EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update)
EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update)
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DOI：
10.1111/pai.13496
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发表时间：
2021-03-29
影响因子：
4.4
通讯作者：
Roberts, Graham
中科院分区：
文献类型：
--
作者：
Halken, Susanne;Muraro, Antonella;Roberts, Graham
欧洲过敏和临床免疫学学会（EAACI）的这一指南推荐了预防婴幼儿速发型/IgE介导的食物过敏的方法。它是一个更新的2014年EAACI guidelines.Methods该指南是使用AGREE II框架和GRADE方法开发的。一个由来自11个国家不同学科和临床背景的代表组成的国际工作队系统地审查了研究，并考虑了专家意见。建议是通过权衡利益和危害，考虑证据的确定性和审查价值观，偏好和资源影响而制定的。该指南由外部专家进行同行评议，并纳入公众consultation.Results的反馈意见，所有关于预防食物过敏的建议涉及婴儿（最多1年）和幼儿（最多5年），无论过敏的风险。在其他年龄组中，预防食物过敏的证据不足。EAACI工作组建议，在出生后的第一周内，应避免使用常规牛奶配方作为母乳喂养婴儿的补充饲料。EAACI工作组建议在婴儿饮食中引入煮熟的鸡蛋，而不是生鸡蛋或未经巴氏消毒的鸡蛋，作为补充喂养的一部分。在花生过敏高发的人群中，EAACI工作组建议以适合年龄的形式引入花生作为补充喂养的一部分。根据研究，似乎引入鸡蛋和花生的最有效年龄是4到6个月的生命。EAACI工作组建议不要采取以下预防食物过敏的措施：（i）在怀孕或哺乳期间避免食用食物过敏原;（ii）在出生后的前6个月内使用大豆蛋白配方奶粉作为预防食物过敏的手段。没有建议支持或反对以下内容：在怀孕期间，母乳喂养或婴儿期使用维生素补充剂，鱼油，益生元，益生菌或合生元;改变纯母乳喂养的持续时间;和水解的婴儿配方，结论2014年指南的主要变化包括建议（i）在婴儿出生一周后，使用常规牛奶配方奶粉或使用润肤剂。引入花生和煮熟的鸡蛋作为补充喂养的一部分（证据的确定性中等）和（ii）避免在出生后第一周补充常规牛奶配方奶粉（证据的确定性低）。如何预防食物过敏仍然存在不确定性，需要进一步开展强有力的多国研究，使用强有力的诊断标准。
Background This guideline from the European Academy of Allergy and Clinical Immunology (EAACI) recommends approaches to prevent the development of immediate-onset / IgE-mediated food allergy in infants and young children. It is an update of a 2014 EAACI guideline.Methods The guideline was developed using the AGREE II framework and the GRADE approach. An international Task Force with representatives from 11 countries and different disciplinary and clinical backgrounds systematically reviewed research and considered expert opinion. Recommendations were created by weighing up benefits and harms, considering the certainty of evidence and examining values, preferences and resource implications. The guideline was peer-reviewed by external experts, and feedback was incorporated from public consultation.Results All of the recommendations about preventing food allergy relate to infants (up to 1 year) and young children (up to 5 years), regardless of risk of allergy. There was insufficient evidence about preventing food allergy in other age groups. The EAACI Task Force suggests avoiding the use of regular cow's milk formula as supplementary feed for breastfed infants in the first week of life. The EAACI Task Force suggests introducing well-cooked, but not raw egg or uncooked pasteurized, egg into the infant diet as part of complementary feeding. In populations where there is a high prevalence of peanut allergy, the EAACI Task Force suggests introducing peanuts in an age-appropriate form as part of complementary feeding. According to the studies, it appears that the most effective age to introduce egg and peanut is from four to 6 months of life. The EAACI Task Force suggests against the following for preventing food allergy: (i) avoiding dietary food allergens during pregnancy or breastfeeding; and (ii) using soy protein formula in the first 6 months of life as a means of preventing food allergy. There is no recommendation for or against the following: use of vitamin supplements, fish oil, prebiotics, probiotics or synbiotics in pregnancy, when breastfeeding or in infancy; altering the duration of exclusive breastfeeding; and hydrolysed infant formulas, regular cow's milk-based infant formula after a week of age or use of emollients.Conclusions Key changes from the 2014 guideline include suggesting (i) the introduction of peanut and well-cooked egg as part of complementary feeding (moderate certainty of evidence) and (ii) avoiding supplementation with regular cow's milk formula in the first week of life (low certainty of evidence). There remains uncertainty in how to prevent food allergy, and further well-powered, multinational research using robust diagnostic criteria is needed.