Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews

Paula Kuper; Claudia Hasenpusch; Simone Proebstl; Uwe Matterne; Catherine J Hornung; Esther Grätsch; Mengtong Li; Antonia A Sprenger; Dawid Pieper; Jennifer J Koplin; Michael R Perkin; Jon Genuneit; Christian Apfelbacher

doi:10.1111/cea.14399

Timing of complementary feeding for early childhood allergy prevention: An overview of systematic reviews

Clin Exp Allergy. 2023 Dec;53(12):1243-1255. doi: 10.1111/cea.14399. Epub 2023 Oct 1.

Authors

Affiliations

¹ Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.
² Murdoch Children's Research Institute, Parkville, Victoria, Australia.
³ Centre for Food & Allergy Research, Parkville, Victoria, Australia.
⁴ Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Rüdersdorf, Germany.
⁵ Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.
⁶ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
⁷ Population Health Research Institute, St. George's University London, London, UK.
⁸ Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany.

PMID: 37779264
DOI: 10.1111/cea.14399

Abstract

Objective: To summarise and critically appraise systematic review (SR) evidence on the effects of timing of complementary feeding (CF) on the occurrence of allergic sensitisation and disease.

Design: Overview of SRs. AMSTAR-2 and ROBIS were used to assess methodological quality and risk of bias (RoB) of SRs. RoB 2 Tool was used to assess RoB of primary randomised controlled trials (RCTs) (or extracted). The certainty of evidence (CoE) was assessed using GRADE. Findings were synthesised narratively.

Data sources: MEDLINE (via PubMed and Ovid), the Cochrane Library and Web of Science Core Collection (2010 to 27 February 2023).

Eligibility criteria: SRs investigating the effects of timing of CF in infants or young children (0-3 years) on risk of developing food allergy (FA), allergic sensitisation, asthma, allergic rhinitis, atopic eczema and adverse events based on RCT evidence.

Results: Eleven SRs were included. Only two SRs had low RoB; common issues were failure to report on funding of primary studies and failure to provide a list of excluded trials. Common limitations of included trials were lack of blinding of outcome assessment or detailed trial preregistration, and inadequate handling of high loss to follow up. Primary study overlap was very high for specific FA and slight to moderate for FA in general and other primary outcomes. Introducing specific foods (peanut, cooked egg) early probably reduces the risk of specific FA. Evidence for other allergic outcomes was mostly very uncertain and based on few primary studies. Trials varied regarding timing of CF, nature of complementary foods and population risk, which limited comparability between SRs.

Conclusions: For developing guidelines to support decision-making on the timing of CF as a preventive strategy, early introduction of specific foods (i.e. egg and peanut) seems promising and safe, whereas more extensive research is required regarding other allergic outcomes and potential adverse events.

Keywords: allergic diseases; complementary feeding; overview of reviews; prevention; timing of CF.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Asthma*
Child
Child, Preschool
Dermatitis, Atopic*
Food Hypersensitivity* / prevention & control
Humans
Infant
Infant Nutritional Physiological Phenomena
Systematic Reviews as Topic

Grants and funding

Deutsche Forschungsgemeinschaft