Is it possible to reduce the burden of food allergy and atopic dermatitis in children, or Why prevention is better than cure
https://doi.org/10.53529/2500-1175-2024-4-15-30
Abstract
Introduction. The increasing prevalence of allergic diseases, the variety of clinical forms, the severity of manifestations and a significant violation of the quality of life of patients determine the importance of the allergy problem and the search for its solutions. The purpose of the review is to analyze the advantages and possibilities of preventing allergic diseases at the present stage.
Content. The review presents current data reflecting various aspects of the burden of food allergies and atopic dermatitis in the pediatric population, an analysis of clinical recommendations, as well as the results of modern clinical and pharmacoeconomical studies of the effectiveness of nutritional strategies in the field of primary allergy prevention.
Conclusion. The analysis of the results of numerous studies in the field of prevention of allergic diseases, their qualitative interpretation and translation into relevant clinical recommendations should become the basis for solving the problem of the allergy epidemic and confirming the golden rule of medicine that prevention is better than treatment.
Keywords
About the Author
N. B. MigachevaRussian Federation
Natalia Begievna Migacheva — Dr. Sci., Associate Professor, Head of Department of Pediatrics
89 Chapaevskaya street, Samara, 443099
References
1. Devereux G. The increase in the prevalence of asthma and allergy: food for thought. Nat Rev Immunol. 2006; 6 (11): 869–874.
2. Pawankar R. Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organ J. 2014; 7 (1): 12.
3. Platts-Mills T. The allergy epidemics: 1870–2010. J Allergy Clin Immunol. 2015: 136: 3–13.
4. Prescott S., Allen K.J. Food allergy: Riding the second wave of the allergic epidemic. Pediatr Allergy Immunol. 2011; 22: 155–161.
5. Grafanaki K., Bania A., Kaliatsi E.G., Vryzaki E., Vasilopoulos Y., Georgiou S. The Imprint of Exposome on the Development of Atopic Dermatitis across the Lifespan: A Narrative Review. J Clin Med. 2023; 12 (6): 2180.
6. Weidinger S., Simpson E.L., Silverberg J.I., Barbarot S., Eckert L., Mina-Osorio P., Rossi A.B., Brignoli L., Mnif T., Guillemin I., Fenton M.C., Delevry D., Chuang C.C., Pellan M., Gadkari A. Burden of atopic dermatitis in paediatric patients: an international cross-sectional study. Br J Dermatol. 2024; 190 (6): 846–857.
7. Silverberg J.I., Barbarot S., Gadkari A., Simpson E.L., Weidinger S., Mina-Osorio P., Rossi A.B., Brignoli L., Saba G., Guillemin I., Fenton M.C., Auziere S., Eckert L. Atopic dermatitis in the pediatric population: A cross-sectional, international epidemiologic study. Ann Allergy Asthma Immunol. 2021; 126 (4): 417–428.e2.
8. Langan S.M., Mulick A.R., Rutter C.E., et al. Trends in Eczema Prevalence in Children and Adolescents: A Global Asthma Network Phase I Study. Clin Exp Allergy. 2023; 53 (3): 337–352.
9. Shin Y.H., Hwang J., Kwon R., Lee S.W., Kim M.S., GBD 2019 Allergic Disorders Collaborators; Shin J.I., Yon D.K. Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Allergy. 2023; 78 (8): 2232–2254.
10. Smolkin Y.S., Balabolkin I.I., Gorlanov I.A., Kruglova L.S., Kudryavtseva A.V., Meshkova R.Y., Migacheva H.B., Khakimova R.F., Cheburkin A.A., Kuropatnikova E.A., Lyan N.A., Maksimova A.V., Masalskiy S.S., Smolkina O.Y. Consensus document APAIR: atopic dermatitis in children — update 2019 (short version) part 1. Allergology and Immunology in Pediatrics. 2020; 60 (1): 4-25, https://doi.org/10.24411/2500-1175-2020-10001.
11. Venter C., Maslin K., Patil V., et al. The prevalence, natural history and time trends of peanut allergy over the first 10 years of life in two cohorts born in the same geographical location 12 years apart. Pediatr Allergy Immunol. 2016; 27 (8): 804–811.
12. Tang M.L., Mullins R.J. Food allergy: is prevalence increasing? Intern Med J. 2017; 47 (3): 256–261.
13. Ma Z., Chen L., Xian R., Fang H., Wang J., Hu Y. Time trends of childhood food allergy in China: three crosssectional surveys in 1999, 2009, and 2019. Pediatr Allergy Immunol. 2021; 32 (5): 1073–1079.
14. Peters R.L., Koplin J.J., Gurrin L.C., et al. The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immunol. 2017; 140: 145–153.
15. Leung A.S.Y., Tham E.H., Samuel M., Munblit D., Chu D.K., Dahdah L., Yamamoto-Hanada K., Trikamjee T., Warad V., van Niekerk A., Martinez S., Ellis A., Bielory L., Cuadros G., van Bever H., Wallace D., Tang M., Sublett J., Wong G.W.K. Quality and consistency of clinical practice guidelines on the prevention of food allergy and atopic dermatitis: Systematic review protocol. World Allergy Organ J. 2022; 15 (9): 100679.
16. Spolidoro G.C.I., Amera Y.T., Ali M.M., Nyassi S., Lisik D., Ioannidou A., Rovner G., Khaleva E., Venter C., van Ree R., Worm M., Vlieg-Boerstra B., Sheikh A., Muraro A., Roberts G., Nwaru B.I. Frequency of food allergy in Europe: An updated systematic review and meta-analysis. Allergy. 2023 Feb; 78 (2): 351–368.
17. Spolidoro G.C.I., Ali M.M., Amera Y.T., Nyassi S., Lisik D., Ioannidou A., Rovner G., Khaleva E., Venter C., van Ree R., Worm M., Vlieg-Boerstra B., Sheikh A., Muraro A., Roberts G., Nwaru B.I. Prevalence estimates of eight big food allergies in Europe: Updated systematic review and meta-analysis. Allergy. 2023; 78 (9): 2361–2417.
18. Wang Y., Allen K.J., Suaini N.H.A., et al. The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. Allergy. 2019; 74: 1063–1080.
19. Tham E.H., Leung A.S.Y., Pacharn P., et al. Anaphylaxis — lessons learnt when east meets west. Pediatr Allergy Immunol. 2019; 30: 681–688.
20. Esakova N.V., Zakharova I.N., Osmanov I.M., et al. Anaphylaxis among children hospitalized with severe allergic reactions: a 5-year retrospective analysis. Problems of pediatric nutritiology. 2022; 20 (4): 21–30. (In Russ.)
21. Pampura A.N., Esakova N.V., Konyukova N.G. Anaphylaxis to cow’s milk proteins is a multifaceted and unresolved problem. Paediatrics Eastern Europe. 2023; 11 (3): 302–312. (In Russ.)
22. Lepeshkova T.S. Analysis of the prevalence of food hypersensitivity and food anaphylaxis in the children’s population of Ekaterinburg. Russian journal of allergy. 2021; 18 (2): 46–54. (In Russ.)
23. Irvine A.D., Mina-Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner’s guide. Br J Dermatol. 2019; 181: 895–906.
24. Silverberg J.I., Simpson E.L. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013; 24 (5): 476–86.
25. de Las Vecillas L., Quirce S. The Multiple Trajectories of the Allergic March. J Investig Allergol Clin Immunol. 2024; 34 (2): 75–84.
26. Paller A.S., Spergel J.M., Mina-Osorio P., Irvine A.D. The atopic march and atopic multimorbidity: Many trajectories, many pathways. J Allergy Clin Immunol. 2019; 143 (1): 46–55.
27. Knyziak-Mędrzycka I., Majsiak E., Cukrowska B. Allergic March in Children: The Significance of Precision Allergy Molecular Diagnosis (PAMD@) in Predicting Atopy Development and Planning Allergen-Specific Immunotherapy. Nutrients. 2023; 15 (4): 978.
28. Jeong K., Lee S. Natural course of IgE-mediated food allergy in children. Clin Exp Pediatr. 2023; 66 (12): 504–511.
29. Ali F., Vyas J., Finlay A.Y. Counting the Burden: Atopic Dermatitis and Health-related Quality of Life. Acta Derm Venereol. 2020 Jun 9; 100 (12): adv00161.
30. Allen C.W., Bidarkar M.S., vanNunen S.A., Campbell D.E. Factors impacting parental burden in food-allergic children. J Paediatr Child Health 2015; 51: 696–698.
31. Chen G., Dunn Galvin A., Greenhawt M., et al. Deriving health utility indices from a food allergy quality-of-life questionnaire. Pediatr Allergy Immunol. 2021; 32: 1773–1780.
32. Luger T., Romero W.A., Gruben D., et al. Clinical and humanistic burden of atopic dermatitis in Europe: analyses of the National Health and Wellness Survey. Dermatol Ther (Heidelb). 2022; 12: 949–969.
33. Yagudina R.I., Skulkova R.S. Principles of pharmacoeconomic analysis. The Bulletin of the Scientific Centre for expert evaluation of medicinal products. 2011; 2: 56-59. URL: https://cyberleninka.ru/article/n/osnovy-farmakoekonomicheskogo-analiza (date of access: 11.11.2024). (In Russ.)
34. Conway A.E., Greenhawt M., Abrams E.M., Shaker M.S. Food allergy prevention through the decades: An ounce of humility is worth a pound of cure. J Food Allergy. 2024; 6 (1): 3–14.
35. Fong A.T., Ahlstedt S., Golding M.A., Protudjer J.L.P. The Economic Burden of Food Allergy: What We Know and What We Need to Learn. Curr Treat Options Allergy. 2022; 9 (3): 169–186.
36. Wang X., Boytsov N.N., Gorritz M., Malatestinic W.N., Goldblum O.M., Wade R.L. US health care utilization and costs in adult patients with atopic dermatitis by disease severity. J Manag Care Spec Pharm. 2022; 28 (1): 69–77.
37. Krysanov I.S., Krysanova V.S., Karpov O.I., Ermakova V.Yu. Social-economic burden of severe atopic dermatitis in the Russian Federation. Kachestvennaya klinicheskaya praktika. 2019; 4: 4–14. (In Russ.)
38. Conway A.E., Greenhawt M., Abrams E.M., Shaker M.S. Food allergy prevention through the decades: An ounce of humility is worth a pound of cure. J Food Allergy. 2024 Jul 1; 6 (1): 3–14.
39. Zepeda-Ortega B., Goh A., Xepapadaki P., Sprikkelman A., Nicolaou N., Hernandez R.E.H, Latiff A.H.A., Yat M.T., Diab M., Hussaini B.A., Setiabudiawan B., Kudla U., van Neerven R.J.J., Muhardi L., Warner J.O. Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy. Front Immunol. 2021; 12: 608372.
40. Halken S., Muraro A., de Silva D., Khaleva E., Angier E., Arasi S., Arshad H., Bahnson H.T., Beyer K., Boyle R., du Toit G., Ebisawa M., Eigenmann P., Grimshaw K., Hoest A., Jones C., Lack G., Nadeau K., O’Mahony L., Szajewska H., Venter C., Verhasselt V., Wong G.W.K., Roberts G. European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021 Jul; 32 (5): 843–858.
41. Abrams E.M., Shaker M., Stukus D., et al. Updates in Food Allergy Prevention in Children. Pediatrics. 2023; 152 (5): e2023062836.
42. Brandwein M., Enten Vissoker R., Jackson H., Rogan T., Pitcock J., Krinkin E., Venter C. Redefining the Role of Nutrition in Infant Food Allergy Prevention: A Narrative Review. Nutrients. 2024; 16 (6): 838.
43. Muraro A., Halken S., Arshad S.H., Beyer K., Dubois A.E.J., et al. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy. 2014; 69: 590–601.
44. Pelkonen A.S., Kuitunen M., Dunder T., et al. Allergy in children: practical recommendations of the Finnish Allergy Programme 2008–2018 for prevention, diagnosis, and treatment. Pediatr Allergy Immunol. 2012; 23 (2): 103–116.
45. Chan A.W.M., Chan J.K.C., Tam A.Y.C., Lee T.H. Guidelines for allergy prevention in Hong Kong. Medical Practice. 2016; 22 (3): 279–285.
46. Pabst O., Mowat A.M. Oral tolerance to food protein. Mucosal Immunol. 2012; 5 (3): 232–239.
47. Lambers T.T., Gloerich J., van Hoffen E., Alkema W., Hondmann D.H., van Tol E.A. Clustering analyses in peptidomics revealed that peptide profiles of infant formulae are descriptive. Food Sci Nutr. 2015; 3 (1): 81–90.
48. Hochwallner H., Schulmeister U., Swoboda I., Focke-Tejkl M., Reininger R., Civaj V., Campana R., Thalhamer J., Scheiblhofer S., Balic N., Horak F., Ollert M., Papadopoulos N.G., Quirce S., Szepfalusi Z., Herz U., van Tol E.A., Spitzauer S., Valenta R. Infant milk formulas differ regarding their allergenic activity and induction of T-cell and cytokine responses. Allergy. 2017; 72 (3): 416–424.
49. von Berg A., Filipiak-Pittroff B., Krämer U., Link E., Heinrich J., Koletzko S., Grübl A., Hoffmann U., Beckmann C., Reinhardt D., Bauer C.P., Wichmann E., Berdel D. The German Infant Nutritional Intervention Study (GINI) for the preventive effect of hydrolyzed infant formulas in infants at high risk for allergic diseases. Design and selected results. Allergol Select. 2017; 1 (1): 28–38.
50. Szajewska H., Horvath A. Meta-analysis of the evidence for a partially hydrolyzed 100 % whey formula for the prevention of allergic diseases. Curr Med Res Opin. 2010; 26 (2): 423–437.
51. Alexander D.D., Cabana M.D. Partially hydrolyzed 100 % whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010; 50 (4): 422–430.
52. Szajewska H., Horvath A. A partially hydrolyzed 100 % whey formula and the risk of eczema and any allergy: an updated meta-analysis. World Allergy Organ J. 2017; 10 (1): 27.
53. Gappa M., Filipiak-Pittroff B., Libuda L., von Berg A., Koletzko S., Bauer C.P., Heinrich J., Schikowski T., Berdel D., Standl M. Long-term effects of hydrolyzed formulae on atopic diseases in the GINI study. Allergy. 2021; 76 (6): 1903–1907.
54. Boyle R.J., Ierodiakonou D., Khan T., Chivinge J., Robinson Z., Geoghegan N., Jarrold K., Afxentiou T., Reeves T., Cunha S., Trivella M., Garcia-Larsen V., Leonardi-Bee J. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ. 2016; 352: i974.
55. Osborn D.A., Sinn J.K., Jones L.J. Infant formulas containing hydrolysed protein for prevention of allergic disease and food allergy. Cochrane Database Syst Rev. 2017; 3 (3): CD003664.
56. Vandenplas Y., Latiff A.H.A., Fleischer D.M., Gutiérrez-Castrellón P., Miqdady M.S., Smith P.K., von Berg A., Greenhawt M.J. Partially hydrolyzed formula in non-exclusively breastfed infants: A systematic review and expert consensus. Nutrition. 2019; 57: 268–274.
57. EU Commission. Commission delegated regulation (EU) 2016/127. Off J Eur Union. 2016. P. 20–30.
58. Vale S.L., Lobb M., Netting M.J., Murray K., Clifford R., Campbell D.E., Salter S.M. A systematic review of infant feeding food allergy prevention guidelines - can we AGREE? World Allergy Organ J. 2021 May 29; 14 (6): 100550.
59. Nicolaou N., Pancheva R., Karaglani E., Sekkidou M., Marinova-Achkar M., Popova S., Tzaki M., Kapetanaki A., Iacovidou N., Boutsikou T., Iliodromiti Z., Papaevangelou V., Sardeli O., Xepapadaki P., Papathoma E., Thijs-Verhoeven I., Kudla U., Ulfman L.H., Schaafsma A., Manios Y. The Risk Reduction Effect of a Nutritional Intervention With a Partially Hydrolyzed Whey-Based Formula on Cow’s Milk Protein Allergy and Atopic Dermatitis in High-Risk Infants Within the First 6 Months of Life: The Allergy Reduction Trial (A.R.T.), a Multicenter Double-Blinded Randomized Controlled Study. Front Nutr. 2022; 9: 863599.
60. Li X., He T., Duan S., Liang J., Feng G., Li F., Shen Z., Ye W., Liu B., Jiang B., Chen Y., Liu N., Szeto I.M., Cai L. Infant Formulas With Partially or Extensively Hydrolyzed Milk Proteins for the Prevention of Allergic Diseases: A Systematic Review and Meta-Analysis of Clinical Trials. Adv Nutr. 2024 May; 15 (5): 100217.
61. Vandenplas Y., Ksiażyk J., Luna M.S., Migacheva N., Picaud J.C., Ramenghi L.A., Singhal A., Wabitsch M. Partial Hydrolyzed Protein as a Protein Source for Infant Feeding: Do or Don’t? Nutrients. 2022; 14 (9): 1720.
62. Mertens J., Stock S., Lüngen M., von Berg A., Krämer U., Filipiak-Pittroff B., Heinrich J., Koletzko S., Grübl A., Wichmann H.E., Bauer C.P., Reinhardt D., Berdel D., Gerber A. Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany. Pediatr Allergy Immunol. 2012; 23 (6): 597–604.
63. Spieldenner J., Belli D., Dupont C., Haschke F., Iskedjian M., Nevot Falcó S., Szajewska H., von Berg A. Partially hydrolysed 100 % whey-based infant formula and the prevention of atopic dermatitis: comparative pharmacoeconomic analyses. Ann Nutr Metab. 2011; 59 Suppl 1: 44–52.
64. Iskedjian M., Belli D., Farah B., Navarro V., Detzel P. Economic evaluation of a 100 % whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Swiss children. J Med Econ. 2012; 15 (2): 378–393.
65. Iskedjian M., Haschke F., Farah B., van Odijk J., Berbari J., Spieldenner J. Economic evaluation of a 100 % whey-based partially hydrolyzed infant formula in the prevention of atopic dermatitis among Danish children. J Med Econ. 2012; 15 (2): 394–408.
66. Su J., Prescott S., Sinn J., Tang M., Smith P., Heine RG., Spieldenner J., Iskedjian M. Cost-effectiveness of partially-hydrolyzed formula for prevention of atopic dermatitis in Australia. J Med Econ. 2012; 15 (6): 1064–1077.
67. Botteman M., Detzel P. Cost-effectiveness of partially hydrolyzed whey protein formula in the primary prevention of atopic dermatitis in high-risk urban infants in Southeast Asia. Ann Nutr Metab. 2015; 66 Suppl 1: 26–32.
68. Ogorodova L.M., Petrovskiy F.I., Deev I.A., Petrovskaya Y.A. Efficacy and financial viability of primary prevention of atopic dermatitis: protein-hydrolysate-based formulae. Pediatric pharmacology. 2013; 10 (4): 46–51.
69. Derkach E.V., Avksent’eva M.V., Fedyaeva V.K., Rebrova O.Yu., Soldatova I.G. A clinico-economic study of an infant formula based on partially hydrolyzed serum protein as compared with a standard whole cow’s milk formula for prevention of atopic dermatitis in children under 3 years old. Problems of practical pediatrics. 2014; 9 (2): 29–43.
70. Sach T.H., McManus E., Levell N.J. Understanding economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol. 2019; 181 (4): 707–716.
71. Shaker M., Stukus D., Chan E.S., et al. “To screen or not to screen”: comparing the health and economic benefits of early peanut introduction strategies in five countries. Allergy. 2018; 73: 1707–1714.
72. Shaker M., Verma K., Greenhawt M. The health and economic outcomes of early egg introduction strategies. Allergy. 2018; 73: 2214–2223.
Review
For citations:
Migacheva N.B. Is it possible to reduce the burden of food allergy and atopic dermatitis in children, or Why prevention is better than cure. Allergology and Immunology in Paediatrics. 2024;(4):15-30. (In Russ.) https://doi.org/10.53529/2500-1175-2024-4-15-30