Allergy Journal club

HANI GOWAI
NOV 2020
 Article first published in May 2020.

 Funded by the European Academy of Allergy and Clinical Immunology (EAACI)

 Published in Paediatric allergy and immunology journal.

Aim

 To assess the effectiveness of any approach (intervention) for preventing the

development of immediate-onset/IgE-mediated food allergy (outcome) in infants,

children, and adults (population) compared to any other intervention or

placebo(comparator)
Methods

 Task force: multiprofessional, included patient representatives, spanned 4

continents.

 Gastro, immunology, allergy, researchers, IT, dietetics.

Methods

 Population: infants to adults with or without increased risk for developing

allergic disease and with or without any sensitization or atopic manifestations

 Comparator: independently sampled groups with or without placebo or

intervention(s)

 Outcome: studies reporting new cases of immediate onset food allergy (defined:
adverse response to food protein within hours caused by immunologic reaction.
Methods

 Included studies from 1946 – Oct 2019

 All published RCTs were included regardless of size.
 Only included studies available in full form.
 All languages included.
Methods

 Trials were assessed for bias using the Cochrane Risk of Bias Tool 2 (ROB2)
 Searched 11 databases.
 Searched reference lists.
 Screened all abstracts and full texts.
 2 studies were not agreed by all, but decided to include them by consensus.
Characteristics of studies

 46 studies were included.

 41 trials and 5 cohort studies.

 Most studies were from Europe (65%).

 57% of studies published between 2010-2019
 All studies focused on preventing the development of food allergy in infants (up
to 1 year old, 35%) or early childhood (up to 5 years, 43%) or both (22%)

 Examined dietary strategies.

 Majority focused on those at increased risk of developing food allergy.

Results

 They used GRADE statements to describe the evidence and the certainty
(Grading of Recommendations, Assessment, Development, and Evaluation)

 Is meant to evaluate evidence regarding desired outcomes.

 Consensus of all authors on conclusions

 High risk of bias in 57%, moderate in 33%.

 Grade certainty of evidence was generally low.

 Grade affected by bias, imprecision, indirectness.

 Issues with confounding, blinding, loss of follow up, diagnostic criteria and
underpowering.
Conclusion

 There is no good evidence that families should avoid food allergens or take
supplements to prevent food allergy

 More research is needed.

Comments

 Up-to-date review. (previous 35 systematic reviews).

 Low powered studies for the effect desired.
 Safety reports were limited among studies included.
 Heterogeneity of included interventions.
 Represents population of high income communities.
 High bias among studies included.
Would it change the practice?

 Clearly we need more research on the subject.

 No robust evidence can be generalised so far on all children.

 Some evidence in certain populations with certain interventions.

 When counselling patients and families.