EAACI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy

Authors

  • A. Muraro,

    Corresponding author
    1. The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
    • Correspondence

      Antonella Muraro, MD, PhD, Head of the Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Department of Mother and Child Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.

      Tel.: +39 049 821 2538

      Fax: +39 049 821 8091

      E-mail: muraro@centroallergiealimentari.eu

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    • Both are joint first authors.
  • S. Halken,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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    • Both are joint first authors.
  • S. H. Arshad,

    1. Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
    2. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
    3. NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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  • K. Beyer,

    1. Clinic for Pediatric Pneumology & Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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  • A. E. J. Dubois,

    1. Department of Pediatric Pulmonology and Paediatric Allergy, GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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  • G. Du Toit,

    1. Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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  • P. A. Eigenmann,

    1. Department of Child and Adolescent, Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
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  • K. E. C. Grimshaw,

    1. Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
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  • A. Hoest,

    1. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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  • G. Lack,

    1. Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
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  • L. O'Mahony,

    1. Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland
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  • N. G. Papadopoulos,

    1. Institute of Human Development, University of Manchester, Manchester, UK
    2. Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
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  • S. Panesar,

    1. Evidence-Based Health Care Ltd, Edinburgh, UK
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  • S. Prescott,

    1. School of Paediatrics and Child Health Research, University of Western Australia, Perth, WA, Australia
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  • G. Roberts,

    1. Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
    2. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
    3. NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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  • D. de Silva,

    1. Evidence-Based Health Care Ltd, Edinburgh, UK
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  • C. Venter,

    1. David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
    2. School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
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  • V. Verhasselt,

    1. Hôpital de l'Archet, Université de Nice Sophia-Antipolis EA 6302 “Tolérance Immunitaire”, Nice, France
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  • A. C. Akdis,

    1. Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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  • A. Sheikh,

    1. Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Scotland, UK
    2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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  • and on behalf of EAACI Food Allergy and Anaphylaxis Guidelines Group


  • Edited by: Thomas Bieber

Abstract

Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review.

Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4–6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.

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