Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics

Abstract

BackgroundAllergic sensitization in children and allergic diseases arising therefrom are increasing for decades.Several interventions, functional foods, pro- and prebiotics, vitamins are proposed for the prevention of allergies and they can’t be uncritically adopted.ObjectiveThis Consensus document was developed by the Italian Society of Preventive and Social Paediatrics and the Italian Society of Paediatric Allergy and Immunology.The aim is to provide updated recommendations regarding allergy prevention in children.MethodsThe document has been issued by a multidisciplinary expert panel and it is intended to be mainly directed to primary care paediatricians.It includes 19 questions which have been preliminarily considered relevant by the panel. Relatively to each question, a literature search has been performed, according to the Italian National Guideline Program. Methodology, and a brief summary of the available literature data, has been provided.Many topics have been analyzed including the role of mother’s diet restriction, use of breast/formula/hydrolyzed milk; timing of introduction of complementary foods, role (if any) of probiotics, prebiotics, vitamins, exposure to dust mites, animals and to tobacco smoke.ResultsSome preventive interventions have a strong level of recommendation. (e.g., the dehumidifier to reduce exposure to mite allergens). With regard to other types of intervention, such as the use of partially and extensively hydrolyzed formulas, the document underlines the lack of evidence of effectiveness.No preventive effect of dietary supplementation with polyunsaturated fatty acids, vitamins or minerals has been demonstrated.There is no preventive effect of probiotics on asthma, rhinitis and allergic diseases. It has demonstrated a modest effect, but steady, in the prevention of atopic dermatitis.ConclusionsThe recommendations of the Consensus are based on a careful analysis of the evidence available.The lack of evidence of efficacy does not necessarily imply that some interventions may not be effective, but currently they can’t be recommended.

The Role of Nutritional Aspects in Food Allergy: Prevention and Management

“…Measures to prevent allergy and food allergy have traditionally included maternal allergen avoidance during pregnancy and/or lactation, periods of exclusive breast feeding and avoidance of potential allergens, including food and environmental antigens, during the first year of life and beyond [ 29 ]. The value and significance of food avoidance for preventive purposes has been completely reconsidered in recent years.…”

The Role of Hydrolyzed Formula in Allergy Prevention

“…However, the clinical interpretation of such studies varies, as do the subsequent clinical recommendations. Different professional medical societies have guidelines with varying levels of enthusiasm regarding the effectiveness of hydrolyzed formulas in preventing allergic disease, as well as which types of formulas are most effective [41][42][43]45] .…”

Nutrition and Allergic Diseases

“…Essentially, all dietary antigens are proteins, and therefore highly digestible diets are recommended for food allergic individuals to reduce the number of intact antigens reaching the Peyer’s patches. Solid foods associated with lowered allergy prevalence include fruit and vegetables, vitamins, polyunsaturated fatty acids, and (raw) cow’s milk, but the processing of foods can possibly also affect allergy development [ 10 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. These food components, as well as the effects of food processing, are also addressed in the papers by Hosseini et al (fruit & vegetables), Brick et al (milk and processing), and Teodorowicz et al (food processing) in this issue [ 51 , 52 , 53 ].…”