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Clinical Review | Clinician's Corner

Diagnosing and Managing Common Food Allergies:  A Systematic Review FREE

Jennifer J. Schneider Chafen, MD, MS; Sydne J. Newberry, PhD; Marc A. Riedl, MD; Dena M. Bravata, MD, MS; Margaret Maglione, MPP; Marika J. Suttorp, MS; Vandana Sundaram, MPH; Neil M. Paige, MD, MSHS; Ali Towfigh, MD; Benjamin J. Hulley, BS; Paul G. Shekelle, MD, PhD
[+] Author Affiliations

Author Affiliations: VA Palo Alto Healthcare System, Palo Alto, California (Dr Chafen and Ms Sundaram); Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California (Drs Chafen and Bravata, and Ms Sundaram); Southern California Evidence Based Practice Center, Rand Health, Santa Monica, California (Drs Newberry, Paige, Towfigh, and Shekelle, and Mss Maglion and Suttorp and Mr Hulley); Clinical Immunology and Allergy, University of California Los Angeles—David Geffen School of Medicine, Los Angeles (Dr Riedl); and West Los Angeles VA Medical Center, Los Angeles, California (Drs Paige, Towfigh, and Shekelle).


JAMA. 2010;303(18):1848-1856. doi:10.1001/jama.2010.582.
Text Size: A A A
Published online

Context There is heightened interest in food allergies but no clear consensus exists regarding the prevalence or most effective diagnostic and management approaches to food allergies.

Objective To perform a systematic review of the available evidence on the prevalence, diagnosis, management, and prevention of food allergies.

Data Sources Electronic searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials. Searches were limited to English-language articles indexed between January 1988 and September 2009.

Study Selection Diagnostic tests were included if they had a prospective, defined study population, used food challenge as a criterion standard, and reported sufficient data to calculate sensitivity and specificity. Systematic reviews and randomized controlled trials (RCTs) for management and prevention outcomes were also used. For foods where anaphylaxis is common, cohort studies with a sample size of more than 100 participants were included.

Data Extraction Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles and resolved discrepancies by repeated review and discussion. Quality of systematic reviews and meta-analyses was assessed using the AMSTAR criteria, the quality of diagnostic studies using the QUADAS criteria most relevant to food allergy, and the quality of RCTs using the Jadad criteria.

Data Synthesis A total of 12 378 citations were identified and 72 citations were included. Food allergy affects more than 1% to 2% but less than 10% of the population. It is unclear if the prevalence of food allergies is increasing. Summary receiver operating characteristic curves comparing skin prick tests (area under the curve [AUC], 0.87; 95% confidence interval [CI], 0.81-0.93) and serum food-specific IgE (AUC, 0.84; 95% CI, 0.78-0.91) to food challenge showed no statistical superiority for either test. Elimination diets are the mainstay of therapy but have been rarely studied. Immunotherapy is promising but data are insufficient to recommend use. In high-risk infants, hydrolyzed formulas may prevent cow's milk allergy but standardized definitions of high risk and hydrolyzed formula do not exist.

Conclusion The evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.

Figures in this Article

Food allergies have significant deleterious effects on family economics, social interactions, school and work attendance, and health-related quality of life.1,2 However, currently licensed treatments target only the symptoms of reactions and anaphylaxis, not the allergies themselves.

Food allergies are heterogeneous in terms of both their underlying pathophysiology (eg, mediated via both IgE and non-IgE immunologic pathways) and their clinical manifestations (ranging from mild rashes to life-threatening anaphylaxis). The literature on food allergies lacks a clear consensus regarding the most effective diagnostic and management approaches to even the most common conditions.

Under contract from the National Institute of Allergy and Infectious Diseases (NIAID) and in support of ongoing work to produce clinical practice guidelines, we reviewed the available evidence on the prevalence, diagnosis, management, and prevention of food allergies.3 This review presents our findings for the most common allergenic foods: cow's milk, hen's egg, peanut, tree nut, fish, and shellfish, which account for more than 50% of all allergies to food.4

Literature Search and Study Selection

We searched 4 electronic databases: PubMed, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials (eAppendix). We restricted searches to English-language articles between January 1988 and September 2009; however, we included older articles identified via reference mining or expert input. Food allergy is not a Medical Subject Headings (MeSH) term; therefore, the search terms included the MeSH term food hypersensitivity, text words such as food allerg*, and terms for foods and conditions such as cow milk, peanut, asthma, oral allergy syndrome, and anaphylaxis.

Our initial inclusion criteria were broad and included prior systematic reviews, meta-analyses, or both, and studies presenting original data related to the prevalence, diagnosis, management, or prevention of food allergy. After assessing the relative quantities of studies on these topics, we restricted studies of prevalence to those with population-based samples (and systematic reviews of such studies); studies of diagnostic tests to those that presented sufficient data to calculate both sensitivity and specificity, had a prospective, defined study population, and used food challenge as a criterion standard; and studies of management and prevention to those that were either controlled trials (both randomized and nonrandomized) or systematic reviews. For food allergies where anaphylaxis is disproportionately common (eg, shellfish, fish, or peanut), we included cohort studies with a sample size of more than 100 participants. Complete inclusion and exclusion criteria are available in our evidence report.3

Data Abstraction

Two investigators (S.J.N. and P.G.S.) independently reviewed all titles and abstracts to identify potentially relevant articles. We independently abstracted articles that met inclusion criteria and resolved discrepancies by repeated review and discussion. The principal investigator (P.G.S.) served as the arbiter for conflict resolution. If 2 or more studies presented the same data from a single patient population, we included these data only once in our analysis.

Quality Assessment

We assessed the quality of systematic reviews and meta-analyses using the AMSTAR criteria, the quality of diagnostic studies using the QUADAS criteria most relevant to food allergy, and the quality of randomized controlled trials (RCTs) using the Jadad criteria.58 For studies on prevalence, we evaluated quality based on the criterion standard used for diagnosis, evaluation of a population-based sample, and participation rate. For management studies, we initially considered all observational studies to be of poor quality but then upgraded the rating to good if the study had a high level of follow-up (≥90%), large sample size (>500 patients), and made attempts to reduce bias either through study design or statistical analysis.

Data Synthesis

For prevalence studies, we reported the literature estimates. The heterogeneity of management and prevention studies prevented data pooling; therefore, we summarized those data narratively.

For diagnostic studies, we examined the distribution of sensitivity and specificity pairs by food allergy, test type, and food allergy × test type. We calculated summary receiver operator characteristic (ROC) curves by transforming sensitivity and specificity pairs (weighted by sample size) using logistic transforms and regressing logit sensitivities on logit specificities.9 Summary ROC curves were calculated by back transforming predicted values from these regression models. We calculated the 95% confidence interval (CI) for the summary ROC curves by reestimating the curves on bootstrap samples. The bootstrap was also used to test differences in areas under the curves for subsets of the studies. The bootstrap incorporated the clustering of observations within studies by resampling at the study level rather than the sensitivity-specificity pair level. These analyses were performed with Stata version 10.0 (StataCorp LP, College Station, Texas).

Our searches identified 12 378 titles, of which 1216 articles underwent full text review and 182 studies met inclusion criteria for allergies to any food (eFigure 1). Our review is restricted to the 72 studies that reported data on food allergies to cow's milk, hen's egg, peanut, tree nut, fish, and shellfish. These studies included 1 meta-analysis on incidence and prevalence; 18 studies on diagnosis; and 53 studies on management and prevention (28 studies on management, 4 meta-analyses, and 21 studies on prevention).

Definition of Food Allergy

Food allergy has no universally accepted definition.Quiz Ref IDThe NIAID has suggested that food allergy be defined as an “adverse immune response that occurs reproducibly on exposure to a given food and is distinct from other adverse responses to food, such as food intolerance, pharmacologic reactions, and toxin-mediated reactions.”3 To assess agreement with this definition, we retrieved 85 reviews of food allergy, 73 of which did not otherwise meet inclusion criteria (eReferences). Seventy-one of these articles (82%) provided a definition of food allergy. Generally, definitions overlapped considerably with the NIAID definition: 62 reviews (87%) included the phrase immune response, 22 (31%) included the concept of reproducibility, 32 (45%) included the concept of a particular food, and 35 (49%) required distinction from food intolerance, pharmacologic, or toxin-mediated reactions. Furthermore, 56 reviews (79%) stated that food allergy involved IgE-mediated reactions and 47 (66%) included non–IgE-mediated immunologic reactions.

Prevalence of Food Allergies

We identified an existing systematic review on the prevalence of food allergies4 that identified 51 relevant studies that provided population-based estimates of prevalence. Studies varied in how food allergy was diagnosed. Some used self-report, other studies used skin prick testing (SPT) or food-specific IgE determinations, and a few studies used double-blind, placebo-controlled food challenges. In general, studies that used self-report found a higher prevalence of food allergies than studies that used the other 3 methods. For cow's milk allergy, the pooled estimate of prevalence was 3.5% (95% CI, 2.9%-4.1%) from self-report and 0.6% to 0.9% from the other 3 methods. For the other common foods, the pooled estimates for self-report and other methods were for egg allergies, 1.3% (95% CI, 1.0%-1.6%) vs 0.3% to 0.9%; for peanut allergies, 0.75% (95% CI, 0.6%-0.9%) vs 0.75%; for fish allergies, 0.6% (95% CI, 0.5%-0.7%) vs 0.2% to 0.3%; and for shellfish allergies, 1.1% (95% CI, 1.0%-1.2%) vs 0.6%. The authors noted that the precision of these latter estimates was very poor and that more standardized methods for diagnosis are needed to minimize this source of variability across studies. The self-reported prevalence of allergy to cow's milk and hen's egg (but not peanut, fish, or shellfish) was higher in children than in adults.

Changes in the Prevalence of Food Allergies

We identified 3 population-based studies (1 each from the United States, Canada, and the United Kingdom) that assessed whether food allergies are changing over time.1014 The parentally-reported prevalence of peanut allergy among children living on the Isle of Wight increased from 0.5% in 1989 to 1.0% in 1994-1996 (P = .20), and the prevalence of IgE antibodies increased from 1.1% to 3.3% (P = .001).10 A response rate of 43% in the 1994-1996 sample is a limitation of this study. The prevalence of peanut allergy among schoolchildren in Montreal (assessed using an algorithm that included parental self-report, SPT, food-specific IgE, and food challenge) was 1.5% in 2000-2002 and increased to 1.63% in 2005-2007, a difference that was not statistically significant.11,12 The authors noted that the width of the CIs on these estimates prevented identifying the true change in prevalence. The US studies used administrative data from hospital discharges, self-report, and food-specific IgE to estimate changes in food allergy prevalence over time and estimated that 3.3% of US children had food allergies in 1997 vs 3.9% in 2007, a statistically significant difference.13,14 However, these authors noted that this increase could be due to increased awareness and reporting rather than a true increase in disease.

Diagnosis of Food Allergies

There are no well-accepted criteria for diagnosing food allergies. Numerous diagnostic tests have been proposed as useful adjuncts to the clinical history for establishing the diagnosis. The most commonly studied are SPT, serum food-specific IgE determinations, and atopy patch testing (APT), although APT is not in widespread clinical use. The placebo-controlled food challenge is usually considered the criterion standard. Most authorities consider it necessary to perform the food challenge under double-blind conditions, although at least 1 study has shown that open challenges give the same results.15 Unfortunately, the need for specialized personnel, time, expense, risk of anaphylaxis, and lack of criteria for what constitutes a positive food challenge limits the widespread use of this test.

We identified 18 studies of diagnostic tests that were prospective, had an identified patient population, compared SPT, serum food-specific IgE, or APT with a food challenge reference standard, and reported both sensitivity and specificity (Table).1532 In general, the quality of these studies was fair (eFigure 2). Of these studies, 13 studied SPT,15,1724,2932 11 studied serum food-specific IgE,16,18,2026,29,31 and 8 studied APT.15,18,20,22,24,25,27,28 The Figure presents the summary ROC curves comparing SPT and serum food-specific IgE to a food challenge overall, and separately for cow's milk and hen's egg. Quiz Ref IDThere were no statistically significant differences for the diagnostic tests overall or for the specific foods. There were insufficient data to calculate summary ROC curves for the APT or for peanut or tree nut or fish or shellfish allergies. Ten studies attempted to improve diagnostic accuracy by combining tests, but results were generally inconclusive.3 Other proposed tests for diagnosing food allergy (eg, histamine, tryptase, and chymase assays) were either not assessed or had too few studies meeting inclusion criteria to allow conclusions regarding their use for diagnosing food allergies.

Place holder to copy figure label and caption
Figure. Summary ROC Curves for the Diagnosis of All Food Allergies, Cow's Milk Allergy, and Hen's Egg Allergy Comparing SPT With sIgE Testing
Graphic Jump Location

ROC indicates receiver operator characteristic; SPT, skin prick testing; sIgE, serum food-specific IgE. Each of the individual circles represents the sensitivity/specificity pair from an individual study. More than 1 data point may be shown for each study due to a study reporting multiple thresholds for sensitivity/specificity. For all food allergies, the area under the curve for SPT and sIgE was 0.87 (95% confidence interval [CI], 0.81-0.93) and 0.84 (95% CI, 0.78-0.91), respectively (mean difference, 0.03; 95% CI, −0.05 to 0.11). For cow's milk allergy, 0.84 (95% CI, 0.75-0.92) and 0.78 (95% CI, 0.70-0.86), respectively (mean difference, 0.06; 95% CI, −0.06 to 0.18). For hen's egg allergy, 0.87 (95% CI, 0.76-0.97) and 0.85 (95% CI, 0.62-1.09), respectively (mean difference, 0.01; 95% CI, −0.25 to 0.27).

Table Graphic Jump LocationTable. Studies of Diagnosis of Food Allergies
Management of Food Allergies

We identified 25 studies of 7 food allergy management strategies3357 (elimination diets [1 study33]; immunotherapy [7 studies3440]; food substitutions or alterations [8 studies4148]; diets in breastfeeding women [1 study49]; medical or pharmacologic therapies [5 studies5054]; probiotics [2 studies55,56]; and education [1 study57]) (eTable 1). Overall study quality was fair. The variability of the studies did not allow for pooling of results or for a clear consensus regarding the most effective management strategies.

Elimination Diets. Only 1 study33 evaluated the effects of an elimination diet and reported improvement in atopic dermatitis in patients on elimination diets compared with those who were not on elimination diets.

Immunotherapy. In immunotherapy, the immune response to allergen exposure is altered using protocols designed to administer increasing doses of the causative allergen over time. Immunotherapy may result in desensitization or tolerance to the specific allergen. Quiz Ref IDDesensitization refers to a temporary clinical state in which allergen exposure fails to cause allergic symptoms, whereas tolerance indicates clinical nonreactivity to allergen exposure even after long periods of abstinence. Five studies gave oral immunotherapy3436,38,39 and 2 studies gave subcutaneous immunotherapy.37,40 Immunotherapy was somewhat effective for desensitization but tolerance and safety were inadequately evaluated.

Food Substitutions or Alterations. Five studies4145 reported feeding infants with presumed cow's milk allergy with alternatives to cow's milk formula. These studies did not present sufficient data to conclude which formula was most beneficial. Three studies4648 treated cow's milk allergy by substituting non–cow's milk, but methodological limitations of these studies prevent conclusive determination of the benefits of these substitutes for cow's milk.

Diets in Breastfeeding Women. One study49 evaluated hypoallergenic diets in nursing women to reduce food allergy–related colic in their children and found a statistically significant improvement in the low allergen group, with an adjusted relative risk of 37% (95% CI, 18%-56%).

Medical or Pharmacologic Therapies. An elimination diet combined with either thymomodulin50 or cromolyn51 appeared to improve food allergy–related skin lesions, whereas cromolyn without an elimination diet did not.52 Two studies53,54 evaluated pharmacologic management of peanut or tree nut allergy. One study53 found that a 450-mg dose of TNX-901, a humanized IgG1 monoclonal antibody, increased the sensitivity from one-half a peanut to almost 9 peanuts, and the other study54 found that aztemizole decreased symptom severity in an oral provocation test.

Probiotics. Probiotics did not improve atopic dermatitis outcomes, either standardized measures of disease severity or rectal bleeding, in infants with suspected food allergies.55,56

Education. After giving patients with a peanut allergy advice on nut avoidance and self-recognition of reactions, 1 study57 found 88 of 567 patients (15%) had a follow-up reaction of reduced severity and 3 of 567 patients (0.5%) had a severe follow-up reaction compared with an initial 12% of patients.

Prevention of Food Allergies and Atopic Eczema

In general, studies addressing food allergy prevention outcomes enrolled pregnant women, their newborns, or both with a history of allergic disease and randomized them to receive special diets (or formula) or receive placebo (to be given with or without breast milk), and followed up the children to compare the cumulative incidence of allergic disease in the intervention and placebo groups. We identified 6 systematic reviews5863 and 47 RCTs33,64109 that evaluated methods to prevent food allergies. Twenty of the included RCTs were evaluated in 1 or more of these systematic reviews and were not analyzed further.6483 Two publications84,85 reporting information on the same population were excluded because they did not report data comparing the intervention and control groups. We also excluded studies by Chandra et al65, given published reports that question the validity of those data.87,88 The studies meeting inclusion criteria evaluated 5 prevention strategies: breastfeeding and delayed introduction of solids (2 studies89,90), maternal diet during pregnancy or lactation (3 studies58,91,92), exclusive breastfeeding (3 studies93,95,110), special diets in infants and young children (12 studies5961,94,96100,106108), and probiotics (5 studies101105) (eTable 2).

Breastfeeding and Delayed Introduction of Solids. Both of the included studies found some association between delayed solids and incidence of atopic symptoms (parents reported decreased food intolerance89 and nonsignificant higher incidence of atopy in controls90). However, their findings should be interpreted with caution given the multimodal nature89 and poor quality.90

Maternal Diet During Pregnancy or Lactation. Maternal diet during pregnancy, lactation, or both demonstrated conflicting effects on atopic disease among children at high risk. One systematic review58 reported no evidence to support a protective effect of maternal diet; 2 studies91,92 reporting on 1 nonrandomized comparative study (115 patients evaluated at 10 months and at 4 years) found a significantly reduced incidence of atopic dermatitis in children whose mothers had a restricted diet during lactation (free from cow's milk, hen's egg, and fish product for 3 months' postpartum).

Exclusive Breastfeeding. Three analyses93,95,110 of data from the same population provided conflicting evidence on the prevention of atopic disease by exclusive breastfeeding, depending on which control group was used (2 of these studies reported decreased atopic dermatitis among children who were exclusively breastfed compared with children who were not).

Special Diets in Infants. Hydrolyzed formulas, soy formulas, and early exposure to cow's milk have been tested for prevention of allergy development. Two systematic reviews60,61 and 5 RCTs96100 evaluated the effects of hydrolyzed formulas on the development of food allergies in children. The effects of soy formula were evaluated by 1 systematic review59 and 1 RCT.94 Three RCTs106108 evaluated neonatal exposure to cow's milk on 2 distinct populations.

Hydrolyzed formulas (particularly extensively and partially hydrolyzed formulas) may reduce infant and childhood cow's milk allergy in high-risk infants when compared with cow's milk formula. However, the terms partially and extensively hydrolyzed as well as high risk were not well-defined in the literature. There was little difference between soy formula and cow's milk formula for the prevention of allergies in high-risk infants. The benefits and harms of early exposure to cow's milk remain uncertain.

Probiotics. Two studies101,102 evaluated probiotics in combination with breastfeeding, and 3 studies103105 evaluated probiotics in pregnant women and their newborn infants. The use of probiotics in the perinatal period may be associated with mild reductions in the cumulative incidence of allergic skin disease in children. However, these results are interpreted with caution because the trials with the most significant results used probiotics in conjunction with breastfeeding, hypoallergenic formula, or both, and the independent effects of probiotics could not be established.

This systematic review of food allergies found that the evidence on the prevalence, diagnosis, management, and prevention of food allergies is voluminous, diffuse, and critically limited by the lack of uniformity for the diagnosis of a food allergy, severely limiting conclusions about best practices for management and prevention.

Our review found several key results. First, food allergies affect more than 1% or 2% but less than 10% of the US population. Whether the prevalence of food allergies is increasing is not well established. Second, food challenges, SPT, and serum food-specific IgE all have a role to play in making the diagnosis but no one test has sufficient ease of use or sensitivity or specificity to be recommended over the other tests. Numerous other proposed diagnostic tests are of uncertain value due to lack of evidence.

Third, although elimination diets are the mainstay of therapy, we identified only 1 RCT of an elimination diet. Many authorities would consider RCTs of elimination diets for serious life-threatening food allergy reactions unnecessary and unethical; however, it should be recognized that such studies are generally lacking for other potential food allergic conditions, such as atopic dermatitis and eosinophilic esophagitis. In these instances, the benefits of an elimination diet are uncertain based on published evidence, and potential benefits need to be weighed against the potential nutritional risks of such a diet, particularly in children. More controlled studies of elimination diets in patients with non–anaphylactic food allergy symptoms are needed.

Fourth, immunotherapy, although currently not a licensed method for the treatment of food allergy, may be effective in generating desensitization, but whether this treatment can also generate long-term tolerance remains to be determined. The safety of immunotherapy is likely to vary with the food allergen and the route of therapy administration (eg, oral, sublingual) and, to date, it has been inadequately studied.

Fifth, among high-risk infants, hydrolyzed formula may prevent against cow's milk allergy but standardized definitions of high risk and hydrolyzed formula do not exist. Probiotics in conjunction with breastfeeding, hypoallergenic formula, or both may help prevent food allergy but their independent effects remain unclear.

Quiz Ref IDA clinical consequence of our findings regarding lack of uniformity of criteria for diagnosis and the limited sensitivity and specificity of existing office-based tests for IgE sensitization is the potential for overdiagnosis of food allergy in the general population. Patients with nonspecific symptoms (rash, abdominal complaints) who have positive SPT or serum food-specific IgE studies to foods have less than a 50% likelihood of actually having a food allergy (given the sensitivity, specificity, and prevalence).Quiz Ref IDInappropriately diagnosing such individuals with food allergy may unnecessarily subject them to broad dietary restrictions, the risk of nutritional problems from elimination diets (eg, milk or egg elimination in children), significant anxiety and worry, and the social challenges food allergies cause.1 Proper interpretation of SPT and serum food-specific IgE results requires evaluation of the data within the context of the clinical history and physician understanding of symptoms consistent with clinical food allergy to separate out false positives from true positives for food allergy. Furthermore, the overdiagnosis or misdiagnosis of food allergy by medical practitioners obscures the substantial morbidity caused in patients truly affected by immune-mediated food allergy and serves to perpetuate some public misperceptions that food allergy is a trivial medical condition.

The limitations of our study reflect the limitations of the included articles in terms of the quality of the original studies. We have attempted to limit our conclusions accordingly. In addition to the need for greater rigor in the design, execution, and reporting of food allergy studies, a key limitation of these studies is the heterogeneity in the criteria used for the diagnosis of food allergy. This makes comparisons of prevalence across studies dependent on the methods used for the diagnosis, limits all studies of diagnostic tests by the lack of a consistent criterion standard, and introduces heterogeneity into studies of management, making comparisons across studies more challenging. Another key limitation of our analysis was that we were unable to perform formal evaluations for publication bias due to the heterogeneity of the included studies. The potential for publication bias may be magnified in a review of food allergy, because food allergy is not a PubMed index term, and there is no good agreement on the conditions that constitute a food allergy. This makes searching for the relevant literature particularly challenging. Consideration should be given to creating a food allergy index term to facilitate future searches for relevant evidence. Our restriction to English-language−only articles also may have excluded some relevant studies. Even with these limitations, we screened more than 12 000 citations and reviewed in detail more than 1000 full-text articles. However, food allergy is a subject of much current study. Three abstracts111113 have recently been presented (1 regarding the prevalence in different racial groups of symptoms and serum food-specific IgE sensitization in a nationally-representative US sample111 and 2 more on preliminary positive early results of desensitization112,113). We expect the evidence base about food allergy to change more rapidly in the near future than it has in the past.

In conclusion, there is a voluminous literature related to food allergy, but high-quality studies are few. Prime needs for advancement of the field are uniformity in the criteria for what constitutes a food allergy and a set of evidence-based guidelines on which to make this diagnosis.

Corresponding Author: Jennifer J. Schneider Chafen, MD, MS, Center for Primary Care and Outcomes Research, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305-6019 (jjschnei@stanford.edu).

Author Contributions: Dr Shekelle had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Bravata, Maglione, Shekelle.

Acquisition of data: Newberry, Bravata, Maglione, Paige, Towfigh.

Analysis and interpretation of data: Chafen, Newberry, Riedl, Bravata, Suttorp, Sundaram, Paige, Hulley, Shekelle.

Drafting of the manuscript: Chafen, Bravata, Suttorp, Sundaram, Paige, Towfigh, Hulley, Shekelle.

Critical revision of the manuscript for important intellectual content: Chafen, Newberry, Riedl, Bravata, Maglione, Sundaram, Paige, Hulley, Shekelle.

Statistical analysis: Suttorp, Sundaram, Hulley.

Obtained funding: Maglione, Shekelle.

Administrative, technical, or material support: Chafen, Maglione, Paige.

Study supervision: Riedl, Bravata, Maglione, Shekelle.

Financial Disclosures: None reported.

Funding/Support: This work was funded in part by contract HHSN272200800065C from the National Institutes of Health. This work was commissioned by National Institute of Allergy and Infectious Diseases in support of the development of practice guidelines.

Role of the Sponsors: The National Institutes of Health had a role in designing the scope of the study and in review of intermediate versions of the evidence report from which this manuscript is derived, but had no role in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Additional Contributions: Matthew Fenton, PhD, and Marshall Plaut, MD (National Institute of Allergy and Infectious Diseases [NIAID]), provided assistance with the development of search terms, strategies for this systematic review, and comments. Julie Schwaninger, MS (NIAID), and Joshua Boyce, MD, provided comments on the Evidence Report. Jerome Hawkins, BA, Breanne Johnsen, BS, Aneesa Motala, BA, Yee-Wei Lim, PhD, and Elizabeth Roth, MA (Southern California Evidence Based Practice Center, Rand Health, Santa Monica, California), provided contributions to the Evidence Report prepared for NIAID. John Adams, PhD (Southern California Evidence Based Practice Center, Rand Health), provided help constructing the receiver operator characteristic curves.

Bollinger ME, Dahlquist LM, Mudd K,  et al.  The impact of food allergy on the daily activities of children and their families.  Ann Allergy Asthma Immunol. 2006;96(3):415-421
PubMed   |  Link to Article
Perry TT, Scurlock AM, Jones SM, Tilford JM. Economic and caregiver impacts of food allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; March 13-17, 2009; Washington, DC. Abstract 113
Shekelle P, Maglione M, Riedl M. Food Allergy: Evidence Report. http://www.rand.org/health/centers/epc/. Accessed April 8, 2010
Rona RJ, Keil T, Summers C,  et al.  The prevalence of food allergy: a meta-analysis.  J Allergy Clin Immunol. 2007;120(3):638-646
PubMed   |  Link to Article
Shea BJ, Grimshaw JM, Wells GA,  et al.  Development of AMSTAR.  BMC Med Res Methodol. 2007;7:10
PubMed   |  Link to Article
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.  BMC Med Res Methodol. 2003;3:25
PubMed   |  Link to Article
Jadad AR, Moore RA, Carroll D,  et al.  Assessing the quality of reports of randomized clinical trials.  Control Clin Trials. 1996;17(1):1-12
PubMed   |  Link to Article
Lijmer JG, Mol BW, Heisterkamp S,  et al.  Empirical evidence of design-related bias in studies of diagnostic tests.  JAMA. 1999;282(11):1061-1066
PubMed   |  Link to Article
Littenberg B, Moses LE. Estimating diagnostic accuracy from multiple conflicting reports.  Med Decis Making. 1993;13(4):313-321
PubMed   |  Link to Article
Grundy J, Matthews S, Bateman B, Dean T, Arshad SH. Rising prevalence of allergy to peanut in children.  J Allergy Clin Immunol. 2002;110(5):784-789
PubMed   |  Link to Article
Kagan RS, Joseph L, Dufresne C,  et al.  Prevalence of peanut allergy in primary-school children in Montreal, Canada.  J Allergy Clin Immunol. 2003;112(6):1223-1228
PubMed   |  Link to Article
Ben-Shoshan M, Kagan RS, Alizadehfar R,  et al.  Is the prevalence of peanut allergy increasing?   J Allergy Clin Immunol. 2009;123(4):783-788
PubMed   |  Link to Article
Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations.  NCHS Data Brief. 2008;(10):1-8
PubMed
Branum AM, Lukacs SL. Food allergy among children in the United States.  Pediatrics. 2009;124(6):1549-1555
PubMed   |  Link to Article
Isolauri E, Turjanmaa K. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis.  J Allergy Clin Immunol. 1996;97(1 pt 1):9-15
PubMed   |  Link to Article
Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy.  J Allergy Clin Immunol. 2001;107(5):891-896
PubMed   |  Link to Article
Wananukul S, Chatchatee P, Chatproedprai S. Food induced urticaria in children.  Asian Pac J Allergy Immunol. 2005;23(4):175-179
PubMed
Mehl A, Rolinck-Werninghaus C, Staden U,  et al.  The atopy patch test in the diagnostic workup of suspected food-related symptoms in children.  J Allergy Clin Immunol. 2006;118(4):923-929
PubMed   |  Link to Article
Calvani M, Mauro C, Alessandri C,  et al.  Correlation between skin prick test using commercial extract of cow's milk protein and fresh milk and food challenges.  Pediatr Allergy Immunol. 2007;18(7):583-588
PubMed   |  Link to Article
Canani RB, Ruotolo S, Auricchio L,  et al.  Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms.  Allergy. 2007;62(7):738-743
PubMed   |  Link to Article
Osterballe M, Andersen KE, Bindslev-Jensen C. The diagnostic accuracy of the atopy patch test in diagnosing hypersensitivity to cow's milk and hen's egg in unselected children with and without atopic dermatitis.  J Am Acad Dermatol. 2004;51(4):556-562
PubMed   |  Link to Article
Keskin O, Tuncer A, Adalioglu G,  et al.  Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy.  Ann Allergy Asthma Immunol. 2005;94(5):553-560
PubMed   |  Link to Article
García-Ara C, Boyano-Martinez T, Diaz-Pena JM,  et al.  Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant.  J Allergy Clin Immunol. 2001;107(1):185-190
PubMed   |  Link to Article
Saarinen KM, Suomalainen H, Savilahti E. Diagnostic value of skin-prick and patch tests and serum eosinophil cationic protein and cow's milk-specific IgE in infants with cow's milk allergy.  Clin Exp Allergy. 2001;31(3):423-429
PubMed   |  Link to Article
De Boissieu D, Waguet JC, Dupont C. The atopy patch tests for detection of cow's milk allergy with digestive symptoms.  J Pediatr. 2003;142(2):203-205
PubMed   |  Link to Article
Tainio VM, Savilahti E. Value of immunologic tests in cow milk allergy.  Allergy. 1990;45(3):189-196
PubMed   |  Link to Article
Cudowska B, Kaczmarski M. Atopy patch test in the diagnosis of food allergy in children with atopic eczema dermatitis syndrome.  Rocz Akad Med Bialymst. 2005;50:261-267
PubMed
Järvinen KM, Turpeinen M, Suomalainen H. Concurrent cereal allergy in children with cow's milk allergy manifested with atopic dermatitis.  Clin Exp Allergy. 2003;33(8):1060-1066
PubMed   |  Link to Article
Monti G, Muratore MC, Peltran A,  et al.  High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children.   Clin Exp Allergy. 2002;32(10):1515-1519
PubMed   |  Link to Article
Diéguez MC, Cerecedo I, Muriel A,  et al.  Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children.  Pediatr Allergy Immunol. 2008;19(4):319-324
PubMed   |  Link to Article
Rancé F, Abbal M, Lauwers-Cances V. Improved screening for peanut allergy by the combined use of skin prick tests and specific IgE assays.  J Allergy Clin Immunol. 2002;109(6):1027-1033
PubMed   |  Link to Article
Wainstein BK, Yee A, Jelley D,  et al.  Combining skin prick, immediate skin application and specific-IgE testing in the diagnosis of peanut allergy in children.  Pediatr Allergy Immunol. 2007;18(3):231-239
PubMed   |  Link to Article
Agata H, Kondo N, Fukutomi O, Shinoda S, Orii T. Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens.  J Allergy Clin Immunol. 1993;91(2):668-679
PubMed   |  Link to Article
Staden U, Rolinck-Werninghaus C, Brewe F,  et al.  Specific oral tolerance induction in food allergy in children.  Allergy. 2007;62(11):1261-1269
PubMed   |  Link to Article
Morisset M, Moneret-Vautrin DA, Guenard L,  et al.  Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases.   Eur Ann Allergy Clin Immunol. 2007;39(1):12-19
PubMed
Skripak JM, Nash SD, Rowley H,  et al.  A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy.  J Allergy Clin Immunol. 2008;122(6):1154-1160
PubMed   |  Link to Article
Nelson HS, Lahr J, Rule R, Bock A, Leung D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract.  J Allergy Clin Immunol. 1997;99(6 pt 1):744-751
PubMed   |  Link to Article
Enrique E, Pineda F, Malek T,  et al.  Sublingual immunotherapy for hazelnut food allergy.   J Allergy Clin Immunol. 2005;116(5):1073-1079
PubMed   |  Link to Article
Patriarca G, Nucera E, Pollastrini E,  et al.  Oral specific desensitization in food-allergic children.  Dig Dis Sci. 2007;52(7):1662-1672
PubMed   |  Link to Article
Bucher X, Pichler WJ, Dahinden CA, Helbling A. Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut.  Allergy. 2004;59(12):1272-1276
PubMed   |  Link to Article
Klemola T, Vanto T, Juntunen-Backman K,  et al.  Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy.  J Pediatr. 2002;140(2):219-224
PubMed   |  Link to Article
Niggemann B, von Berg A, Bollrath C,  et al.  Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy.  Pediatr Allergy Immunol. 2008;19(4):348-354
PubMed   |  Link to Article
Garzi A, Messina M, Frati F,  et al.  An extensively hydrolysed cow's milk formula improves clinical symptoms of gastroesophageal reflux and reduces the gastric emptying time in infants.  Allergol Immunopathol (Madr). 2002;30(1):36-41
PubMed   |  Link to Article
Savino F, Castagno E, Monti G,  et al.  Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life.  Acta Paediatr Suppl. 2005;94(449):115-119
PubMed   |  Link to Article
Jirapinyo P, Densupsoontorn N, Wongarn R, Thamonsiri N. Comparisons of a chicken-based formula with soy-based formula in infants with cow milk allergy.  Asia Pac J Clin Nutr. 2007;16(4):711-715
PubMed
Vita D, Passalacqua G, Di Pasquale G,  et al.  Ass's milk in children with atopic dermatitis and cow's milk allergy: crossover comparison with goat's milk.  Pediatr Allergy Immunol. 2007;18(7):594-598
PubMed   |  Link to Article
Iacono G, Cavataio F, Montalto G,  et al.  Intolerance of cow's milk and chronic constipation in children.  N Engl J Med. 1998;339(16):1100-1104
PubMed   |  Link to Article
Salpietro CD, Gangemi S, Briuglia S,  et al.  The almond milk.  Minerva Pediatr. 2005;57(4):173-180
PubMed
Hill DJ, Roy N, Heine RG,  et al.  Effect of a low-allergen maternal diet on colic among breastfed infants.  Pediatrics. 2005;116(5):e709-e715
PubMed   |  Link to Article
Cavagni G, Piscopo E, Rigoli E,  et al.  Food allergy in children: an attempt to improve the effects of the elimination diet with an immunomodulating agent (thymomodulin).  Immunopharmacol Immunotoxicol. 1989;11(1):131-142
PubMed   |  Link to Article
Businco L, Cantani A. Food allergy in children: diagnosis and treatment with sodium cromoglycate.  Allergol Immunopathol (Madr). 1990;18(6):339-348
PubMed
Burks AW, Sampson HA. Double-blind placebo-controlled trial of oral cromolyn in children with atopic dermatitis and documented food hypersensitivity.  J Allergy Clin Immunol. 1988;81(2):417-423
PubMed   |  Link to Article
Leung DY, Sampson HA, Yunginger JW,  et al.  Effect of anti-IgE therapy in patients with peanut allergy.  N Engl J Med. 2003;348(11):986-993
PubMed   |  Link to Article
Bindslev-Jensen C, Vibits A, Stahl Skov P, Weeke B. Oral allergy syndrome: the effect of astemizole.  Allergy. 1991;46(8):610-613
PubMed   |  Link to Article
Szajewska H, Gawronska A, Wos H,  et al.  Lack of effect of Lactobacillus GG in breast-fed infants with rectal bleeding.  J Pediatr Gastroenterol Nutr. 2007;45(2):247-251
PubMed   |  Link to Article
Viljanen M, Savilahti E, Haahtela T,  et al.  Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants.  Allergy. 2005;60(4):494-500
PubMed   |  Link to Article
Ewan PW, Clark AT. Long-term prospective observational study of patients with peanut and nut allergy after participation in a management plan.  Lancet. 2001;357(9250):111-115
PubMed   |  Link to Article
Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.  Cochrane Database Syst Rev. 2006;3:CD000133
PubMed
Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants.  Cochrane Database Syst Rev. 2006;(4):CD003741
PubMed
Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants.  Cochrane Database Syst Rev. 2006;(4):CD003664
PubMed
Hays T, Wood RA. A systematic review of the role of hydrolyzed infant formulas in allergy prevention.  Arch Pediatr Adolesc Med. 2005;159(9):810-816
PubMed   |  Link to Article
Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease.   Clin Exp Allergy. 2008;38(4):634-642
PubMed   |  Link to Article
Koplin J, Allen K, Gurrin L,  et al.  Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.  Pediatr Allergy Immunol. 2008;19(8):682-687
PubMed   |  Link to Article
Halken S, Host A, Hansen LG, Osterballe O. Preventive effect of feeding high-risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula.  Pediatr Allergy Immunol. 1993;4(4):173-181
PubMed   |  Link to Article
Chandra RK, Puri S, Hamed A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants.  BMJ. 1989;299(6693):228-230
PubMed   |  Link to Article
Juvonen P, Mansson M, Andersson C,  et al.  Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life.  Acta Paediatr. 1996;85(9):1047-1052
PubMed   |  Link to Article
Saarinen KM, Juntunen-Backman K, Jarvenpaa AL,  et al.  Breast-feeding and the development of cows' milk protein allergy.  Adv Exp Med Biol. 2000;478:121-130
PubMed
Willems R, Duchateau J, Magrez P,  et al.  Influence of hypoallergenic milk formula on the incidence of early allergic manifestations in infants predisposed to atopic diseases.  Ann Allergy. 1993;71(2):147-150
PubMed
Vandenplas Y, Hauser B, Van den Borre C,  et al.  The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease.  Eur J Pediatr. 1995;154(6):488-494
PubMed   |  Link to Article
Nentwich I, Michkova E, Nevoral J, Urbanek R, Szepfalusi Z. Cow's milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula.  Allergy. 2001;56(12):1144-1156
PubMed   |  Link to Article
Lilja G, Dannaeus A, Foucard T,  et al.  Effects of maternal diet during late pregnancy and lactation on the development of IgE and egg- and milk-specific IgE and IgG antibodies in infants.  Clin Exp Allergy. 1991;21(2):195-202
PubMed   |  Link to Article
Lovegrove JA, Hampton SM, Morgan JB. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study.  Br J Nutr. 1994;71(2):223-238
PubMed   |  Link to Article
Lilja G, Dannaeus A, Foucard T,  et al.  Effects of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age: in-vivo results.  Clin Exp Allergy. 1989;19(4):473-479
PubMed   |  Link to Article
Fälth-Magnusson K, Kjellman NI. Allergy prevention by maternal elimination diet during late pregnancy.  J Allergy Clin Immunol. 1992;89(3):709-713
PubMed   |  Link to Article
Burr ML, Limb ES, Maguire MJ,  et al.  Infant feeding, wheezing, and allergy: a prospective study.  Arch Dis Child. 1993;68(6):724-728
PubMed   |  Link to Article
von Berg A, Koletzko S, Grubl A,  et al.  The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life.  J Allergy Clin Immunol. 2003;111(3):533-540
PubMed   |  Link to Article
Halken S, Hansen KS, Jacobsen HP,  et al.  Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention.  Pediatr Allergy Immunol. 2000;11(3):149-161
PubMed   |  Link to Article
Saarinen KM, Juntunen-Backman K, Jarvenpaa  AL,  et al.  Supplementary feeding in maternity hospitals and the risk of cow's milk allergy.  J Allergy Clin Immunol. 1999;104(2 pt 1):457-461
PubMed   |  Link to Article
Vandenplas Y, Hauser B, Van den Borre C, Sacre L, Dab I. Effect of a whey hydrolysate prophylaxis of atopic disease.  Ann Allergy. 1992;68(5):419-424
PubMed
Zeiger RS, Heller S, Mellon MH,  et al.  Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy.  J Allergy Clin Immunol. 1989;84(1):72-89
PubMed   |  Link to Article
Marini A, Agosti M, Motta G, Mosca F. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants.  Acta Paediatr Suppl. 1996;414:1-21
PubMed   |  Link to Article
Chandra RK, Puri S, Suraiya C, Cheema PS. Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants.  Clin Allergy. 1986;16(6):563-569
PubMed   |  Link to Article
Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies.  Br Med J (Clin Res Ed). 1986;293(6541):231-233
PubMed   |  Link to Article
Pöysä L, Remes K, Korppi M, Launiala K. Compliance with a dietary manipulation programme in families with infants prone to atopy.  Acta Paediatr Scand. 1988;77(4):563-568
PubMed   |  Link to Article
Pöysä L, Korppi M, Remes K, Juntunen-Backman K. Atopy in childhood and diet in infancy.  Allergy Proc. 1991;12(2):107-111
PubMed   |  Link to Article
Simons FE. Prevention of acute urticaria in young children with atopic dermatitis.  J Allergy Clin Immunol. 2001;107(4):703-706
PubMed   |  Link to Article
Chandra RK, Hamed A. Cumulative incidence of atopic disorders in high risk infants fed whey hydrolysate, soy, and conventional cow milk formulas.  Ann Allergy. 1991;67(2 pt 1):129-132
PubMed
Chandra RK, Singh G, Shridhara B. Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic disease in high risk infants.  Ann Allergy. 1989;63(2):102-106
PubMed
Halmerbauer G, Gartner C, Schier M,  et al.  Study on the Prevention of Allergy in Children in Europe (SPACE).  Pediatr Allergy Immunol. 2002;13:(suppl 15)  47-54
PubMed   |  Link to Article
Kajosaari M. Atopy prevention in childhood: the role of diet.  Pediatr Allergy Immunol. 1994;5(6):(suppl)  26-28
PubMed   |  Link to Article
Hattevig G, Kjellman B, Sigurs N, Bjorksten B, Kjellman NI. Effect of maternal avoidance of eggs, cow's milk and fish during lactation upon allergic manifestations in infants.  Clin Exp Allergy. 1989;19(1):27-32
PubMed   |  Link to Article
Sigurs N, Hattevig G, Kjellman B. Maternal avoidance of eggs, cow's milk, and fish during lactation.  Pediatrics. 1992;89(4 pt 2):735-739
PubMed
Filipiak B, Zutavern A, Koletzko S,  et al.  Solid food introduction in relation to eczema.  J Pediatr. 2007;151(4):352-358
PubMed   |  Link to Article
Bardare M, Vaccari A, Allievi E,  et al.  Influence of dietary manipulation on incidence of atopic disease in infants at risk.  Ann Allergy. 1993;71(4):366-371
PubMed
Schoetzau A, Filipiak-Pittroff B, Franke K,  et al.  Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age.  Pediatr Allergy Immunol. 2002;13(4):234-242
PubMed   |  Link to Article
von Berg A, Filipiak-Pittroff B, Kramer U,  et al.  Preventive effect of hydrolyzed infant formulas persists until age 6 years.  J Allergy Clin Immunol. 2008;121(6):1442-1447
PubMed   |  Link to Article
von Berg A, Koletzko S, Filipiak-Pittroff B,  et al.  Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma.   J Allergy Clin Immunol. 2007;119(3):718-725
PubMed   |  Link to Article
Odelram H, Vanto T, Jacobsen L, Kjellman NI. Whey hydrolysate compared with cow's milk-based formula for weaning at about 6 months of age in high allergy-risk infants.  Allergy. 1996;51(3):192-195
PubMed   |  Link to Article
Szajewska H, Mrukowicz JZ, Stoinska B, Prochowska A. Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants.  Acta Paediatr. 2004;93(9):1159-1165
PubMed   |  Link to Article
Arslanoglu S, Moro GE, Schmitt J,  et al.  Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life.  J Nutr. 2008;138(6):1091-1095
PubMed
Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant.  J Allergy Clin Immunol. 2002;109(1):119-121
PubMed   |  Link to Article
Huurre A, Laitinen K, Rautava S,  et al.  Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization.  Clin Exp Allergy. 2008;38(8):1342-1348
PubMed   |  Link to Article
Kuitunen M, Kukkonen K, Juntunen-Backman K,  et al.  Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.  J Allergy Clin Immunol. 2009;123(2):335-341
PubMed   |  Link to Article
Kukkonen K, Savilahti E, Haahtela T,  et al.  Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases.  J Allergy Clin Immunol. 2007;119(1):192-198
PubMed   |  Link to Article
Abrahamsson TR, Jakobsson T, Bottcher MF,  et al.  Probiotics in prevention of IgE-associated eczema.  J Allergy Clin Immunol. 2007;119(5):1174-1180
PubMed   |  Link to Article
de Jong MH, Scharp-Van Der Linden VT, Aalberse R,  et al.  The effect of brief neonatal exposure to cows' milk on atopic symptoms up to age 5.  Arch Dis Child. 2002;86(5):365-369
PubMed   |  Link to Article
de Jong MH, Scharp-van der Linden VT, Aalberse RC,  et al.  Randomised controlled trial of brief neonatal exposure to cows' milk on the development of atopy.  Arch Dis Child. 1998;79(2):126-130
PubMed   |  Link to Article
Lindfors AT, Danielsson L, Enocksson E,  et al.  Allergic symptoms up to 4-6 years of age in children given cow milk neonatally.  Allergy. 1992;47(3):207-211
PubMed   |  Link to Article
Kvenshagen B, Halvorsen R, Jacobsen M. Adverse reactions to milk in infants.  Acta Paediatr. 2008;97(2):196-200
PubMed   |  Link to Article
Laubereau B, Brockow I, Zirngibl A,  et al.  Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life.   J Pediatr. 2004;144(5):602-607
PubMed   |  Link to Article
Liu H. In the United States, black male children have an increased risk of food allergy: results from NHANES 2005-2006. Paper presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; March 13-17, 2009; Washington, DC
Mudd KE, Driggers SK, Matsui EC, Wood RA. Home introduction of baked milk in children with a history of milk allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; February 26-March 2, 2010; New Orleans, LA. Abstract 52
Bird JA, Pons L, Kulis M,  et al.  Double-blinded, placebo-controlled Sublingual Immunotherapy (SLIT) trial for peanut allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; February 26-March 2, 2010; New Orleans, LA. Abstract 20

Figures

Place holder to copy figure label and caption
Figure. Summary ROC Curves for the Diagnosis of All Food Allergies, Cow's Milk Allergy, and Hen's Egg Allergy Comparing SPT With sIgE Testing
Graphic Jump Location

ROC indicates receiver operator characteristic; SPT, skin prick testing; sIgE, serum food-specific IgE. Each of the individual circles represents the sensitivity/specificity pair from an individual study. More than 1 data point may be shown for each study due to a study reporting multiple thresholds for sensitivity/specificity. For all food allergies, the area under the curve for SPT and sIgE was 0.87 (95% confidence interval [CI], 0.81-0.93) and 0.84 (95% CI, 0.78-0.91), respectively (mean difference, 0.03; 95% CI, −0.05 to 0.11). For cow's milk allergy, 0.84 (95% CI, 0.75-0.92) and 0.78 (95% CI, 0.70-0.86), respectively (mean difference, 0.06; 95% CI, −0.06 to 0.18). For hen's egg allergy, 0.87 (95% CI, 0.76-0.97) and 0.85 (95% CI, 0.62-1.09), respectively (mean difference, 0.01; 95% CI, −0.25 to 0.27).

Tables

Table Graphic Jump LocationTable. Studies of Diagnosis of Food Allergies

References

Bollinger ME, Dahlquist LM, Mudd K,  et al.  The impact of food allergy on the daily activities of children and their families.  Ann Allergy Asthma Immunol. 2006;96(3):415-421
PubMed   |  Link to Article
Perry TT, Scurlock AM, Jones SM, Tilford JM. Economic and caregiver impacts of food allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; March 13-17, 2009; Washington, DC. Abstract 113
Shekelle P, Maglione M, Riedl M. Food Allergy: Evidence Report. http://www.rand.org/health/centers/epc/. Accessed April 8, 2010
Rona RJ, Keil T, Summers C,  et al.  The prevalence of food allergy: a meta-analysis.  J Allergy Clin Immunol. 2007;120(3):638-646
PubMed   |  Link to Article
Shea BJ, Grimshaw JM, Wells GA,  et al.  Development of AMSTAR.  BMC Med Res Methodol. 2007;7:10
PubMed   |  Link to Article
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.  BMC Med Res Methodol. 2003;3:25
PubMed   |  Link to Article
Jadad AR, Moore RA, Carroll D,  et al.  Assessing the quality of reports of randomized clinical trials.  Control Clin Trials. 1996;17(1):1-12
PubMed   |  Link to Article
Lijmer JG, Mol BW, Heisterkamp S,  et al.  Empirical evidence of design-related bias in studies of diagnostic tests.  JAMA. 1999;282(11):1061-1066
PubMed   |  Link to Article
Littenberg B, Moses LE. Estimating diagnostic accuracy from multiple conflicting reports.  Med Decis Making. 1993;13(4):313-321
PubMed   |  Link to Article
Grundy J, Matthews S, Bateman B, Dean T, Arshad SH. Rising prevalence of allergy to peanut in children.  J Allergy Clin Immunol. 2002;110(5):784-789
PubMed   |  Link to Article
Kagan RS, Joseph L, Dufresne C,  et al.  Prevalence of peanut allergy in primary-school children in Montreal, Canada.  J Allergy Clin Immunol. 2003;112(6):1223-1228
PubMed   |  Link to Article
Ben-Shoshan M, Kagan RS, Alizadehfar R,  et al.  Is the prevalence of peanut allergy increasing?   J Allergy Clin Immunol. 2009;123(4):783-788
PubMed   |  Link to Article
Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations.  NCHS Data Brief. 2008;(10):1-8
PubMed
Branum AM, Lukacs SL. Food allergy among children in the United States.  Pediatrics. 2009;124(6):1549-1555
PubMed   |  Link to Article
Isolauri E, Turjanmaa K. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis.  J Allergy Clin Immunol. 1996;97(1 pt 1):9-15
PubMed   |  Link to Article
Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy.  J Allergy Clin Immunol. 2001;107(5):891-896
PubMed   |  Link to Article
Wananukul S, Chatchatee P, Chatproedprai S. Food induced urticaria in children.  Asian Pac J Allergy Immunol. 2005;23(4):175-179
PubMed
Mehl A, Rolinck-Werninghaus C, Staden U,  et al.  The atopy patch test in the diagnostic workup of suspected food-related symptoms in children.  J Allergy Clin Immunol. 2006;118(4):923-929
PubMed   |  Link to Article
Calvani M, Mauro C, Alessandri C,  et al.  Correlation between skin prick test using commercial extract of cow's milk protein and fresh milk and food challenges.  Pediatr Allergy Immunol. 2007;18(7):583-588
PubMed   |  Link to Article
Canani RB, Ruotolo S, Auricchio L,  et al.  Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms.  Allergy. 2007;62(7):738-743
PubMed   |  Link to Article
Osterballe M, Andersen KE, Bindslev-Jensen C. The diagnostic accuracy of the atopy patch test in diagnosing hypersensitivity to cow's milk and hen's egg in unselected children with and without atopic dermatitis.  J Am Acad Dermatol. 2004;51(4):556-562
PubMed   |  Link to Article
Keskin O, Tuncer A, Adalioglu G,  et al.  Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy.  Ann Allergy Asthma Immunol. 2005;94(5):553-560
PubMed   |  Link to Article
García-Ara C, Boyano-Martinez T, Diaz-Pena JM,  et al.  Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant.  J Allergy Clin Immunol. 2001;107(1):185-190
PubMed   |  Link to Article
Saarinen KM, Suomalainen H, Savilahti E. Diagnostic value of skin-prick and patch tests and serum eosinophil cationic protein and cow's milk-specific IgE in infants with cow's milk allergy.  Clin Exp Allergy. 2001;31(3):423-429
PubMed   |  Link to Article
De Boissieu D, Waguet JC, Dupont C. The atopy patch tests for detection of cow's milk allergy with digestive symptoms.  J Pediatr. 2003;142(2):203-205
PubMed   |  Link to Article
Tainio VM, Savilahti E. Value of immunologic tests in cow milk allergy.  Allergy. 1990;45(3):189-196
PubMed   |  Link to Article
Cudowska B, Kaczmarski M. Atopy patch test in the diagnosis of food allergy in children with atopic eczema dermatitis syndrome.  Rocz Akad Med Bialymst. 2005;50:261-267
PubMed
Järvinen KM, Turpeinen M, Suomalainen H. Concurrent cereal allergy in children with cow's milk allergy manifested with atopic dermatitis.  Clin Exp Allergy. 2003;33(8):1060-1066
PubMed   |  Link to Article
Monti G, Muratore MC, Peltran A,  et al.  High incidence of adverse reactions to egg challenge on first known exposure in young atopic dermatitis children.   Clin Exp Allergy. 2002;32(10):1515-1519
PubMed   |  Link to Article
Diéguez MC, Cerecedo I, Muriel A,  et al.  Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children.  Pediatr Allergy Immunol. 2008;19(4):319-324
PubMed   |  Link to Article
Rancé F, Abbal M, Lauwers-Cances V. Improved screening for peanut allergy by the combined use of skin prick tests and specific IgE assays.  J Allergy Clin Immunol. 2002;109(6):1027-1033
PubMed   |  Link to Article
Wainstein BK, Yee A, Jelley D,  et al.  Combining skin prick, immediate skin application and specific-IgE testing in the diagnosis of peanut allergy in children.  Pediatr Allergy Immunol. 2007;18(3):231-239
PubMed   |  Link to Article
Agata H, Kondo N, Fukutomi O, Shinoda S, Orii T. Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens.  J Allergy Clin Immunol. 1993;91(2):668-679
PubMed   |  Link to Article
Staden U, Rolinck-Werninghaus C, Brewe F,  et al.  Specific oral tolerance induction in food allergy in children.  Allergy. 2007;62(11):1261-1269
PubMed   |  Link to Article
Morisset M, Moneret-Vautrin DA, Guenard L,  et al.  Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases.   Eur Ann Allergy Clin Immunol. 2007;39(1):12-19
PubMed
Skripak JM, Nash SD, Rowley H,  et al.  A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy.  J Allergy Clin Immunol. 2008;122(6):1154-1160
PubMed   |  Link to Article
Nelson HS, Lahr J, Rule R, Bock A, Leung D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract.  J Allergy Clin Immunol. 1997;99(6 pt 1):744-751
PubMed   |  Link to Article
Enrique E, Pineda F, Malek T,  et al.  Sublingual immunotherapy for hazelnut food allergy.   J Allergy Clin Immunol. 2005;116(5):1073-1079
PubMed   |  Link to Article
Patriarca G, Nucera E, Pollastrini E,  et al.  Oral specific desensitization in food-allergic children.  Dig Dis Sci. 2007;52(7):1662-1672
PubMed   |  Link to Article
Bucher X, Pichler WJ, Dahinden CA, Helbling A. Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut.  Allergy. 2004;59(12):1272-1276
PubMed   |  Link to Article
Klemola T, Vanto T, Juntunen-Backman K,  et al.  Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy.  J Pediatr. 2002;140(2):219-224
PubMed   |  Link to Article
Niggemann B, von Berg A, Bollrath C,  et al.  Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy.  Pediatr Allergy Immunol. 2008;19(4):348-354
PubMed   |  Link to Article
Garzi A, Messina M, Frati F,  et al.  An extensively hydrolysed cow's milk formula improves clinical symptoms of gastroesophageal reflux and reduces the gastric emptying time in infants.  Allergol Immunopathol (Madr). 2002;30(1):36-41
PubMed   |  Link to Article
Savino F, Castagno E, Monti G,  et al.  Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life.  Acta Paediatr Suppl. 2005;94(449):115-119
PubMed   |  Link to Article
Jirapinyo P, Densupsoontorn N, Wongarn R, Thamonsiri N. Comparisons of a chicken-based formula with soy-based formula in infants with cow milk allergy.  Asia Pac J Clin Nutr. 2007;16(4):711-715
PubMed
Vita D, Passalacqua G, Di Pasquale G,  et al.  Ass's milk in children with atopic dermatitis and cow's milk allergy: crossover comparison with goat's milk.  Pediatr Allergy Immunol. 2007;18(7):594-598
PubMed   |  Link to Article
Iacono G, Cavataio F, Montalto G,  et al.  Intolerance of cow's milk and chronic constipation in children.  N Engl J Med. 1998;339(16):1100-1104
PubMed   |  Link to Article
Salpietro CD, Gangemi S, Briuglia S,  et al.  The almond milk.  Minerva Pediatr. 2005;57(4):173-180
PubMed
Hill DJ, Roy N, Heine RG,  et al.  Effect of a low-allergen maternal diet on colic among breastfed infants.  Pediatrics. 2005;116(5):e709-e715
PubMed   |  Link to Article
Cavagni G, Piscopo E, Rigoli E,  et al.  Food allergy in children: an attempt to improve the effects of the elimination diet with an immunomodulating agent (thymomodulin).  Immunopharmacol Immunotoxicol. 1989;11(1):131-142
PubMed   |  Link to Article
Businco L, Cantani A. Food allergy in children: diagnosis and treatment with sodium cromoglycate.  Allergol Immunopathol (Madr). 1990;18(6):339-348
PubMed
Burks AW, Sampson HA. Double-blind placebo-controlled trial of oral cromolyn in children with atopic dermatitis and documented food hypersensitivity.  J Allergy Clin Immunol. 1988;81(2):417-423
PubMed   |  Link to Article
Leung DY, Sampson HA, Yunginger JW,  et al.  Effect of anti-IgE therapy in patients with peanut allergy.  N Engl J Med. 2003;348(11):986-993
PubMed   |  Link to Article
Bindslev-Jensen C, Vibits A, Stahl Skov P, Weeke B. Oral allergy syndrome: the effect of astemizole.  Allergy. 1991;46(8):610-613
PubMed   |  Link to Article
Szajewska H, Gawronska A, Wos H,  et al.  Lack of effect of Lactobacillus GG in breast-fed infants with rectal bleeding.  J Pediatr Gastroenterol Nutr. 2007;45(2):247-251
PubMed   |  Link to Article
Viljanen M, Savilahti E, Haahtela T,  et al.  Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants.  Allergy. 2005;60(4):494-500
PubMed   |  Link to Article
Ewan PW, Clark AT. Long-term prospective observational study of patients with peanut and nut allergy after participation in a management plan.  Lancet. 2001;357(9250):111-115
PubMed   |  Link to Article
Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.  Cochrane Database Syst Rev. 2006;3:CD000133
PubMed
Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants.  Cochrane Database Syst Rev. 2006;(4):CD003741
PubMed
Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants.  Cochrane Database Syst Rev. 2006;(4):CD003664
PubMed
Hays T, Wood RA. A systematic review of the role of hydrolyzed infant formulas in allergy prevention.  Arch Pediatr Adolesc Med. 2005;159(9):810-816
PubMed   |  Link to Article
Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease.   Clin Exp Allergy. 2008;38(4):634-642
PubMed   |  Link to Article
Koplin J, Allen K, Gurrin L,  et al.  Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review.  Pediatr Allergy Immunol. 2008;19(8):682-687
PubMed   |  Link to Article
Halken S, Host A, Hansen LG, Osterballe O. Preventive effect of feeding high-risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula.  Pediatr Allergy Immunol. 1993;4(4):173-181
PubMed   |  Link to Article
Chandra RK, Puri S, Hamed A. Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants.  BMJ. 1989;299(6693):228-230
PubMed   |  Link to Article
Juvonen P, Mansson M, Andersson C,  et al.  Allergy development and macromolecular absorption in infants with different feeding regimens during the first three days of life.  Acta Paediatr. 1996;85(9):1047-1052
PubMed   |  Link to Article
Saarinen KM, Juntunen-Backman K, Jarvenpaa AL,  et al.  Breast-feeding and the development of cows' milk protein allergy.  Adv Exp Med Biol. 2000;478:121-130
PubMed
Willems R, Duchateau J, Magrez P,  et al.  Influence of hypoallergenic milk formula on the incidence of early allergic manifestations in infants predisposed to atopic diseases.  Ann Allergy. 1993;71(2):147-150
PubMed
Vandenplas Y, Hauser B, Van den Borre C,  et al.  The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease.  Eur J Pediatr. 1995;154(6):488-494
PubMed   |  Link to Article
Nentwich I, Michkova E, Nevoral J, Urbanek R, Szepfalusi Z. Cow's milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula.  Allergy. 2001;56(12):1144-1156
PubMed   |  Link to Article
Lilja G, Dannaeus A, Foucard T,  et al.  Effects of maternal diet during late pregnancy and lactation on the development of IgE and egg- and milk-specific IgE and IgG antibodies in infants.  Clin Exp Allergy. 1991;21(2):195-202
PubMed   |  Link to Article
Lovegrove JA, Hampton SM, Morgan JB. The immunological and long-term atopic outcome of infants born to women following a milk-free diet during late pregnancy and lactation: a pilot study.  Br J Nutr. 1994;71(2):223-238
PubMed   |  Link to Article
Lilja G, Dannaeus A, Foucard T,  et al.  Effects of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age: in-vivo results.  Clin Exp Allergy. 1989;19(4):473-479
PubMed   |  Link to Article
Fälth-Magnusson K, Kjellman NI. Allergy prevention by maternal elimination diet during late pregnancy.  J Allergy Clin Immunol. 1992;89(3):709-713
PubMed   |  Link to Article
Burr ML, Limb ES, Maguire MJ,  et al.  Infant feeding, wheezing, and allergy: a prospective study.  Arch Dis Child. 1993;68(6):724-728
PubMed   |  Link to Article
von Berg A, Koletzko S, Grubl A,  et al.  The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life.  J Allergy Clin Immunol. 2003;111(3):533-540
PubMed   |  Link to Article
Halken S, Hansen KS, Jacobsen HP,  et al.  Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention.  Pediatr Allergy Immunol. 2000;11(3):149-161
PubMed   |  Link to Article
Saarinen KM, Juntunen-Backman K, Jarvenpaa  AL,  et al.  Supplementary feeding in maternity hospitals and the risk of cow's milk allergy.  J Allergy Clin Immunol. 1999;104(2 pt 1):457-461
PubMed   |  Link to Article
Vandenplas Y, Hauser B, Van den Borre C, Sacre L, Dab I. Effect of a whey hydrolysate prophylaxis of atopic disease.  Ann Allergy. 1992;68(5):419-424
PubMed
Zeiger RS, Heller S, Mellon MH,  et al.  Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy.  J Allergy Clin Immunol. 1989;84(1):72-89
PubMed   |  Link to Article
Marini A, Agosti M, Motta G, Mosca F. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants.  Acta Paediatr Suppl. 1996;414:1-21
PubMed   |  Link to Article
Chandra RK, Puri S, Suraiya C, Cheema PS. Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants.  Clin Allergy. 1986;16(6):563-569
PubMed   |  Link to Article
Cant AJ, Bailes JA, Marsden RA, Hewitt D. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies.  Br Med J (Clin Res Ed). 1986;293(6541):231-233
PubMed   |  Link to Article
Pöysä L, Remes K, Korppi M, Launiala K. Compliance with a dietary manipulation programme in families with infants prone to atopy.  Acta Paediatr Scand. 1988;77(4):563-568
PubMed   |  Link to Article
Pöysä L, Korppi M, Remes K, Juntunen-Backman K. Atopy in childhood and diet in infancy.  Allergy Proc. 1991;12(2):107-111
PubMed   |  Link to Article
Simons FE. Prevention of acute urticaria in young children with atopic dermatitis.  J Allergy Clin Immunol. 2001;107(4):703-706
PubMed   |  Link to Article
Chandra RK, Hamed A. Cumulative incidence of atopic disorders in high risk infants fed whey hydrolysate, soy, and conventional cow milk formulas.  Ann Allergy. 1991;67(2 pt 1):129-132
PubMed
Chandra RK, Singh G, Shridhara B. Effect of feeding whey hydrolysate, soy and conventional cow milk formulas on incidence of atopic disease in high risk infants.  Ann Allergy. 1989;63(2):102-106
PubMed
Halmerbauer G, Gartner C, Schier M,  et al.  Study on the Prevention of Allergy in Children in Europe (SPACE).  Pediatr Allergy Immunol. 2002;13:(suppl 15)  47-54
PubMed   |  Link to Article
Kajosaari M. Atopy prevention in childhood: the role of diet.  Pediatr Allergy Immunol. 1994;5(6):(suppl)  26-28
PubMed   |  Link to Article
Hattevig G, Kjellman B, Sigurs N, Bjorksten B, Kjellman NI. Effect of maternal avoidance of eggs, cow's milk and fish during lactation upon allergic manifestations in infants.  Clin Exp Allergy. 1989;19(1):27-32
PubMed   |  Link to Article
Sigurs N, Hattevig G, Kjellman B. Maternal avoidance of eggs, cow's milk, and fish during lactation.  Pediatrics. 1992;89(4 pt 2):735-739
PubMed
Filipiak B, Zutavern A, Koletzko S,  et al.  Solid food introduction in relation to eczema.  J Pediatr. 2007;151(4):352-358
PubMed   |  Link to Article
Bardare M, Vaccari A, Allievi E,  et al.  Influence of dietary manipulation on incidence of atopic disease in infants at risk.  Ann Allergy. 1993;71(4):366-371
PubMed
Schoetzau A, Filipiak-Pittroff B, Franke K,  et al.  Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age.  Pediatr Allergy Immunol. 2002;13(4):234-242
PubMed   |  Link to Article
von Berg A, Filipiak-Pittroff B, Kramer U,  et al.  Preventive effect of hydrolyzed infant formulas persists until age 6 years.  J Allergy Clin Immunol. 2008;121(6):1442-1447
PubMed   |  Link to Article
von Berg A, Koletzko S, Filipiak-Pittroff B,  et al.  Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma.   J Allergy Clin Immunol. 2007;119(3):718-725
PubMed   |  Link to Article
Odelram H, Vanto T, Jacobsen L, Kjellman NI. Whey hydrolysate compared with cow's milk-based formula for weaning at about 6 months of age in high allergy-risk infants.  Allergy. 1996;51(3):192-195
PubMed   |  Link to Article
Szajewska H, Mrukowicz JZ, Stoinska B, Prochowska A. Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants.  Acta Paediatr. 2004;93(9):1159-1165
PubMed   |  Link to Article
Arslanoglu S, Moro GE, Schmitt J,  et al.  Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life.  J Nutr. 2008;138(6):1091-1095
PubMed
Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant.  J Allergy Clin Immunol. 2002;109(1):119-121
PubMed   |  Link to Article
Huurre A, Laitinen K, Rautava S,  et al.  Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization.  Clin Exp Allergy. 2008;38(8):1342-1348
PubMed   |  Link to Article
Kuitunen M, Kukkonen K, Juntunen-Backman K,  et al.  Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort.  J Allergy Clin Immunol. 2009;123(2):335-341
PubMed   |  Link to Article
Kukkonen K, Savilahti E, Haahtela T,  et al.  Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases.  J Allergy Clin Immunol. 2007;119(1):192-198
PubMed   |  Link to Article
Abrahamsson TR, Jakobsson T, Bottcher MF,  et al.  Probiotics in prevention of IgE-associated eczema.  J Allergy Clin Immunol. 2007;119(5):1174-1180
PubMed   |  Link to Article
de Jong MH, Scharp-Van Der Linden VT, Aalberse R,  et al.  The effect of brief neonatal exposure to cows' milk on atopic symptoms up to age 5.  Arch Dis Child. 2002;86(5):365-369
PubMed   |  Link to Article
de Jong MH, Scharp-van der Linden VT, Aalberse RC,  et al.  Randomised controlled trial of brief neonatal exposure to cows' milk on the development of atopy.  Arch Dis Child. 1998;79(2):126-130
PubMed   |  Link to Article
Lindfors AT, Danielsson L, Enocksson E,  et al.  Allergic symptoms up to 4-6 years of age in children given cow milk neonatally.  Allergy. 1992;47(3):207-211
PubMed   |  Link to Article
Kvenshagen B, Halvorsen R, Jacobsen M. Adverse reactions to milk in infants.  Acta Paediatr. 2008;97(2):196-200
PubMed   |  Link to Article
Laubereau B, Brockow I, Zirngibl A,  et al.  Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life.   J Pediatr. 2004;144(5):602-607
PubMed   |  Link to Article
Liu H. In the United States, black male children have an increased risk of food allergy: results from NHANES 2005-2006. Paper presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; March 13-17, 2009; Washington, DC
Mudd KE, Driggers SK, Matsui EC, Wood RA. Home introduction of baked milk in children with a history of milk allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; February 26-March 2, 2010; New Orleans, LA. Abstract 52
Bird JA, Pons L, Kulis M,  et al.  Double-blinded, placebo-controlled Sublingual Immunotherapy (SLIT) trial for peanut allergy. Abstract presented at: Annual Meeting of the American Academy of Allergy, Asthma, and Immunology; February 26-March 2, 2010; New Orleans, LA. Abstract 20
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