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Food allergy is a significant issue worldwide, particularly in Westernised countries. There is no clear explanation why food allergy appears to have increased so rapidly in recent years, particularly in young children, hence ongoing research to identify effective primary prevention strategies. Food allergy prevention guidelines for health professionals have been developed based on existing clinical trial evidence for effective translation and implementation. As these guidelines underpin clinical practice, it is important to ensure robust processes of development. We conducted a systematic review to identify food allergy prevention guidelines for health professional use; to compare the recommendations made by the identified guideline documents; and to assess the quality of the identified guideline documents.
We searched Medline, EMBASE, CINAHL, Scopus, Global Health and Guidelines International Network for the period 1990 to 13 August 2019, to identify articles referring to English-language food allergy prevention guidelines or the guidelines themselves. A grey literature search of Google Scholar and reference checking was also undertaken. The guidelines were compared for recommendation similarities and differences. An Appraisal Guidelines for Research and Evaluation (AGREE II) appraisal was undertaken to assess guideline quality.
The electronic database search yielded 1121 publications and reference checking identified an additional 16 publications. After title, abstract and full text screening, data extraction was undertaken on 156 publications and with additional reference checking, 28 food allergy prevention guidelines and advice documents were identified. Comparison of the recommendations within the guidelines and advice documents indicated the greatest variation in recommendations related to exclusive breastfeeding and timing of solid food introduction. Eight of the 10 guidelines and none of the 18 advice documents met the quality threshold set by the reviewers. Overall, documents specifically termed "guidelines" scored better than advice documents when assessed using the AGREE II tool.
Variation in recommendations may create confusion for health professionals and result in inconsistent advice being provided to parents, and less translation of the evidence into actual food allergy reduction in the population. Appraisal using the AGREE II tool identified that there is considerable room for improvement in the development of guidelines and advice documents for food allergy prevention. The AGREE II appraisal identified common areas of poorer quality development and/or documentation of processes to inform future guideline development. Based on this study, we recommend the use of validated guideline development tools, to direct food allergy prevention guideline review or development. Use of the AGREE II tool, to direct the review and development of guidelines, is very likely to improve guideline quality.
Workgroup report by the joint task force involving American Academy of allergy, asthma & immunology (AAAAI); food allergy, anaphylaxis, dermatology and drug allergy (FADDA)(Adverse reactions to foods committee and adverse reactions to drugs, biologicals, and latex committee); and the centers for disease control and prevention botulism clinical treatment guidelines work group - allergic reactions to botulinum antitoxin: a systematic review.
There is also evidence of a high prevalence of food allergy in developing countries, with a 2.5% incidence of challenge-proven food allergy observed in South Africa in 2015
Preventing food allergy is, therefore, a logical step in minimising the mortality, significant morbidity, and related costs associated with this condition.
Food allergy prevention strategies based on delaying introduction of common food allergens in high risk individuals have been largely ineffective,
and, consequently, the search for effective primary prevention strategies has shifted to interventions including: timeframe for exclusive breastfeeding, breastmilk substitutes, early introduction of foods including common food allergen introduction, vitamin D and omega-3 fatty acid supplementation, and modification of the maternal and infant microbiome.
In 2015, several randomised controlled trials (RCTs) and a meta-analysis of these trials examining the effect of early introduction of food allergens on the development of food allergy were published.
Several large RCTs have examined the effect of early introduction of egg into the diet compared with delayed introduction and have shown some evidence that, depending on the baseline risk status of the treatment group, prevention of IgE-egg sensitisation or egg allergy may be associated with earlier introduction of egg.
Two-step egg introduction for prevention of egg allergy in high-riak infants with eczema (PETIT): a radnomized, double-blind, placebo-controlled trial.
However, the Enquiring about Tolerance (EAT) study which examined the effect of introduction of 6 foods (cow's milk, egg, peanut, wheat, fish, sesame) to the diet of exclusively breastfed infants from 3 months of age,
Two-step egg introduction for prevention of egg allergy in high-riak infants with eczema (PETIT): a radnomized, double-blind, placebo-controlled trial.
The Learning Early About Peanut (LEAP) study, which randomised 640 high risk infants aged 4–11 months to consume or avoid peanut until 60 months of age, was a pivotal peanut allergy prevention study.
Food allergy prevention guidelines for health professionals should be developed based on existing clinical trial evidence for effective translation and implementation. As guidelines are intended to underpin clinical practice, it is important that high quality evidence is integrated, and the development and reported process is robust.
The Appraisal Guidelines for Research and Evaluation (AGREE II) tool
The AGREE II tool assesses guidelines across 6 domains: scope/purpose; stakeholder involvement; rigor of development; presentation; applicability; and editorial independence. Assessing the quality of guidelines (including advice documents) is important to determine (1) if adequate guideline development processes were used; and (2) where the guideline documents differ in quality based on their nominated title (eg, guideline vs. consensus statement) and processes used in development.
This systematic review aimed to identify food allergy prevention guidelines for health professional use; to compare the recommendations made by the identified guideline documents; and to assess the quality of the identified guideline documents.
Methodology
In this review, the word "guideline" is defined as any document termed an evidence-based guideline, expert recommendation, consensus statement, joint statement, position paper, or clinical report/guidance document, in accordance with the World Health Organisation (WHO) definition of “any document that contains recommendation for clinical health practice or public health policy”.
The AGREE II consortium acknowledges that documents specifically titled as "guidelines" generally score higher when appraised using the AGREE II tool than non-official guideline documents.
Hence, for this AGREE II assessment, a comparison has been made between documents specifically named "guidelines" by their authors in their title and all other documents which have been grouped together as "advice documents".
Search strategy
The literature was systematically searched to identify guidelines and advice documents developed for health professional use for the primary prevention of food allergy. A two-phase search was employed with the initial phase identifying both guideline documents and publications that referred to a guideline document. The second phase involved sourcing all the guideline documents identified in phase 1.
The following databases were searched for the period 1990 to 13 August 2019: Medline, EMBASE, CINAHL, Scopus, Global Health and Guidelines International Network. A grey literature search of Google Scholar was also undertaken. In addition, a search of the reference lists from publications included in the full-text screen and references from identified guideline documents was undertaken. English language restrictions were applied. Guideline documents and studies reporting guideline documents between January 1990 and the date of the search (13 August 2019) were sought.
The following search terms were used: (“health professionals” OR “general practitioners” OR “nurses” OR “dietitians” OR “dieticians”) AND (“food allergy” OR “food hypersensitivity” OR “allergy”) AND (“guidelines” OR “guideline” OR “policies” OR “policy” OR “strategy” OR “recommendation” OR “statement” OR “protocol” OR “consensus” OR “clinical practice”) AND (“prevention” OR “primary prevention”).
Article selection
Publications identified from the search were exported to Endnote reference management software, version 8 (Clarivate Analytics, Philadelphia, PA), duplicates removed, then uploaded to Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia) for screening. Two reviewers independently screened the titles and abstracts of all publications identified in the search. All publications meeting the inclusion criteria were retained. Where the titles and abstracts provided insufficient details, full-text publications were retrieved and screened again by both reviewers against the inclusion criteria. All disagreements were resolved by discussion between the reviewers without the need for moderation.
Two reviewers independently extracted data of interest using standardised data extraction forms developed for this review. The following information, where available, was extracted for each publication: authors; article title; name of guideline document; year of guideline document; name of organisation; country. Once identified through data extraction, the guideline documents were retrieved.
Selection criteria
For phase 1 of the search, the following were included: guideline documents whose stated purpose was the primary prevention of food allergy (including the original guideline document and articles referring to such guideline documents); guideline documents and articles in English; and guideline documents intended specifically for health professional use. Guideline documents for stated purposes other than primary prevention of food allergy were included only if they provided detailed, specific recommendations regarding food allergy prevention within their scope.
For phase 2 of the search, English language guideline documents whose stated purpose was the primary prevention of food allergy for health professionals were included; and guideline documents for stated purposes other than primary prevention of food allergy were included only if they provided detailed, specific recommendations regarding food allergy prevention within their scope.
If one professional organisation or government published more than one guideline document, all versions meeting the selection criteria were included in the review.
Guideline comparison
The recommendations contained within the guideline documents relating to maternal diet during pregnancy and lactation; breastfeeding substitutes; solid food timing; advice regarding introduction of common food allergens; specific advice regarding egg and peanut introduction; and spacing of introduction of new foods, were retrieved as these are key factors in relation to food allergy prevention. The guidelines were compared for their recommendations relating to these factors. Other interventions such as Vitamin D, omega-3 fatty acid supplementation, and modification of the maternal diet and the infant microbiome, were not included in this review.
Quality appraisal of guideline documents
Quality assessment of all identified guideline documents was undertaken independently by 2 reviewers who reviewed and scored each guideline document using the AGREE II tool.
The AGREE II tool assesses guidelines using the following domains: scope/purpose (objectives, question, population); stakeholder involvement (group membership, target population, target users); rigor of development (search methods, evidence criteria, evidence strengths and limitations, recommendations, benefits and harms considerations, recommendations and evidence link, external review, and updating procedures); presentation clarity (specific, unambiguous recommendations, management options, and identifiable key recommendations); applicability (application facilitators and barriers, implementation of advice/tools, resource implications, and monitor/audit criteria); and editorial independence (funding body, competing interests).
The reviewers referred to the AGREE II tool with the user's manual
when assessing the guideline documents and were masked to scores assigned by the other reviewer. Each domain has a different number of quality assessment questions, each requiring a score between 1 and 7 (7 being the highest score). The quality scores were synthesised and domain scores for each guideline document calculated according to the AGREE II manual protocol.
Domain scores are calculated by subtracting the minimum possible score for the domain from the obtained score for the domain; this is then divided by the maximum possible score for the domain minus the minimum possible score for the domain; this score is multiplied by 100 to achieve a percentage.
the quality threshold for guideline acceptability was defined as guideline documents achieving at least 50% for Domain 3 (rigor of development) and at least 50% for at least 2 other domains.
Statistical analysis
Data were analysed in SPSS 26.0 (SPSS Inc, Chicago, IL). Descriptive statistics for the AGREE II assessment were obtained, and comparison of the means of the guidelines compared to the advice documents was undertaken using an independent t-test.
Results
The electronic database search yielded 1121 publications and reference checking identified an additional 18 publications. After removal of duplicates (n = 477); title and abstract screening was undertaken on 660 publications; 239 publications underwent full-text screening. Data extraction was undertaken on 156 publications to identify guideline documents including: the name of the guideline, creator/owner, country, and date. Two additional guideline documents were identified through reference searching. This yielded 28 guideline documents (from 17 organisations) over a period of 21 years (Supplemental Figure 1). The AGREE II appraisal was undertaken on all 28 guideline documents identified.
Identified guideline documents
A summary of included guideline documents is provided in Table 1.
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Where an organisation had more than 1 version of their guideline document, all versions were included. A timeline of the 28 food allergy prevention guidelines is provided in Fig. 1.
Table 1Summary of included guideline documents
Organisation
Name of document
Author specified type of document
Region
Year
American Academy of Paediatrics
Effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods and hydrolysed formulas
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
The effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, hydrolysed formulas and timing of introduction of allergenic complementary foods
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
European Society for Paediatric Allergology and Clinical Immunology (ESPACI) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Dietary products used in infants for treatment and prevention of food allergy
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Complementary feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Italian Society of Preventative and Social Paediatrics (ISPSP), the Italian Society of Paediatric Allergy and Immunology (ISPAI) and the Italian Society of Pediatrics (ISP)
Prevention of food and airway allergy: consensus of the Italian Society of Preventative and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
Philippine Society of Allergy, Asthma and Immunology (PSAAI) and the Philippine Society for Paediatric Gastroenterology, Hepatology and Nutrition (PSPGHN)
Dietary prevention of allergic diseases in children: the Philippine guidelines
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
The recommendations within the 28 guidelines document in relation to maternal diet, exclusive breastfeeding, breastmilk substitutes, timing of solid food introduction, and any recommendations for specific food introduction are summarised in Table 2.
Table 2Summary of comparison of recommendations.
Guideline document
Maternal diet (pregnancy and breastfeeding)
Breastfeeding
Breastmilk substitutes
Solid food timing
Peanut and egg
AAP 2019
No restrictions
-
not applicable for 2015 document
-
no change from 2008 document
Exclusive BF for at least 4 months
-
not applicable for 2015 document
-
no change from 2008 document
Hydrolysed formula not recommended
-
not applicable for 2015 document
-
2008 document ‘soy formula not recommended’
4–6 months of age: Do not delay common allergens
-
not applicable for 2015 document
-
no change from 2008 document
HRI - earliest age of peanut introduction is 4–6 months and consider evaluation of HRI by allergist before peanut introduction; Infants with mild-moderate eczema - earliest age of peanut introduction is around 6 months; Infants with no eczema or any food allergy - earliest age of peanut introduction is age appropriate and based on family meals and culture 2015 document ‘For HRI - introduce peanut between 4 and 11 months of age; Consider evaluation of HRI by allergist before peanut introduction’
ACAAI 2006
Not applicable
Exclusive BF for 6 months
Standard cow's milk formula
6 months of age; Delay introduction of common allergens; Cooked, homogenised foods should be preferred over fresh counterparts if reduced allergenicity (e.g. beef and kiwifruit); egg, peanut, tree nuts fish and seafood introduction requires caution
Peanut and egg introduction requires caution
APAPARI 2017
Not applicable
Continue BF alongside solid food introduction up to 2 years if possible, according to cultural practice
Not specified
HRI - recommend allergy testing to egg and peanut; At risk infants - no delay in introduction of allergenic foods; Healthy infants - 6 months of age
Allergy testing for HRI prior to introduction of egg and peanut
ASCIA 2016
No restrictions; Healthy balanced diet; Up to 3 serves oily fish/week during pregnancy
-
2005 and 2008 documents only stipulated ‘no restrictions’
At least 6 months (where possible) and for as long as mother and infant wish to continue
-
No change from 2008 document
-
2005 document ‘exclusive BF for 4–6 months’
All infants - standard cow's milk formula
-
2008 document ‘pHF for HRI; soy milk is not recommended’
-
2005 document ‘pHF or eHF for HRI; soy milk is not recommended’
When infant is ready, around 6 months, not before 4 months; Introduce all common allergens; egg should be cooked; Continue to regularly include in infant diet once introduced
-
2008 document ‘From around 4–6 months; Introduce all common allergens’
-
2005 document ‘From 4 to 6 months; Introduce; peanut, nuts and shellfish for the first 2–4 years of life may be recommended. However, peanut, nut and shellfish avoidance may be recommended’
Introduce cooked egg and peanut before 12 months of age; Procedure for high risk infants
-
2008 document ‘Do not delay’
-
2005 document ‘Peanut avoidance for first 2–4 years may be recommended’
BSACI 2018
Not applicable
Exclusive BF for around 6 months; Continue to breastfeed while introducing solids if possible
Standard cow's milk formula
From around 6 months, but not before 4 months, when infant is ready; HRI - parents may wish to introduce solids from 4 months, cooked egg then peanut should be given, then other allergenic foods; egg should be cooked; Introduce before 12 months of age; Continue to regularly include in infant diet once introduced
HRI - may benefit from introduction of peanut and egg from 4 months alongside other foods
CPS and CSACI 2019
Not applicable
-
2013 document ‘no restrictions’
Breastfeed for up to 2 years and beyond - 2013 document ‘Exclusive BF for first 6 months’
Not applicable
-
2013 document ‘Hydrolysed formula; Soy formula not recommended’
HRI - around 6 months of age but not before 4 months; All other infants - around 6 months; Introduce all common allergens; Continue to regularly include in infant diet once introduced
-
2013 dcoument ‘From 6 months of age; introduce all common allergens’
Do not delay
-
No change from 2013 dcoument
DGAKI and DGKJ 2014
Balanced and varied diet; No restrictions; Fish should form part of the maternal diet
-
No change from 2009 document
Predominantly breastfed up to 4 months of age
-
2009 document ‘Exclusive BF up to 4 months of age’
Hydrolysed infant formula until 4 months of age; Soy based formula is not recommended for allergy prevention
-
2009 specified pHF or eHF, otherwise no change
From over the age of 4 months; Common allergens should not be delayed; Fish should be introduced by 12 months of age
-
No change from 2009 document
Not specified
-
No change from 2009 document
EAACI 2014
No restrictions; No supplements while breastfeeding
-
2004 only stipulated ‘no restrictions’
Exclusive BF for 4–6 months
-
2004 document ‘Exclusive BF for at least 4 months’
HRI - hydrolysed formula until 4 months of age then standard cow's milk formula; All other infants - standard cow's milk formula; Soy and hydrolysed formulas not recommended
-
2004 document ‘eHF until 4–6 months; pHF may have an effect; Soy formulas not recommended’
From 4 to 6 months of age, when infant is ready; Neither withhold nor encourage exposure of common food allergens
-
2004 document ‘Preferably 6 months but at least 4 months of age; No evidence for restrictive diets beyond 6 months for common food allergens’
Not specified
-
No change from 2004 document
ESPGHAN 2017
Not applicable
-
No change from 1999 to 2017 documents
Continue BF while introducing solid foods
-
2007 document ‘Exclusive BF for around 6 months
-
1999 document ‘Exclusive BF for 4–6 months’
Not specified
-
No change from 2007 document
-
1999 document ‘HRI - reduced allergenicity formula; All other infants - standard cow's milk formula’
Not before 17 weeks; Do not delay common food allergens
-
No change from 2007 document
-
1999 document ‘From 5 months; no information specified regarding common food allergens’
High risk infants - introduce peanut between 4 and 11 months
-
2007 document ‘Do not delay’
-
Not specified in 1999 document
Finish Allergy Program 2012
No restrictions
Exclusive BF for 4–6 months
Standard cow's milk formula
From 4 to 6 months while continuing BF; Introduce wheat and oats by 6 months of age
Do not delay
HKIA 2016
Not applicable
-
2015 document ‘Healthy diet during pregnancy; No restrictions’
Not applicable
-
2015 document ‘At least 4–6 months’
Not applicable
-
2015 document ‘HRI - consider hydrolysed formula if exclusive breastfeeding is not possible’
HRI - SPT before introduction encouraged; Low risk infants - introduce peanut upon introduction of foods; Do not delay common food allergens
-
2015 document ‘From 4 to 6 months of age when developmentally ready; Neither withhold nor encourage exposure to common food allergens’
HRI - SPT; negative and mild positive SPT - 6g peanut protein/wk 3 times/wk until 5 years of age; Positive SPT - oral peanut challenge, include peanut if negative challenge an avoid peanut if positive challenge
-
Not specified in 2015 document
ISPSP and ISPAI and ISP 2016
Fish oil supplementation not recommended
Exclusive BF for at least 4 months (possibly 6 months)
Standard cow's milk formula
After the 4th month and if possible after the 6th month; Introduce common food allergens in the same way as for children without allergic risk
Not specified
JSPACI 2017
No restrictions
Insufficient evidence to indicate superiority of BF in the prevention of allergic disease
Insufficient evidence to support the use of hydrolysed formula
From 5 to 6 months of age when developmentally ready; Do not delay common food allergens
Introduce peanuts sooner rather than later after weaning
NIAID 2017
Not applicable
-
2010 document ‘no restrictions’
Not applicable
-
2010 document ‘Exclusive BF until 4–6 months of age, unless BF is contraindicated for medical reasons’
Not applicable
-
2010 document ‘HRI - hydrolysed formulas may be considered; Soy formula not recommended’
4–6 months of age; Introduce common food allergens from 4 to 6 months of age
-
No change from 2010 document
HRI - earliest age of peanut introduction is 4–6 months and consider evaluation of HRI by allergist before peanut introduction; Infants with mild-moderate eczema - earliest age of peanut introduction is around 6 months; Infants with no eczema or any food allergy - earliest age of peanut introduction is age appropriate and based on family meals and culture
-
Not specified in 2010 document
PSAAI and PSPGHN 2017
No increased intake of certain foods recommended; No restrictions
Exclusive BF for at least 3–6 months
HRI – pHF or eHF recommended for at least 6 months; Soy milk not recommended
From 6 months of age; Cooked egg at 4–6 months; wheat before 6 months; fish at 6–9 months; peanut at 4–11 months
Cooked egg at 4–6 months; peanut at 4–11 months
SACN and COT 2018
Not applicable
Exclusive BF for around 6 months
Not specified
Around 6 months of age; No information regarding common food allergens
Introduce peanut and egg around 6 months of age; If history of eczema or suspected food allergy, medical advice before peanut introduction may be sought; once introduced, peanut and egg should continue to be consumed as part of the usual infant diet
AMS-MOH 2010
No restrictions
Exclusive BF for at least 4–6 months
HRI - hydrolysed formula recommended; Avoid cow's milk formula in the first 5 days of life
4–6 months of age for all infants; No information regarding common food allergens
Not specified
Abbreviations: BF = breastfeeding; HRI = High risk infants; SPT = Skin prick test; AAP = American Academy of Pediatrics; ACAAI = American College of Allergy, Asthma and Immunology; APAPARI = Asia Pacific Association of Paediatric Allergy, Respirology & Immunology; ASCIA = Australasian Society of Clinical Immunology and Allergy; BSACI = British Society for Allergy & Clinical Immunology; CPS = Canadian Paediatric Society; CSACI = Canadian Society of Allergy and Clinical Immunology; DGAKI = German Society for Allergology and Clinical Immunology; DGKJ = German Society for Paediatric and Adolescent Medicine; EAACI = European Academy for Allergy and Clinical Immunology; ESPACI = European Society for Paediatric Allergology and Clinical Immunology; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HKIA = Hong Kong Institute of Allergy; ISPSP = Italian Society of Preventative and Social Paediatrics; ISPAI = Italian Society of Paediatric Allergy and Immunology; ISP = Italian Society of Pediatrics; JSPACI = Japanese Society of Paediatric Allergy and Clinical Immunology; NIAID = National Institute of Allergy and Infectious Diseases; PSAAI = Philippine Society of Allergy, Asthma and Immunology; PSPGHN = Philippine Society for Paediatric Gastroenterology, Hepatology and Nutrition; SACN = Scientific Advisory Committee on Nutrition; COT = Committee on Toxicity of Chemicals in food, consumer products and the environment; AMS-MOH = Academy of Medicine, Singapore Ministry of Health
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
included recommendations regarding maternal diet during pregnancy and lactation. Eleven guideline documents did not include maternal dietary recommendations as they were guidelines specific to infant feeding. Of the 17 with maternal diet recommendations, all stipulated "no dietary restrictions".
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Two guideline documents provided no recommendation regarding exclusive breastfeeding but stipulated that breastfeeding "should continue up to 2 years or longer".
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
Prevention of food and airway allergy: consensus of the Italian society of preventive and social Paediatrics, the Italian society of paediatric allergy and immunology, and Italian society of Pediatrics.
Committee for Japanese pediatric guideline for food allergy, the Japanese society of pediatric allergy and clinical immunology, the Japanese society of Allergology. Japanese guidelines for food allergy 2017.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
Joint Statement from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Assessing the Health Benefits and Risks of the Introduction of Peanut and Hen's Egg into the Infant Diet before Six Months of Age in the UKA. 2018
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
S3-Guideline on allergy prevention: 2014 update: guideline of the German society for Allergology and clinical immunology (DGAKI) and the German society for pediatric and adolescent medicine (DGKJ).
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Where documented, the majority of documents that recommended the use of hydrolysed formulas were based on evidence suggesting potential reduction in allergic disease generally;
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
NIAID-Sponsored Expert Panel Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel.
Academy of medicine, Singapore-Ministry of Health clinical practice guidelines: management of food allergy.
Singapore Med J.2010 Jul; 51 (Erratum in: Singapore Med J. 2013 Aug;54(8):474. Aw, M [corrected to Aw, M M]; Shek, L [corrected to Shek, L P]. PMID: 20730402): 599-607
Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
Committee on nutrition; section on allergy and immunology. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods.
Adverse reactions to foods committee; American College of allergy, asthma and immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse reactions to foods committee, American College of allergy, asthma and immunology.
Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI). Early introduction of allergenic foods for the prevention of food allergy from an asian perspective-an Asia pacific association of pediatric allergy, Respirology & immunology (APAPARI) consensus statement.
Canadian paediatric society, community Paediatrics committee and allergy section. Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian society of allergy and clinical immunology.
Dietary prevention of allergic diseases in infants and small children. Part III: critical review of published peer-reviewed observational and interventional studies and final recommendations.
Dietary products used in infants for treatment and prevention of food allergy. Joint statement of the European society for paediatric Allergology and clinical immunology (ESPACI) committee on hypoallergenic formulas and the European society for paediatric Gastroenterology, Hepatology and nutrition (ESPGHAN) committee on nutrition.
Complementary feeding: a position paper by the European society for paediatric Gastroenterology, Hepatology, and nutrition (ESPGHAN) committee on nutrition.
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