Despite several intervention trials involving modifications to the maternal diet , the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear .
Summary Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants .
Purpose of review In the past decade , food allergy has been increasingly recognized as an important public health issue .
The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period .
Recently , research in this area has moved from observational studies to intervention trials , and the findings from these trials have started to influence infant feeding guidelines .
In this article , we review recent studies of dietary interventions for preventing food allergy , summarize current knowledge and discuss future research directions .
Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial
BACKGROUND Evidence is accumulating that early consumption is more beneficial than is delayed introduction as a strategy for primary prevention of food allergy . However , allergic reactions caused by early introduction of such solid foods have been a problematic issue . We investigated whether or not early stepwise introduction of eggs to infants with eczema combined with optimal eczema treatment would prevent egg allergy at 1 year of age . METHODS In this r and omised , double-blind , placebo-controlled trial , we enrolled infants 4 - 5 months of age with eczema from two centres in Japan . Exclusion criteria were being born before 37 weeks of gestational age , experience of ingestion of hen 's eggs or egg products , history of immediate allergic reaction to hen 's eggs , history of non-immediate allergic reaction to a particular type of food , and complications of any severe disease . Infants were r and omly assigned ( block size of four ; stratified by institution and sex ) to early introduction of egg or placebo ( 1:1 ) . Participants in the egg group consumed orally 50 mg of heated egg powder per day from 6 months to 9 months of age and 250 mg per day thereafter until 12 months of age . We aggressively treated participants ' eczema at entry and maintained control without exacerbations throughout the intervention period . Participants and physicians were masked to assignment , and allocation was concealed . The primary outcome was the proportion of participants with hen 's egg allergy confirmed by open oral food challenges at 12 months of age , assessed blindly by st and ardised methods , in all r and omly allocated participants who received the intervention . This trial is registered with the University Hospital Medical Information Network Clinical Trials Registry , number UMIN000008673 . FINDINGS Between Sept 18 , 2012 , and Feb 13 , 2015 , we r and omly allocated 147 participants ( 73 [ 50 % ] to the egg group and 74 [ 50 % ] to the placebo group ) . This trial was terminated on the basis of the results of the scheduled interim analysis of 100 participants , which showed a significant difference between the two groups ( four [ 9 % ] of 47 participants had an egg allergy in the egg group vs 18 [ 38 % ] of 47 in the placebo group ; risk ratio 0·222 [ 95 % CI 0·081 - 0·607 ] ; p=0·0012 ) . In the primary analysis population , five ( 8 % ) of 60 participants had an egg allergy in the egg group compared with 23 ( 38 % ) of 61 in the placebo group ( risk ratio 0·221 [ 0·090 - 0·543 ] ; p=0·0001 ) . The only difference in adverse events between groups was admissions to hospital ( six [ 10 % ] of 60 in the egg group vs none in the placebo group ; p=0·022 ) . 19 acute events occurred in nine ( 15 % ) participants in the egg group versus 14 events in 11 ( 18 % ) participants in the placebo group after intake of the trial powder . INTERPRETATION Introduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen 's egg allergy in high-risk infants . In this study , we developed a practical approach to overcome the second wave of the allergic epidemic caused by food allergy . FUNDING Ministry of Health , Labour and Welfare , and National Centre for Child Health and Development , Japan
Despite several intervention trials involving modifications to the maternal diet , the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear .
Summary Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants .
Purpose of review In the past decade , food allergy has been increasingly recognized as an important public health issue .
The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period .
Recently , research in this area has moved from observational studies to intervention trials , and the findings from these trials have started to influence infant feeding guidelines .
In this article , we review recent studies of dietary interventions for preventing food allergy , summarize current knowledge and discuss future research directions .