The acute and long‐term management of food allergy: protocol for a rapid systematic review

Background: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. Methods: Seven bibliographic databases were searched from their inception to September 30, 2012, for systematic reviews, randomized controlled trials, quasirandomized controlled trials, controlled clinical trials, controlled before-and-after and interrupted time series studies. Experts were consulted for additional studies. There was no language or geographic restrictions. Two reviewers critically appraised the studies using the appropriate tools. Data were not suitable for meta-analysis due to heterogeneity so were narratively synthesized. Results: Eighty-four studies were included, but two-thirds were at high risk of potential bias. There was little evidence about acute management for non-lifethreatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended, but apart from for infants with cow's milk allergy, there was little high-quality research on this management approach. To reduce symptoms in children with cow's milk allergy, there was evidence to recommend alternatives such as extensively hydrolyzed formula. Supplements such as probiotics have not proved helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration. Conclusions: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened as a matter of priority.

show abstract

“…Experts in the field were contacted for additional studies. Further details are included in the review protocol .…”

Section: Methodsmentioning

confidence: 99%

“…The review was registered with the International Prospective Register of Systematic Reviews. The protocol has been published previously (5) so only brief details about the methodology are provided here.…”

Section: Protocol and Registrationmentioning

confidence: 99%

Acute and long-term management of food allergy: systematic review

Silva

Geromi

Panesar

et al. 2013

Allergy

View full text Add to dashboard Cite

show abstract

“…However, there is evidence for the use of hydrolysed formulas in preventing food allergies in infants who cannot be completely breast milk-fed. (43,44) A study from Singapore has shown that consuming probiotics in the first six months of life does not impact allergic outcomes. (45) The timing of introduction of complementary solids in infancy is a persistent source of contention in allergy prevention.…”

Section: Pr E V Entio N O F Foo D a Llergymentioning

confidence: 99%

Food allergy in Singapore: opening a new chapter

Lee¹

2014

smedj

View full text Add to dashboard Cite

R ev iew A r tic le 244 I NTRO D U C TIO NSingapore has rapidly evolved into a modernised city state and currently faces the health burden of noncommunicable diseases (NCDs), resembling that of developed Western nations.(1) In children, allergic diseases, including food allergy, are among the most common NCDs.(2) Food allergy rates are reported to be more than 10% in challenge-proven studies among Australian infants, (3) while in the United Kingdom (UK) (4) and the United States of America (USA), Singapore have not met the expected rise experienced by other highly industrialised countries, it is also uncertain whether the food allergy epidemic will hit our nation. This unclear prediction, together with ever-changing cultural practices and eating habits due to immigration and overseas influence, has opened a new chapter of food allergy in Singapore.A PubMed search of the terms "food allergy" and "Singapore" generated a total of 45 results from January 1999 to January 2014. All the articles generated are in English. Of these, 12 articles are not food-allergy focused, and two are focused on food testing methodology that is not unique to Singapore. Of the remaining 31 articles found, 16 are studies conducted on children, and 9 are review articles on food allergy in Asia or Singapore. EPID EM IO LO GYIn Asia, food allergy data is just beginning to emerge, providing no satisfactory trend. One study from Chongqing, China, reported a doubling in the challenge-proven prevalence rates from 3.5% to 7.7% among 0-2-year-olds over a ten-year period. (8) Conversely, a South Korean study reported that the prevalence of food allergy symptoms in 6-12-year-olds had decreased from 10.9% to 8.9% over five years.(9) Preliminary findings in an ongoing study of young Singaporean children aged 11-30 months demonstrated that overall, self-reported food allergy prevalence could be as high as 5.4% (Lee AJ, unpublished). Unfortunately, the only prior data for comparison was in 6-12-year-olds, where the rates (also by questionnaire) were estimated to be 4%-5% in 1999.Given that the prevalence of food allergy tends to decrease with age, using this data, we surmise that food allergy has probably not increased in Singapore over a 14-year period. SPECIFIC FOOD ALLERGIES IN SINGAPOREWorldwide and regional differences in food allergies mainly depend on diet and culture (although this may not always be the case). For example, shellfish is the most common food allergen in Singapore and is ubiquitous in Southeast Asia, likely by virtue of its high consumption. However, fish, also eaten abundantly in Singapore, is a rare allergen here. Allergy to egg and cow's milk, despite their high consumption worldwide, is comparatively lower in Singapore than in the West. The reverse is true of peanut allergy, which is epidemic in the West compared to Asia. However, the pattern of food allergy in Singapore appears to have changed over the last decade, with peanut allergy increasing in prevalence and being the most common cause of anaphylaxis in Singaporean childr...

show abstract

“…The guideline is based on the current European Academy of Allergy and Clinical Immunology (EAACI) S3-guideline on the diagnosis and treatment of food allergy [ 11 ], as well as on systematic EAACI reviews [ 12 , 13 ] from 2014, for which systematic literature searches of PubMed, meta-analyses, clinical studies, and other scientific investigations were undertaken. Consensus on the present guideline was achieved independently from the European guidelines by an interdisciplinary panel of German-speaking experts who were nominated by the participating societies.…”

Section: Preamblementioning

confidence: 99%