Updates in Food Allergy Prevention in Children

Implementing the 2017 NIAID Peanut Guidelines into a Pediatric Primary Care Provider Setting: A real-world experience

BACKGROUND

Primary care physicians (PCPs) and nurse practitioners play a key role in guiding caregivers on early peanut protein (PP) introduction, yet many lack adequate knowledge.

AIM STATEMENT

This quality improvement study aimed to enhance understanding among PCPs and caregivers about evidence-based guidelines for early PP introduction in infants' diets.

METHODS

Using the Stetler Model, PCP knowledge was evaluated through pre-test, educational video and some posttest material. Caregivers completed the Patient Education Materials Assessment Tool (PEMAT) survey after reviewing an educational handout RESULTS: The N = 22 PCPs pre-education test score had an average of 61.11% and noted N = 21 PCPs posteducation test score average to increase to 84.09%. The N = 68 caregivers completed the PEMAT survey, with results indicating enhanced caregiver knowledge. Infant participation in PP introduction was tracked, alongside ingestion frequency.

CONCLUSIONS

Findings in this study underscore the value of education in fostering proactive counseling and informed practices in clinical settings.

National Trends and Disparities in Complementary Food Diversity Among Infants: A 12-Year Cross-Sectional Birth Cohort Study

Background: The complementary food introduction and consumption guidelines for atopic dermatitis and food allergy prevention have evolved; however, their impact on infant feeding practices remains unclear. This study aimed to analyze complementary food diversity trends in infants, identify vulnerable infants with limited food diversity, and examine the trends in infants with or without vulnerable factors over time. Methods: This study analyzed infants aged 9-12 months who participated in the food diversity survey, conducted as part of the National Health Screening Program in Korea from 2009 to 2020. The complementary food items included grains, vegetables, fruits, eggs, fish, and meats. Infants consuming "six" and "less than six" complementary food items were categorized into high- and low-food-diversity groups, respectively. The study employed logistic regression models to examine the trends in food diversity and vulnerable factors with an assessment of the interaction effects. Results: This study included 3,425,301 participants (51.5% male) aged 11.3 months (standard deviation, 0.8). The high-food-diversity prevalence significantly increased over time, from 30.8% in 2009 to 52.9% in 2020 (p < 0.001). Vulnerable infants included those with preterm birth, low birth weight, non-breastfeeding status, high socioeconomic status, non-Seoul residence at birth, any perinatal conditions, hospitalization due to wheezing, atopic dermatitis and food allergies. The high-diversity proportion increased significantly over the study period across all vulnerable factors (p for interaction < 0.001). However, no significant interactions were observed between the study years and vulnerable factors, except for food allergy (β Coefficient, -0.0117, p for interaction = 0.004). Conclusions: The increasing trends in high-complementary-food-diversity proportions highlight the substantial progress over the study period. However, persistent disparities in vulnerable populations underline the importance of targeted interventions, including tailored nutritional education and policies, that promote equitable dietary practices during early life.

Early-life risk factors which govern pro-allergic immunity

Allergic diseases affect up to 40% of the global population with a substantial rise in food allergies, in particular, over the past decades. For the majority of individuals with allergy fundamental programming of a pro-allergic immune system largely occurs in early childhood where it is crucially governed by prenatal genetic and environmental factors, including their interactions. These factors include several genetic aberrations, such as filaggrin loss-of-function mutations, early exposure to respiratory syncytial virus, and various chemicals such as plasticizers, as well as the influence of the gut microbiome and numerous lifestyle circumstances. The effects of such a wide range of factors on allergic responses to an array of potential allergens is complex and the severity of these responses in a clinical setting are subsequently not easy to predict at the present time. However, some parameters which condition a pro-allergic immune response, including severe anaphylaxis, are becoming clearer. This review summarises what we currently know, and don't know, about the factors which influence developing pro-allergic immunity particularly during the early-life perinatal period.

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children

PURPOSE OF REVIEW

Over the past two decades, food allergy prevention strategies have shifted from 'delayed introduction' to 'no delayed introduction' to 'early introduction' of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention.

RECENT FINDINGS

Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing.

SUMMARY

Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.

Pharmacoequity and Biologics in the Allergy Clinic: Providing the Right Care, at the Right Time, Every Time, to Everyone

Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status, which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower socioeconomic status, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. Whereas pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and SMART for asthma. Current programs aimed at alleviating cost barriers are imperfect. Patient assistance programs, manufacturer-sponsored free drug programs, and rebates often increase the complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single silver-bullet solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.