■早期引入鸡蛋和花生可能会降低鸡蛋和花生过敏的风险,分别,但是不确定是否可以使用早期的过敏性食物介绍来预防整体食物过敏。
■研究婴儿饮食中引入过敏性食物的时机与食物过敏风险之间的关系。
■在本系统综述和荟萃分析中,Medline,Embase,和CENTRAL数据库搜索从数据库开始到2022年12月29日的文章。搜索词包括婴儿,随机对照试验,以及常见过敏食物和过敏结果的术语。
■评估过敏食物引入年龄的随机临床试验(牛奶,鸡蛋,鱼,贝类,树坚果,小麦,花生,包括婴儿期和1至5岁的免疫球蛋白E(IgE)介导的食物过敏。筛选由多个作者独立进行。
■使用系统评价和Meta分析指南的首选报告项目。数据一式两份提取并使用随机效应模型合成。建议的分级,评估,发展,评估框架用于评估证据的确定性。
■主要结果是对1至5岁的任何食物的IgE介导过敏和退出干预的风险。次要结果包括对特定食物过敏。
■在筛选的9283个标题中,数据来自23项符合条件的试验(56篇文章,13794名随机参与者)。有4项试验(3295名参与者)的中度确定性证据表明,从2至12个月大(中位年龄,3-4个月)与食物过敏风险降低相关(风险比[RR],0.49;95%CI,0.33-0.74;I2=49%)。食物过敏发生率为5%的人群的绝对风险差异为-26例(95%CI,-34至-13例)/1000人群。有5项试验(4703名参与者)的中度确定性证据表明,2至12个月大的多种过敏性食物的引入与干预措施的退出增加有关(RR,2.29;95%CI,1.45-3.63;I2=89%)。退出干预的20%人群的绝对风险差异为每1000人258例(95%CI,90-526例)。来自9项试验(4811名参与者)的高确定性证据表明,从3至6月龄引入鸡蛋与鸡蛋过敏风险降低有关(RR,0.60;95%CI,0.46-0.77;I2=0%)和4项试验(3796名参与者)的高确定性证据表明,3至10个月大的花生摄入量与花生过敏风险降低有关(RR,0.31;95%CI,0.19-0.51;I2=21%)。引入牛奶的时机和牛奶过敏风险的证据是非常低的确定性。
■在本系统综述和荟萃分析中,在生命的第一年较早引入多种过敏食物与发生食物过敏的风险较低相关,但退出干预的比例较高.需要进一步的工作来开发对婴儿及其家庭安全和可接受的过敏性食品干预措施。
Earlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.
To investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy.
In this systematic
review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes.
Randomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)-mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence.
Primary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.
Of 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was -26 cases (95% CI, -34 to -13 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that introduction of multiple allergenic foods from 2 to 12 months of age was associated with increased withdrawal from the intervention (RR, 2.29; 95% CI, 1.45-3.63; I2 = 89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that introduction of egg from 3 to 6 months of age was associated with reduced risk of egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2 = 0%) and high-certainty evidence from 4 trials (3796 participants) that introduction of peanut from 3 to 10 months of age was associated with reduced risk of peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2 = 21%). Evidence for timing of introduction of cow\'s milk and risk of cow\'s milk allergy was very low certainty.
In this systematic
review and meta-analysis, earlier introduction of multiple allergenic foods in the first year of life was associated with lower risk of developing food allergy but a high rate of withdrawal from the intervention. Further work is needed to develop allergenic food interventions that are safe and acceptable for infants and their families.