Randomized placebo-controlled trial of hen's egg consumption for primary prevention in infants

Bellach, Johanna; Schwarz, Veronika; Ahrens, Birgit; Trendelenburg, Valérie; Aksünger, Özlem; Kalb, Birgit; Niggemann, B.; Keil, Thomas; Beyer, Kirsten

doi:10.1016/j.jaci.2016.06.045

Cited by 204 publications

(253 citation statements)

References 28 publications

(41 reference statements)

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“…The proportion of infants with atopic dermatitis was reported in 5 studies (Bellach et al [15], Palmer et al [12], Perkin et al [10], Tan et al [14], Natsume et al [16]) and ranged from 9 to 100%, while 1 study that had no infants with atopic dermatitis (Palmer et al [13]). A family history of atopic diseases was reported in 62–100% of the participants.…”

Section: Resultsmentioning

confidence: 99%

“…A family history of atopic diseases was reported in 62–100% of the participants. The intervention group received pasteurized raw whole egg or egg white powder in 4 studies [12-15] and heated eggs in 2 studies [10, 16]. There were variable doses of egg protein exposure, with a median dose of 2,800 mg/week (range 350–7,500; Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Sensitization to egg at 12 months was 20 and 11% in infants randomized to placebo and egg, respectively (OR 0.46, 95% CI 0.22–0.95, p = 0.03) [14]. Bellach et al [15] also found no evidence that the consumption of raw egg starting at 4–6 months of age prevents egg allergy, as 2.1% in the treated group versus 0.6% in the placebo group developed egg allergy (RR 3.30, 95% CI 0.35–31.32, p = 0.35). In contrast, another recent study by Natsume et al [16] found that the introduction of heated egg in a stepwise dose was safe and effective in preventing egg allergy (RR 0.22, 95% CI 0.09–0.54, p = 0.0001).…”

Section: Introductionmentioning

confidence: 99%

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Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

Al‐Saud

Sigurdardottir

2018

Int Arch Allergy Immunol

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Background: The timing of the introduction of egg to an infant’s diet is of current interest, as new evidence raises questions regarding the benefit of delaying egg introduction. The objective of this study was to systematically review the existing literature regarding the effect of the early introduction of egg on the development of egg allergy. Methods: Literature searches were conducted in MEDLINE, EMBASE, and CENTRAL, and trial protocols were searched in Meta Register and OpenGREY. Only randomized controlled trials (RCTs) comparing early (between 3 and 6 months of age) egg introduction to no early introduction were included. The primary outcome was the development of egg allergy. Results: Of the 416 articles identified and screened, 6 RCTs met the eligibility criteria for data extraction. Allergic outcomes were evaluated in a total of 3,032 participants. A low to moderate level of evidence showed a benefit of the early introduction of egg (relative risk, RR 0.60, 95% CI 0.44–0.82, p = 0.002, mild heterogeneity, I² = 23%). The absolute risk reduction for a population with an incidence of egg allergy of 9.3% was 37 fewer cases (95% CI 17–52) per 1,000 people. Consumption of < 4,000 mg/week of egg protein had a greater preventive effect than a higher dose. Conclusion: This systematic review and meta-analysis showed an association between the early introduction of egg and a lower risk of egg allergy. Furthermore, the nature and dose of egg protein exposure may play a role. These findings should be addressed in the context of primary studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

Al‐Saud

Sigurdardottir

2018

Int Arch Allergy Immunol

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“…[20][21][22] In addition, 8.5% of infants who received egg early experienced significant allergic symptoms upon egg ingestion. 20 The inclusion of an aggressive eczema treatment strategy distinguished the PETIT study from the other clinical trials and thus this was a likely explanation for the difference in results.…”

Section: What Is New In Allergy Prevention That Could Impact On Hong mentioning

confidence: 99%

The unmet provision of allergy services in Hong Kong impairs capability for allergy prevention – implications for the Asia Pacific region

Lee

Leung

Wong

et al. 2017

Asian Pac J Allergy Immunol

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There is a high and rising prevalence of many allergic diseases in the Asia Pacific, including Hong Kong, which is unmatched by a commensurate provision of clinical allergy services. In the last 3 years, the allergy profile in Hong Kong has increased due to greater public engagement and more frequent educational activities, scientific outputs and publication of local guidelines on allergy prevention, diagnosis and treatment. Two new drug allergy clinics have been established in public hospitals, and for the first time in 20 years, Hong Kong has its first trainee in adult allergy. The current ratio of allergists per head of population has improved slightly from 1:1.46 (in 2014) to 1:1.17 million, but it is still low compared to many countries. The Hong Kong community is well supported by allergy-related professional societies and patient organisations. While the recent developments indicated some progress, Hong Kong remains inadequately equipped to take advantage of the new discoveries that may prevent allergic diseases and improve public health. There are also 5-fold more paediatric allergists than adult allergists per head of population. If this unbalance remains uncorrected, continuing care for allergic children as they grow into adulthood will be an increasing problem. This review provides recommendations to improve allergy service provision and training, including the creation of Centres of Excellence in allergy to drive the growth of this specialty.

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“…Di Mario and Cattaneo suggested to exclude these three trials [3, 4, 6] from the analysis because of clinical heterogeneity. However, all three studies included in the forest plot by Di Mario et al [7-9] also had issues in clinical heterogeneity. The population in Perkin et al [7] is healthy babies, while in Palmer et al [8] it is infants with a first-degree relative with atopic disease.…”

mentioning

confidence: 99%

Early Introduction of Egg and Development of Egg Allergy

Al‐Saud

Sigurdardottir

2019

Int Arch Allergy Immunol

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Randomized placebo-controlled trial of hen's egg consumption for primary prevention in infants

Abstract: We found no evidence that consumption of hen's egg starting at 4 to 6 months of age prevents hen's egg sensitization or allergy. In contrast, it might result in frequent allergic reactions in the community considering that many 4- to 6-month-old infants were already allergic to hen's egg.

Cited by 204 publications

References 28 publications

Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis

The unmet provision of allergy services in Hong Kong impairs capability for allergy prevention – implications for the Asia Pacific region

Early Introduction of Egg and Development of Egg Allergy

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