allergic Susceptibility

“…Specific evidence regarding allergenic foods has also been recently reviewed. It suggests that neither maternal exposure nor the early/delayed introduction of allergenic foods in children's diets impact any subsequent development of sensitisation or allergy to such foods [84,85]. …”

Role of the Epidermal Barrier in the Formation of Food Allergies in Children with Genodermatosis

“…Термин ПА подразумевает под собой патологическое состояние, характеризуемое повышенной реактивностью иммунного ответа на различные пищевые антигены [1]. Доказано влияние наследственности (отягощенный семейный анамнез по аллергическим заболеваниям), расовой принадлежности, состава кишечного микробиома и факторов внешней среды (от высокого содержания различных сенсибилизирующих средств в окружающей среде до условий проживания, экономического статуса и даже географической широты) на развитие данной патологии [2,3]. Детская ПА относится к серьезным, зачастую жизнеугрожающим (за счет развития анафилаксии) состояниям, оказывающим колоссальное влияние на качество жизни не только больных, но и членов их семей [4].…”