Dietary prevention of allergic disease in children: Are current recommendations really based on good evidence?
Article first published online: 11 JUN 2007
Pediatric Allergy and Immunology
Volume 18, Issue 6, pages 475–479, September 2007
How to Cite
Brand, P. L. P., Vlieg-Boerstra, B. J. and Dubois, A. E. J. (2007), Dietary prevention of allergic disease in children: Are current recommendations really based on good evidence?. Pediatric Allergy and Immunology, 18: 475–479. doi: 10.1111/j.1399-3038.2007.00541.x
- Issue published online: 2 AUG 2007
- Article first published online: 11 JUN 2007
- Accepted 13 January 2007
- hypoallergenic infant formula;
- protein hydrolysates;
- allergy prevention;
- cow's milk allergy;
- atopic eczema
We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to ‘high risk’ families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted.