PreventADALL - early food intervention and skin emollients to prevent food allergy in young children

Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL)

• to determine whether early food introduction or the application of regular skin emollients in infants from a general population reduced the risk of food allergy
  • recruited 2697 women with 2701 pregnancies, from whom 2397 newborn infants were enrolled between April 14, 2015, and April 11, 2017
    • of these infants, 597 were randomly assigned to the no intervention group, 575 to the skin intervention group, 642 to the food intervention group, and 583 to the combined intervention group
    • food allergy was diagnosed in 44 children;
      • 14 (2.3%) of 596 infants in the non-intervention group,
      • 17 (3.0%) of 574 infants in the skin intervention group,
      • six (0.9%) of 641 infants in the food intervention group,
      • seven (1.2%) of 583 infants in the combined intervention group
    • peanut allergy was diagnosed in 32 children, egg allergy in 12 children, and milk allergy in four children. None had allergy to wheat.
    • prevalence of food allergy was reduced in the food intervention group compared with the no food intervention group, but not compared with the skin intervention group, with no significant interaction effect
    • preventing food allergy in one child required early exposure to allergenic foods in 63 children. No serious adverse events were observed
    • found introduction of the four foods resulted in a statistically significant reduction in the primary outcome of allergy to any interventional food at 3 years of age (2.6% of infants in the no food intervention groups versus 1.1% in the food intervention groups), driven by the peanut allergy result
      
      
  • study authors' interpretation:
    • exposure to allergenic foods from 3 months of age reduced food allergy at 36 months in a general population
      • results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy

Notes:

• no consumption dose was specified in this pragmatic study, and therefore there is residual uncertainty regarding the dose of food required to induce tolerance (2)

Reference:

• Skjerven HO et al. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet. 2022; 399: 2398-2411
• NHS Specialist Pharmacy Service - Commentary June 25th 2022.