Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study. Food allergy in children: results of a standardized protocol for oral desensitization. "Food allergy in children: an attempt to improve the effects of the elimination diet with an immunomodulating agent (thymomodulin). A double-blind clinical trial". Prevention of allergic disease during childhood by allergen avoidance: the Isle of Wight prevention study. Dietary prophylaxis of allergic disease in children. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States Effect of allergen avoidance in infancy on allergic manifestations at age two years. Oral Specific Desensitization in Food-Allergic Children Introduction of Complementary Foods and the Relationship to Food Allergy Influence of dietary manipulation on incidence of atopic disease in infants at risk. Comparison of Breast, Cow, and Soy Feedings in the Prevention of Onset of Allergic Disease The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. Effect of allergen avoidance on development of allergic disorders in infancy Utility of food-specific IgE concentrations in predicting symptomatic food allergy. Allergen avoidance in infancy and allergy at 4 years of age Breast feeding and allergic diseases in infants—a prospective birth cohort study
The effect of maternal and infant avoidance of allergenic foods on food allergy was examined in a prenatally r and omized , controlled trial of infants of atopic parents . The diet of the prophylactic-treated group ( N = 103 ) included ( 1 ) maternal avoidance of cow 's milk , egg , and peanut during the third trimester of pregnancy and lactation and ( 2 ) infant use of casein hydrolysate ( Nutramigen ) for supplementation or weaning , and avoidance of solid foods for 6 months ; cow 's milk , corn , soy , citrus , and wheat , for 12 months ; and egg , peanut , and fish , for 24 months . In the control group ( N = 185 ) , mothers had unrestricted diets , and infants followed American Academy of Pediatrics feeding guidelines . The cumulative prevalence of atopy was lower at 12 months in the prophylactic-treated ( 16.2 % ) compared to the control ( 27.1 % ) group ( p = 0.039 ) , result ing from reduced food-associated atopic dermatitis , urticaria and /or gastrointestinal disease by 12 months ( 5.1 % versus 16.4 % ; p = 0.007 ) , and any positive food skin test by 24 months ( 16.5 % versus 29.4 % ; p = 0.019 ) , caused primarily by fewer positive milk skin tests ( 1 % versus 12.4 % ; p = 0.001 ) . The prevalences of allergic rhinitis , asthma , and inhalant skin tests were unaffected . Serum IgE levels in the prophylactic-treated group were marginally lower only at 4 months . Thus , reduced exposure of infants to allergenic foods appeared to reduce food sensitization and allergy primarily during the first year of life BACKGROUND / AIMS Food allergy in children is still an unresolved problem that merits investigation , particularly when the food is fundamental for the child 's growth . Reports in the literature that deal with the possibility of a desensitizing treatment are sporadic and often inconsistent , and no st and ardized protocol s are yet available . In this paper we propose a st and ardized oral desensitization program for food allergy in children . METHODOLOGY The treatment was carried out in 14 cases with allergy to food ( milk in 6 cases , egg in 5 , fish in 2 and apple in 1 case ) . The control group consisted of 10 age and sex matched allergic subjects ( 5 to milk , 4 to egg and 1 to fish ) , who underwent a strict elimination diet regimen .  RESULTS Compliance to treatment was satisfactory , since 12 out of the 14 treated cases ( 85.7 % ) completed the program . Treatment was successful in 100 % of the cases that completed the program : all the treated patients are now able to tolerate any food with no untoward effects or need for preventive drugs . CONCLUSIONS The proposed st and ardized oral desensitization treatment may represent a safe and convenient alternative in the management of food-allergic subjects During 90 days of elimination diet nineteen children with food allergy manifesting atopic dermatitis were treated with either 120 mg/day of thymomodulin ( 10 subjects ) or placebo ( 9 subjects ) in a double blind design . After this period an improvement in skin lesions was observed in both groups . Subsequently a food challenge was performed for two weeks : in the group treated with thymomodulin  skin lesions did not modify while they worsened in the placebo group and the comparison was statistically significant ( p less than 0.01 ) . Before the beginning of the trial laboratory assessment s evidence d an increase in total and specific IgE serum levels , which decreased by the end of the study only in the group receiving the thymic derivative ( p less than 0.05 ) BACKGROUND Early life allergen exposure may increase the risk of childhood allergy , but the protective effect of reduction in allergen exposure remains uncertain . OBJECTIVE To evaluate the effect of reduction in food and house dust mite ( HDM ) allergen exposure in infancy in preventing asthma and allergy . METHODS Infants , at higher risk because of family predisposition , were recruited prenatally and r and omized to prophylactic ( n = 58 ) and control ( n = 62 ) groups . Prophylactic group infants were either breast-fed with mother on a low allergen diet or given an extensively hydrolyzed formula . Exposure to HDM was reduced by the use of an acaricide and mattress covers . The control group followed st and ard advice .  Development of allergic diseases and sensitization to common allergens ( atopy ) was assessed blindly at ages 1 , 2 , 4 , and 8 years in all 120 children . RESULTS Repeated measurement analysis , adjusted for all relevant confounding variables , confirmed a preventive effect on asthma : adjusted odds ratio ( OR ) , 0.24 ; 95 % CI , 0.09 - 0.66 ; P = .005 ; atopic dermatitis , OR , 0.23 ; CI , 0.08 - 0.64 ; P = .005 ; rhinitis , OR , 0.42 ; CI , 0.19 - 0.92 ; P = .03 ; and atopy , OR , 0.13 ; CI , 0.05 - 0.32 ; P < .001 . The protective effect was primarily observed in the subgroup of children with persistent disease ( symptoms at all visits ) and in those with evidence of allergic sensitization . CONCLUSION Allergic diseases can be reduced , for at least the first 8 years of life , by combined food and HDM allergen avoidance in infancy . CLINICAL IMPLICATION S Strict food and HDM allergen avoidance should be considered for prevention of allergy in high-risk infants IN 1953 Glaser and Johnstone1 reported on the use of soybean milk as an aid in the prophylaxis of  allergic disease in children . They concluded that if one withheld cow 's milk , beef , egg and wheat from the diets of potentially allergic children from the time of birth until the age of six to nine months , only one quarter as many of these children acquired major respiratory allergies compared to their siblings and another nonrelated control group . They also reported that the incidence of atopic eczema in infants on the restricted diet was only one fourth as great as in the . . OBJECTIVE : The goal of this study was to better estimate the prevalence and severity of  childhood food allergy in the United States . METHODS : A r and omized , cross-sectional survey was administered electronically to a representative sample of US households with children from June 2009 to February 2010 . Eligible participants included adults ( aged 18 years or older ) able to complete the survey in Spanish or English who resided in a household with at least 1 child younger than 18 years . Data were adjusted using both base and poststratification weights to account for potential biases from sampling design and nonresponse . Data were analyzed as weighted proportions to estimate prevalence and severity of food allergy . Multiple logistic regression models were constructed to identify characteristics significantly associated with outcomes . RESULTS : Data were collected for 40 104 children ; incomplete responses for 1624 children were excluded , which yielded a final sample of 38 480 .  Food allergy prevalence was 8.0 % ( 95 % confidence interval [ CI ] : 7.6–8.3 ) . Among children with food allergy , 38.7 % had a history of severe reactions , and 30.4 % had multiple food allergies . Prevalence according to allergen among food-allergic children was highest for peanut ( 25.2 % [ 95 % CI : 23.3–27.1 ] ) , followed by milk ( 21.1 % [ 95 % CI : 19.4–22.8 ] ) and shellfish ( 17.2 % [ 95 % CI : 15.6–18.9 ] ) . Odds of food allergy were significantly associated with race , age , income , and geographic region . Disparities in food allergy diagnosis according to race and income were observed . CONCLUSIONS : Findings suggest that the prevalence and severity of childhood food allergy  is greater than previously reported . Data suggest that disparities exist in the clinical diagnosis of disease BACKGROUND One hundred twenty children , identified before birth as being at high risk for atopy , were prenatally assigned to prophylactic or control groups . METHODS The infants in the prophylactic group either received breast milk from mothers on an exclusion diet or an extensively hydrolyzed formula . Their bedrooms and living rooms were treated repeatedly with an acaricide , and they used polyvinyl-covered mattresses with vented head areas . The infants in the control group were fed conventionally , and no environmental control was recommended . RESULTS A significant advantage , first demonstrated at 1 year of age , persists for children in the prophylactic group . They have less of any allergy or eczema , but the reduced prevalence of asthma is no longer significant . Only three children in the prophylactic group had positive skin prick test results compared with 16 in the control group , suggesting a significant reduction in sensitization . CONCLUSION A dual approach to allergen avoidance , focusing on foods and aeroallergens , appears to be beneficial in selected high-risk infants . Avoidance of potent allergens in early life increases the threshold for sensitization in these high-risk infants . Whether sensitization has been avoided or merely deferred has yet to be proved The possibility of obtaining oral desensitization in patients with food allergy is still a matter of debate . We decided to evaluate the safety and efficacy of st and ardized protocol s for oral desensitization with the most common food allergens . Forty-two children ( ages up to 16 years ) diagnosed as affected by food allergy ( on the basis of clinical history , skin prick tests , measurement of specific IgE , and double-blind , placebo-controlled food challenge ) underwent a sublingual-oral desensitizing treatment according to new st and ardized protocol s. The control group consisted of 10 patients who followed an elimination diet .  The treatment was successfully completed by 85.7 % of the patients . Specific IgE showed a significant decrease , while specific IgG4 showed a significant increase , in all treated patients . The immunological modifications observed in our patients lead us to hypothesize that oral tolerance may be mediated by the same mechanisms as those involved in traditional desensitizing treatments for respiratory and insect sting allergy OBJECTIVES : To address questions regarding breastfeeding , complementary feeding , allergy development , and current infant-feeding recommendations . METHODS : This was a nested , case-control within a cohort study in which mothers of 41 infants diagnosed with food allergy by the age of 2 years ( according to double-blind , placebo-controlled food challenge ) and their 82 age-matched controls kept prospect i ve food diaries of how their infants were fed in the first year of life . RESULTS : Infants who were diagnosed with food allergy by the time they were 2 years of age were introduced to solids earlier ( ≤16 weeks of age ) and were less likely to be receiving breast milk when cow ’s milk protein was first introduced into their diet . CONCLUSIONS : This study supports the current American Academy of Pediatrics ’ allergy prevention recommendations and the European Society of Pediatric Gastroenterology , Hepatology and Nutrition recommendations on complementary feeding to not introduce solids before 4 to 6 months of age . It also supports the American Academy of Pediatrics ’ breastfeeding recommendations that breastfeeding should continue while solids are introduced into the diet and that breastfeeding should continue for 1 year , or longer , as mutually desired by mother and infant Of 5,500 newborn infants whose family histories were screened , 900 were found to have anamnestic risk .  Cord-blood IgE was evaluable in 4,677 of these newborns , of which 394 had levels > or = 1 IU/mL ; 84 infants had both anamnestic risk and elevated cord-blood IgE levels . Parents of infants with anamnestic risk were informed of their child 's risk of atopy . Additionally , for 391 infants at two of the three participating hospitals , a preventive diet was prescribed that recommended breastfeeding for the first 6 months of life , with maternal diet restricted to no more than 200 dL of cow milk per day , no more than one egg per week , and no tomato , fish , shellfish , nuts , or foods allergenic to the mother . Only soy formula was recommended , and introduction of solid foods was also carefully prescribed . Furthermore , doctors recommended against exposure to tobacco smoke , animal allergens , and early entrance into daycare . Evaluable infants whose parents complied with the prescribed diet were found to have a lower incidence of atopy during the first year of life ( 13.3 % , n = 158 ) than infants whose parents had ignored the prescribed diet ( 54.7 % , n = 86 ) or infants whose parents were offered no dietary recommendations ( 28.9 % , n = 218 ) . Differences between the compliant group and the two groups with unrestricted diets were significant , indicating that this prescribed diet may protect against or delay onset of food allergies during the first year of life It has been reported that the feeding of cow 's milk may enhance the development of atopy in predisposed infants . A prospect i ve study following children from birth through 15 years of age in a private pediatric practice was design ed to determine if the food ingested during the first months of life is related to the development of atopy in the offspring of allergic families . Each of 328 children with a positive family history of allergy was assigned to one of three groups . according to the feeding preference of the parents : 48 were fed breast milk ; 79 , soy-based formula ; and 201 , cow 's milk formula . All groups had egg , citrus , tomato , and wheat restrictions as well as inhalant allergen avoidance . These were compared to a control group of 580 children with no family history of allergy . Breast fed infants were found to have approximately one-half the incidence of atopy of cow 's milk or soy formula fed infants from atopic families when followed for up to 15 years . Soy feeding produced no advantage over cow 's milk in the prophylaxis of allergic disease . There was a threefold increase in clinical ly apparent atopic disease in offspring of allergic families when compared to controls but only a two-fold increase if the infant was breast fed . These results support the hypothesis that breast feeding and delay of exposure to known allergens may reduce the frequency of clinical allergic disease in the offspring of allergic families Current underst and ing of the use of exclusion diets in the management of  asthma in children is limited and controversial . The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinical ly diagnosed as having mild to moderate disease . The investigation was single blind and prospect i ve , and parents were given the option of volunteering to join the ‘ experiment ’ group , avoiding eggs , milk and their products for eight weeks , or the ‘ control ’ group , who consumed their customary food . Thirteen children were recruited to the experimental group and nine to the control group . A trained paediatrician at the beginning and end of the study period assessed the children . A seven-day assessment of food intake was made before , during and immediately after the period of dietary intervention in both groups . A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so , the peak expiratory flow rate ( PEFR ) was measured . Based on the recommended nutrient intake ( RNI ) , the mean percentage energy intake of the children in the experimental group was significantly lower ( p<0.05 ) in the experimental group . After the eight-week study period and compared with baseline values , the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced ( p<0.05 ) for both in the experimental group . In contrast , the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged . The total IgE values were unchanged in both groups . Over the study period , the PEFR in those children in the experimental group able to perform the test was significantly increased , but no such change was noted in the children in the control group who could do the test . These results suggest that even over the short time period of eight weeks , an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children BACKGROUND The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders . This study examines the development of atopy at age 7 years in 165 children in a high-risk cohort , previously reported from birth to age 4 years . METHODS In this prospect i ve , r and omized , controlled study of food allergen avoidance in infancy , the prophylactic-treated group consisted of infants whose mothers avoided cow 's milk , egg , and peanut during the last trimester of pregnancy and lactation and who , themselves ,  avoided cow 's milk until age 1 year ( casein hydrolysate supplementation before age 1 ) , egg until age 2 years , and peanut and fish until age 3 years . The control group consisted of maternal/infant pairs who followed st and ard feeding practice s. RESULTS Despite a significant reduction in food allergy and milk sensitization before age 2 years , none of the following differed between the groups at age 7 years : food allergy , atopic dermatitis , allergic rhinitis , asthma , any atopic disease , lung function , food or aeroallergen sensitization , serum IgE level , or presence of nasal eosinophils or nasal basophilic cells .  Children with food allergy by 4 years evidence d higher 7-year ( current ) prevalences of allergic rhinitis and asthma ( p < 0.01 ) . Atopic diseases/parameters at age 7 years were shown , by multivariate analysis ( p < 0.05 ) , to be associated with several genetic and environmental risk factors ( male gender , maternal nonwhite ethnicity and asthma , and household smoking ) , as well as predictive atopic markers during infancy ( elevated serum IgE level ; egg , cow 's milk , and peanut sensitization ; and nasal eosinophils and nasal basophilic cells ) . CONCLUSIONS These findings help to : ( 1 ) eluci date the natural history of atopic disease in high-risk children ; ( 2 ) document the progression of allergy from atopic dermatitis , food allergy , and food sensitization to respiratory allergy and aeroallergen sensitization despite food allergy prevention in infancy ; ( 3 ) identify allergy predictive markers ; and ( 4 ) exp and our appreciation of the interactions of genetic and environmental factors in the development of atopy There is much evidence that the development of allergic disorders may be related to early exposure of allergens , including those in breastmilk . We have tried to find out whether avoidance of food and inhaled allergens in infancy protects against the development of  allergic disorders in high-risk infants . In a prenatally r and omised , controlled study 120 infants with family history of atopy and high ( greater than 0.5 kU/l ) cord-blood concentrations of total IgE were allocated r and omly to prophylactic and control groups . In the prophylactic group ( n = 58 ) , lactating mothers  avoided allergenic foods ( milk , egg , fish , and nuts ) and avoided feeding their infants these foods and soya , wheat , and orange  up to the age of 12 months ; the infants ' bedrooms and living rooms were treated with an acaricidal powder and foam every 3 months , and concentrations of Dermatophagoides pteronyssinus antigen(Der p l ) in dust sample s were measured by enzyme-linked immunosorbent assay . In the control group ( n = 62 ) , the diet of mothers and infants was unrestricted ; no acaricidal treatment was done and Der p l concentrations were measured at birth and at 9 months . A paediatric allergy specialist unaware of group assignment examined the infants for allergic disorders at 10 - 12 months . Odds ratios were calculated by logistic regression analysis for various factors with control for other confounding variables . At 12 months , allergic disorders had developed in 25 ( 40 % ) control infants and in 8 ( 13 % ) of the prophylactic group ( odds ratio 6.34 , 95 % confidence intervals 2.0 - 20.1 ) . The prevalences at 12 months of asthma ( 4.13 , 1.1 - 15.5 ) and eczema ( 3.6 , 1.0 - 12.5 ) were also significantly greater in the control group .  Parental smoking was a significant risk factor for total allergy at 12 months whether only one parent smoked ( 3.97 , 1.2 - 13.6 ) or both parents smoked ( 4.72 , 1.2 - 18.2 ) BACKGROUND The double-blind , placebo-controlled food challenge is considered the gold st and ard for diagnosing food allergy . However , in a retrospective analysis of children and adolescents with atopic dermatitis and food allergy , discrete food-specific IgE concentrations were established that could predict clinical reactivity to egg , milk , peanut , and fish with greater than 95 % certainty . OBJECTIVE The purpose of this investigation was to determine the utility of these 95 % predictive decision points in a prospect i ve evaluation of food allergy . METHODS Sera from 100 consecutive children and adolescents referred for evaluation of food allergy were analyzed for specific IgE antibodies to egg , milk , peanut , soy , wheat , and fish by using the Pharmacia CAP System FEIA . Food-specific IgE values were compared with history and the results of skin prick tests and food challenges to determine the efficacy of previously established 95 % predictive decision points in identifying patients with increased probability of reacting during a specific food challenge . RESULTS One hundred children ( 62 % male ; median age , 3.8 years ; range , 0.4 - 14.3 years ) were evaluated for food allergy . The diagnosis of food allergy was established by means of history or oral food challenge . On the basis of the previously established 95 % predictive decision points for egg , milk , peanut , and fish allergy , greater than 95 % of food allergies diagnosed in this prospect i ve study were correctly identified by quantifying serum food-specific IgE concentrations . CONCLUSION In a prospect i ve study of children and adolescents referred for evaluation of food allergy , previously established 95 % predictive decision points of food-specific IgE antibody concentrations for 4 major food allergens were effective in predicting clinical reactivity . Quantification of food-specific IgE is a useful test for diagnosing symptomatic allergy to egg , milk , peanut , and fish in the pediatric population and could eliminate the need to perform double-blind , placebo-controlled food challenges in a significant number of children In an attempt to prevent or reduce the manifestations of atopic disease , a group of infants considered to be genetically at high risk of atopy was entered in a prenatally r and omized , controlled study . A prophylactic group ( n= 58 ) was either breast‐fed with their mothers excluding foods regarded as highly antigenic from their diets , or given an extensively hydrolysed formula . In addition , strenuous efforts were made to reduce exposure to the house‐dust mite by application of acaricide to the bedroom and living room carpets and upholstered furniture . A control group ( n= 62 )  was fed conventionally by breast or on formula , and no specific environmental measures were taken . The results ( previously reported ) after 1 year showed significantly less total allergy , asthma , and eczema in the prophylactic group . Similar results were obtained at 2 years although the reduction in asthma no longer achieved statistical significance . However , there was significantly less sensitization , as shown by a battery of skin prick tests ( SPTs ) , to both dietary allergens and aeroallergens in the prophylactic group . A11 the children have now been review ed at the age of 4 years , and SPTs to a wide range of dietary allergens and aeroallergens have been performed . The control group continues to show more total allergy ( odds ratio [ OR ] 2.73 , 95 % confidence interval [ CI ] 1.21–6.13 , P<0.02 ) , definite allergy ( allergic symptoms plus positive SPT ) ( OR 5.6 , CI 1.8–17.9 , P<0.005 ) , and eczema ( OR 3.4 , CI 1.2–10.1 , P<0.05 ) . More control children have positive SPTs ( OR 3.7 , CI 1.3–10.0 , P<0.02 ) . A dual approach to the prevention of allergic disease , avoiding as far as possible sensitization to food and aeroallergens , significantly reduces the risk of atopic disease . This should be reserved for infants considered at very high risk of atopy , and close medical and dietetic supervision must be available Aims : To investigate the effect of breast feeding on  allergic disease in infants up to 2 years of age . Methods : A birth cohort of 4089 infants was followed prospect ively in Stockholm , Sweden . Information about various exposures was obtained by parental question naires when the infants were 2 months old , and about allergic symptoms and feeding at 1 and 2 years of age . Duration of exclusive and partial breast feeding was assessed separately . Symptom related definitions of various allergic diseases were used . Odds ratios ( OR ) and 95 % confidence intervals ( CI ) were estimated in a multiple logistic regression model . Adjustments were made for potential confounders . Results : Children exclusively breast fed during four months or more exhibited less asthma ( 7.7 % v 12 % , ORadj = 0.7 , 95 % CI 0.5 to 0.8 ) , less atopic dermatitis ( 24 % v 27 % , ORadj = 0.8 , 95 % CI 0.7 to 1.0 ) , and less suspected allergic rhinitis ( 6.5 % v 9 % , ORadj = 0.7 , 95 % CI 0.5 to 1.0 ) by 2 years of age . There was a significant risk reduction for asthma related to partial breast feeding during six months or more ( ORadj = 0.7 , 95 % CI 0.5 to 0.9 ) . Three or more of five possible allergic disorders — asthma , suspected allergic rhinitis , atopic dermatitis , food allergy related symptoms , and suspected allergic respiratory symptoms after exposure to pets or pollen — were found in 6.5 % of the children . Exclusive breast feeding prevented children from having multiple allergic disease ( ORadj = 0.7 , 95 % CI 0.5 to 0.9 ) during the first two years of life . Conclusion : Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease — that is , asthma , atopic dermatitis , and suspected allergic rhinitis , up to 2 years of age . This protective effect was also evident for multiple allergic disease
One study found that children with food allergies who did not receive nutrition counseling were more likely to have inadequate intake of calcium and vitamin D.  CONCLUSION Children with multiple food allergies have a higher risk of impaired growth and may have a higher risk of inadequate nutrient intake than children without food allergies .
BACKGROUND Food allergies affect up to 8 % of American children .
The current recommended treatment for food allergies is strict elimination of the allergens from the diet .
Dietary elimination of nutrient-dense foods may result in inadequate nutrient intake and impaired growth .
The purpose of this review was to critically analyze available research on the effect of an elimination diet on nutrient intake and growth in children with multiple food allergies .