Search

Preparing and serving allergen-free meals continue to be challenging for food service establishments due to the associated costs and complexity of menu items. Our study assessed food allergy policies and procedures in independently owned restaurants (n = 103) within the Orlando metropolitan area in Florida. The Florida Department of Business and Professional Regulation HR 5030-038 from the Division of Hotels and Restaurants requires all food service managers and employees to know and name the top 8 major allergens and describe common food allergy symptoms. In total, 71 restaurants accommodated customers who have food allergies. Further, 25 restaurants reported having written food allergy policies and procedures, 63 did not, and 5 did not know. Approximately one half (49) of the owners, operators, and managers did not receive food allergy training. Of the training provided, 27 restaurants offered training in English and 20 restaurants offered training also in Spanish. Food service establishments will benefit from developing and implementing food allergy policies and procedures to serve food safely to customers who have food allergies. [ABSTRACT FROM AUTHOR]

Context Although the nutritional composition of organic food has been thoroughly researched, there is a dearth of published data relating to its impact on human health. Objective This systematic review aimed to examine the association between organic food intake and health effects, including changes in in vivo biomarkers, disease prevalence, and functional changes. Data Sources PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception through Nov 13, 2022. Data Extraction Both observational and interventional studies conducted in human populations were included, and association between level of organic food intake and each outcome was quantified as "no association," "inconsistent," "beneficial correlation/harmful correlation," or "insufficient". For outcomes with sufficient data reported by at least 3 studies, meta-analyses were conducted, using random-effects models to calculate standardized mean differences. Data Analysis Based on the included 23 observational and 27 interventional studies, the association between levels of organic food intake and (i) pesticide exposure biomarker was assessed as "beneficial correlation," (ii) toxic metals and carotenoids in the plasma was assessed as "no association," (iii) fatty acids in human milk was assessed as "insufficient," (iv) phenolics was assessed as "beneficial", and serum parameters and antioxidant status was assessed as "inconsistent". For diseases and functional changes, there was an overall "beneficial" association with organic food intake, and there were similar findings for obesity and body mass index. However, evidence for association of organic food intake with other single diseases was assessed as "insufficient" due to the limited number and extent of studies. Conclusion Organic food intake was found to have a beneficial impact in terms of reducing pesticide exposure, and the general effect on disease and functional changes (body mass index, male sperm quality) was appreciable. More long-term studies are required, especially for single diseases. Systematic Review Registration PROSPERO registration no. CRD42022350175. [ABSTRACT FROM AUTHOR]

Clinical Practice Guidelines (CPGs) are statements informed by a systematic review of research/evidence and provide recommendations for clinical practice to improve healthcare quality and patient outcomes. The National Association of School Nurses (NASN) released School Nursing Evidence-Based Clinical Practice Guideline: Students with Allergies and Risk for Anaphylaxis, in 2023, to provide evidence-based recommendations specific to school nursing practice and support the role of the school nurse in providing high-quality care for school-age children with allergies and risk for anaphylaxis. This article will provide an overview of the CPG and Implementation Toolkit. The implementation toolkit is designed to provide school nurses with tools and resources to implement the recommendations into practice. These tools and resources include school policies; nursing assessments and intake; planning, training, implementing, and evaluating care; and data collection. Examples are discussed, including how to customize the toolkit resources to your current practice needs. [ABSTRACT FROM AUTHOR]

The nutrition of the mother during pregnancy is very important on the development of the child's immune system and immune programming. Nutrition with antioxidant-rich fresh vegetables and fruits, dietary fiber consumption, and intake of n-3 unsaturated fatty acids (PUFA) provide important benefits in the development of the child's immune system and intestinal microbiota. Healthy nutritional components such as the Mediterranean diet, which are high in antioxidants, seem to have a direct effect on immune and metabolic processes as a whole and prevent the occurrence of many diseases by reducing chronic inflammation, oxidative damage, and cell destruction. Such a diet during pregnancy is thought to reduce the child's susceptibility to allergic diseases. For this reason, approaches to improving nutrition for the prevention of allergic diseases have been a very important research area in recent years. According to current data, epidemiological studies reveal conflicting results in terms of antioxidant intake and the development of allergic diseases. Many studies and meta-analyses associate low antioxidant intake with wheezing, increased asthma and airway reactivity, and reduced respiratory function. However, it has not been shown that a diet with high maternal antioxidant content has a protective effect on food allergy and other allergic diseases. In this review, the effects of a diet high in antioxidants and a Mediterranean diet during the pregnancy period of the mother on the prevention of food allergy and other allergic diseases in the child will be discussed in detail. [ABSTRACT FROM AUTHOR]

Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications. [ABSTRACT FROM AUTHOR]

Background: Experiencing food allergies and food insecurity has been linked to socioeconomic, physical, and mental health-related challenges, but less is known about the intersection of these experiences. This study aims to better understand the impact of food insecurity on food allergy patients and their caregivers, with the intention of informing ongoing efforts to improve screening for food insecurity and mental health concerns and reducing their burden among households managing food allergy. Method: As part of a community needs assessment, a cross-sectional survey was administered to a large, national sample (N=5,940) of US households with at least one food-allergic individual, The Hunger Vital Sign was utilized to assess food insecurity, the Patient Health Questionnaire (PHQ-4) and Food Allergy Independent Measure (FAIM) were leveraged to measure psychosocial outcomes. Results: Among respondents, 69.9% screened at-risk of food insecurity on the Hunger Vital Sign, while 5.6% reported very low food security. Both adults and children with food allergy (FA) from households at risk for food insecurity were more likely to report FA-related anxiety, anger, loneliness, fear of eating, and bullying victimization than their counterparts from households not at risk of food insecurity (p <.0001 for all). Among these specific experiences, FA-related anxiety was the most common (25.4%/30.1% of children/adults). Perceived risk of food allergy-related fatality was positively associated with food insecurity status. Conclusion: Individuals with food allergies who are concomitantly experiencing food insecurity are at greater risk of a variety of mental health concerns, including those specific to food allergy as well as more general anxiety and depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: A randomized trial demonstrated consumption of peanut from infancy to age 5 years prevented the development of peanut allergy. An extension of that trial demonstrated the effect persisted after 1 year of peanut avoidance. This follow-up trial examined the durability of peanut tolerance at age 144 months after years of ad libitum peanut consumption. Methods: Participants from a randomized peanut consumption trial were assessed for peanut allergy following an extended period of eating or avoiding peanuts as desired. The primary end point was the rate of peanut allergy at age 144 months. Results: We enrolled 508 of the original 640 participants (79.4%); 497 had complete primary end point data. At age 144 months, peanut allergy remained significantly more prevalent in participants in the original peanut avoidance group than in the original peanut consumption group (15.4% [38 of 246 participants] vs. 4.4% [11 of 251 participants]; P<0.001). Participants in both groups reported avoiding peanuts for prolonged periods of time between 72 and 144 months. Participants at 144 months in the peanut consumption group had levels of Ara h2-specific immunoglobulin E (a peanut allergen associated with anaphylaxis) of 0.03 ± 3.42 kU/l and levels of peanut-specific immunoglobulin G4 of 535.5 ± 4.98 µg/l, whereas participants in the peanut avoidance group had levels of Ara h2-specific immunoglobulin E of 0.06 ± 11.21 kU/l and levels of peanut-specific immunoglobulin G4 of 209.3 ± 3.84 µg/l. Adverse events were uncommon, and the majority were related to the food challenge. Conclusions: Peanut consumption, starting in infancy and continuing to age 5 years, provided lasting tolerance to peanut into adolescence irrespective of subsequent peanut consumption, demonstrating that long-term prevention and tolerance can be achieved in food allergy. (Funded by the National Institute of Allergy and Infectious Diseases and others; ITN070AD, ClinicalTrials.gov number, NCT03546413.) [ABSTRACT FROM AUTHOR]

The study examines the influence of a diversified diet, changes in the consistency of introduced foods, and the method of meal preparation during infancy on the development of sensitization and/or allergy in toddlers. Introducing more product groups into the diet reduced the risk of allergy at 6 months of age (adjusted odds ratio [aOR] = 0.17; 95% confidence interval [CI] 0.04-0.71; P = 0.015) and at 12 months (aOR = 0.14; 95% CI 0.03-0.57; P = 0.006). Children with allergy and/or sensitization had been introduced to fewer product groups at 6 months (P = 0.003; P < 0.001; P = 0.008) and at 12 months (P = 0.001, P < 0.001; P = 0.001) compared with those without allergy and/or sensitization. Children with allergy and/or sensitization were fed ready-made, ie, purchased, products significantly more often than self-prepared foods compared with children without allergy and/or sensitization (P = 0.001; P = 0.006). Allergic and/or sensitized children tended to be switched to solids later (11 vs 10 months, P = 0.041; P = 0.037) (12 vs 10 months, P = 0.013) than children without sensitization and/or allergy. The earlier introduction of a varied diet reduced the risk of allergy and/or sensitization. Delaying the introduction of solid foods and using ready-made products instead of self-prepared ones increases the risk of allergy in toddlers. [ABSTRACT FROM AUTHOR]

The article focuses on a NIH study showing that introducing peanut products to children regularly from infancy to age 5 significantly reduces the risk of peanut allergy in adolescence, reinforcing the benefits of early allergen consumption as a long-term prevention strategy.

Food allergies are on the rise; the incidence and types of foods implicated have increased worldwide. While peanut allergies are the most well-known, allergies exist to almost all types of foods. This article discusses various types of food allergies along with the most recent prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Pollen food syndrome (PFS) is an IgE-mediated food hypersensitivity reaction that typically results in immediate-onset oral and oropharyngeal symptoms in individuals who are sensitized to pollen. Symptoms are often mild, but systemic allergic reactions, including anaphylaxis, occur rarely. Using a cases series of six patients who were referred to our oral medicine department and for whom a diagnosis of PFS was made, we illustrate the clinical features of PFS and discuss the possibility that oral mucosal lesions may be a feature. Patients with PFS (or indeed other food hypersensitivities) may present to dental professionals in the first instance, therefore, it is important to be able to recognize key signs/symptoms, to give advice and to investigate/refer appropriately. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Peanut introduction guidelines have undergone significant reversal since 2001 from recommending delayed introduction to rescinding the recommendations in 2008 to actively recommending early introduction of peanut between 4 and 11 months of age in high-risk infants in 2015. This qualitative study aims to explore pediatrician beliefs, practices, facilitators, and barriers regarding peanut introduction and testing. Methods: General pediatricians from academic, private, large group, and underserved practices in Northern California underwent individual semi-structured interviews in 2017. We asked about experiences surrounding infant peanut introduction, strategies for staying up-to-date with current recommendations, and barriers and facilitators to the new peanut introduction and testing recommendations. The data were coded, and using grounded theory methodology, a conceptual framework was developed around early peanut introduction and testing in infants. Results: Eighteen general pediatricians participated. We identified barriers that may contribute to pediatrician reluctance to recommending early peanut introduction or testing including lack of awareness, lack of agreement, lack of resources, and lack of outcome expectancy. A framework was created that suggests that pediatricians need to be knowledgeable about new recommendations, agree with the recommendations, have resources to carry out the counseling and testing, and have buy-in from the parents in order for successful uptake of peanut introduction guidelines. Conclusion: Recommending early peanut introduction or testing causes significant apprehension in some pediatricians, and there are many barriers to following recent early peanut introduction recommendations. A potential limitation of the study is that it was conducted right after the addendum guidelines were changed, leaving the possibility that attitudes and practices may have evolved since 2017. It is still likely that a multifaceted approach that addresses primary care provider guideline awareness, limited primary care resources for education and testing, and includes support and collaboration from subspecialty practices is more likely to lead to improved early peanut introduction uptake.

BACKGROUND: This article introduces the concept, food allergy literacy (FAL), which encompasses the knowledge, behaviors, and skills needed to manage a food allergy and is thus critical to child safety. Yet, there is limited clarity on how to promote FAL in children. METHODS: Twelve academic databases were systematically searched to identify publications on interventions to promote FAL in children. Five publications met the inclusion criteria, which involved children (3 to 12 years), their parents, or educators and tested the efficacy of an intervention. FINDINGS: Four interventions were for parents and educators, while 1 intervention was for parents with their children. The interventions were educational and focused on promoting participant knowledge and skills of food allergy, and/or psychosocial in nature, promoting coping, confidence, and self‐efficacy in managing children's allergies. All interventions were deemed effective. Only 1 study used a control group, and none assessed the long‐term benefits of the interventions. IMPLICATIONS FOR SCHOOL POLICY, PRACTICE, AND EQUITY: The results can enable health service providers and educators to design evidence‐based interventions to promote FAL. This might involve designing, implementing, and evaluating curricula and play‐based activities, therein, that award greater attention to food allergy—its consequences, risks, skills to prevent risk, and managing food allergy in educational settings. CONCLUSIONS: There is limited evidence on child‐focused interventions that promote FAL. There is, therefore, considerable opportunity to co‐design and test interventions with children. [ABSTRACT FROM AUTHOR]

In January 2022, a group of experts came together to discuss current perspectives and future directions in nutritional immunology as part of a symposium organized by the Canadian Nutrition Society. Objectives included (1) creating an understanding of the complex interplay between diet and the immune system from infants through to older adults, (2) illustrating the role of micronutrients that are vital to the immune system, (3) learning about current research comparing the impact of various dietary patterns and novel approaches to reduce inflammation, autoimmune conditions, allergies, and infections, and (4) discussing select dietary recommendations aimed at improving disease-specific immune function. The aims of this review are to summarize the symposium and to identify key areas of research that require additional exploration to better understand the dynamic relationship between nutrition and immune function. [ABSTRACT FROM AUTHOR]

The Canadian Paediatric Society's Position statement 'Dietary exposures and allergy prevention in high-risk infants' December 2021 provides recommendations for regular ingestion of cow's milk protein (CMP) once introduced in early infancy. These recommendations are based on evidence from randomized controlled trials (RCTs) where researchers supported participants in adhering to diet recommendations. Real-life dilemmas that relate to dietary adherence including cost, food wastage, and practicality are not addressed and are the crux of where -evidence-based recommendations fail. This commentary highlights the difficulties in carrying out the proposed recommendation for regular ingestion of CMP in practice and offers three practical real-world options instead. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mammalian meat allergy can develop after tick bites that introduce the allergen galactose-α-1,3-galacotose, which is also found in non-primate mammalian meat. It is characterized by a delayed onset allergic reaction that can result in dermatological, gastrointestinal and/or anaphylactic symptoms. The condition is managed by avoiding the allergen (i.e. by abstaining from mammalian meat consumption) and further sensitization via tick bites; pharmacological options may be of use for symptom management. [ABSTRACT FROM AUTHOR]

Allergic reactions to allergenic foods can pose a lethal threat to children with food allergies. Previous research has demonstrated the effectiveness of using behavioral skills training (BST) plus in situ training (IST) to teach safety responses to children. However, there has not been an evaluation of using BST to teach food safety to children with food allergies. Three elementary‐school children of neurotypical development with food allergies participated. We evaluated the efficacy of BST with IST in teaching participants to identify and respond to allergenic foods by (a) asking to see the food packaging, (b) scanning the food label for the allergenic food, and (c) reporting the safety threat to an adult while not consuming the food. Trials without allergenic foods were also presented to ensure discriminated responding. All participants demonstrated the three correct safety responses after BST and responded differentially across allergenic and nonallergenic foods, with two participants requiring feedback (IST). [ABSTRACT FROM AUTHOR]

Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow's milk formula during the first week of life should be avoided. Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. The prophylactic effects of breastfeeding have been the subject of many studies, some with weak evidence. In this narrative review, we aim to provide an up-to-date account of the effects of prophylactic breastfeeding on food allergy and other common allergies in infants and children up to 5 years of age. Colostrum in particular has been shown to be prophylactic against food allergy. The American Academy of Pediatrics cautions that the relationship between duration of breastfeeding and incidence of food allergy in early childhood is unclear. The protective role of breastfeeding has a positive effect on allergy prevention, which is opposed by the early introduction of solid foods, but larger studies are needed to confirm the evidence. There is evidence that breastfeeding is effective in providing partial protection to infants. [ABSTRACT FROM AUTHOR]

Objective: Bioinformatics analyses have been becoming important research tools in the field of life science since 2000. New tools have been developed for the detection of allergens in food sources. This study investigated potential allergen proteins similar to the endochitinase class 1(Pers a 1) protein found in avocado using bioinformatics analysis tools. Materials and Methods: The potential allergens were examined with four different in silico tools: Clustal W for multiple sequence comparison, Swiss-MODEL for homology modeling, ProtParam for comparing protein parameters, and AlgPred for allergen prediction. Results: In silico analyses revealed high rates of similarities in protein sequences among the studied species. The highest percent identity was found in Cinnamomum micranthum f. kanehirae as 97.55 while the lowest percent identity was found in Diospyros kaki as 70.23. It is very important to note that 9 of the 10 potential allergen species investigated are plats consumed in daily life and these species were identified as allergens. According to the algorithm of BLAST search on allergen representative peptides (ARPs), ARPs were found in eight potential allergen proteins except for Prunus avium and Citrus unshiu. The ARP sequence related to Persea americana is LQLTWNYNYGAAGNSIGFNGLSNP. Conclusion: People who are allergic to avocado (Persea americana) may be advised to be careful while consuming foods such as Phoenix dactylifera, Allium sativum, Citrus unshiu, Diospyros kaki, and Spinacia oleracea. The present paper can be considered as a model study for understanding allergens in foods by using in silico tools. [ABSTRACT FROM AUTHOR]

Purpose: The incidence and prevalence of food allergy have sharply risen over the past several decades. Oral administration of probiotic stains has been proven as a safe and effective method to control food allergy. In this study, it aims to comprehensively investigate the anti-allergic effect of Lactobacillus plantarum JC7. Methods: Balb/c mice were randomly divided into three groups and received OVA (20 µg/mouse, intraperitoneal injection), L. plantarum JC7 (2 × 108 CFU/mouse, intragastric administration) + OVA (20 µg/mouse, intraperitoneal injection) or 0.9% saline (intragastric administration) for 3 weeks. Body weight was monitored weekly, and allergic reactions were evaluated after challenge of OVA. Serum levels of OVA-specific immunoglobulins and various cytokines were tested using ELISA, and the cecum microbiota was analysed by 16S rRNA sequencing to explore the relationships between these indicators and OVA-induced food allergy. Western blotting was used to identify the expression levels of phosphorylated IκBα and nuclear factor kappa B p65. Results: OVA-sensitised mice showed mitigation of respiratory manifestations, alleviation of lung inflammation and congestion, and the presence of an intact intestinal villus structure. Furthermore, OVA-specific immunoglobulin E (IgE), OVA-specific-IgG1, and plasma histamine levels were declined in mice treated with L. plantarum JC7 than in OVA-sensitised mice. In addition, interferon-γ (IFN-γ) and interleukin 10 (IL-10) levels were significantly increased, while IL-4 and IL-17A levels were clearly decreased in mice that had undergone oral administration of L. plantarum JC7, compared with OVA-sensitised mice. These findings indicated imbalances of T helper cell type 1 (Th1)/Th2 and regulatory T cells (Treg)/Th17, which were confirmed by quantitative polymerase chain reaction (PCR). Western blotting demonstrated that the expression levels of phosphorylated IκBα and nuclear factor kappa B p65 were significantly increased in OVA-sensitised mice, but these changes were partly reversed after treatment with L. plantarum JC7. Oral administration of L. plantarum JC7 increased the richness, diversity, and evenness of cecum microbiota, characterised by higher Bacteroidetes abundance and lower Firmicutes abundance. Additionally, the intestinal microbial community composition was significantly altered in the OVA-sensitised group, indicating a disordered intestinal microbiota that was restored by the oral administration of L. plantarum JC7. Conclusion: Overall, L. plantarum JC7 can prevent food allergy by rectifying Th1/Th2 and Treg/Th17 imbalances, combined with modifications of disordered intestinal microbiota. [ABSTRACT FROM AUTHOR]

Objectives To establish the prevalence of non-coeliac gluten sensitivity (NCGS) in a cohort of fibromyalgia patients and to evaluate their clinical response to a six-week gluten-free diet (GFD), the improvement in their symptoms, the percentage of diet responders who did not fulfil the diagnostic criteria for NCGS and the baseline characteristics that were associated with diet response and diagnostic criteria fulfilment. Methods Uncontrolled prospective experimental study in a cohort of patients with fibromyalgia from a specialized hospital unit. The percentage of patients that fulfilled the Salerno Experts' Criteria, that responded to GFD, that improved their symptomatology and baseline characteristics associated with GFD response and diagnostic criteria fulfilment was analysed. Results In total, 142 patients were selected and a NCGS prevalence of 5.6% was observed. A total of 21.8% responded to GFD due to their improvement in intestinal symptoms. In total, 74.2% of the responders did not fulfil the Salerno Experts' Criteria. The presence of diarrhoea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of GFD response. No predictive factors of NCGS criteria fulfilment were found due to the low number of discriminators between gluten and placebo. Conclusions A NCGS prevalence similar to that estimated in the general population was found. A GFD cannot be systematically recommended to all patients with fibromyalgia, although it could be evaluated in those with diarrhoea or intraepithelial lymphocytosis to evaluate if there are improvements in their intestinal symptoms. [ABSTRACT FROM AUTHOR]

With the increase in prevalence in food allergies and an increase in food allergy research, there is a corresponding increase in public confusion about the best way to identify and manage food allergies. Current descriptions are provided to clarify the various types of adverse food reactions, specifically what is classified as food allergy and the different types of food allergies. Understanding the type of food allergy can be crucial to making a formal medical diagnosis and providing high-quality nutrition care. Patients rely on healthcare teams' expertise to manage their food allergy and improve their quality of life. A summary of current evidence-based guidelines and roles of the multidisciplinary healthcare team set the stage for this series of articles on food allergies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine whether a multicomponent intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children. METHODS: The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large health care organization. Intervention activities occurred over 16 months and included provider educational programs, electronic health record tools, and new patient instructions. We used an interrupted time series design to assess whether peanut allergy incidence differed across 3 time periods (preintervention, interim, postintervention) among high- and lowrisk children. The primary outcome was incident peanut allergy by age 24 months, defined as peanut allergy in the allergy field or active problem list plus a positive supportive test. Severe eczema and/or egg allergy presence defined highrisk. Because the study was conducted as part of routine care, it was not feasible to measure what counseling clinicians provided, or how and when parents fed their children peanutcontaining foods. RESULTS: In a cohort of 22,571 children, the percent with peanut allergy by age 24 months was 17.3% (116 of 671) among high-risk and 0.8% (181 of 21,900) among low-risk children. In multivariate analyses, the adjusted peanut allergy rate per 100 person-years was not significantly different across study periods among high-risk (9.6 preintervention, 11.7 interim, and 9.9 postintervention, P = .70) or low-risk (0.5 preintervention, 0.7 interim, and 0.5 postintervention, P = .17) children. CONCLUSIONS: In a community-based setting, the incidence of peanut allergy did not decline following a multicomponent intervention focused on early peanut introduction. [ABSTRACT FROM AUTHOR]

Background: Schoolchildren are likely to consume meals and snacks at school, with a possibility of allergic food reactions and anaphylaxis in the school environment. The school personnel should be informed of the presence of schoolchildren with food allergy (FA) and need to be trained in the management of allergic reactions, as to prepare them to intervene appropriately when necessary. Limited knowledge of FA and its management is documented globally among school staff and there is no uniform protocol in schools. Methods: In this observational cross-sectional study, teachers at state schools throughout Greece completed an online anonymous questionnaire on their awareness of FA reactions and the plans for the management of medical emergencies in their schools of employment. Results: Among the 289 teachers who responded the online invitation, 203 (70.24%) were female and 157 (54%) were aged under 40 years. Females expressed a higher level of concern about the presence of school personnel trained to manage FA symptoms (p = 0.001), written instructions, and the availability of adrenaline (epinephrine) at school (p < 0.001). A younger age was associated with a higher level of both interest and knowledge on FA management in schools. School directors were more certain about the availability of a special record of children with FA at school (p = 0.01), the availability of adrenaline (p = 0.006), and written guidelines on the management of serious health incidents at school (p = 0.04). Written guidelines instructing children to avoid sharing cutlery, glasses, home-prepared meals, and snacks bought from the school canteen were more common in schools in urban areas (p = 0.015). Only 20% of respondents could confirm with certainty that adrenaline autoinjectors (AAIs) were available at their schools, for the purpose of administering to children in the case of a severe FA reaction. Approximately 3/4 of the participating teachers stated that completion of this questionnaire raised their awareness of the risk of FA reactions in children at school. Conclusions: This study, the first in Greece to explore the knowledge of teachers about FA in schoolchildren, revealed the following absences in many schools: a process for identifying children with FA, a written emergency treatment plan, and immediate access to emergency AAI. School FA guidelines are necessary in Greece, and training, which includes the use of AAIs, is required to prepare teachers to manage FA reactions in children at school. [ABSTRACT FROM AUTHOR]

During the last decades the prevalence of food allergy (FA), an adverse immune response to a specific food antigen, has risen, with negative effects on the quality of life (QoL) of many children and their families. The pathogenesis of FA is complex, involving both genetic and environmental factors. SPINK5, STAT6, HLA and FOXP3 are some of the genes that are reported to be implicated in FA development. Regarding environmental factors, particular interest has been focused on modification of the dietary habits of pregnant women for the primary prevention of FA. Specifically, Vitamin D and omega-3 (Ω-3) fatty acid supplementation during pregnancy may influence the development of FA in the offspring. Vitamin D is a hormone with various actions, including mediation of the immune system, reducing the production of inflammatory cytokines and promoting tolerance. Vitamin D deficiency in pregnancy suppresses T-regulatory cells in the fetus, and Vitamin D supplementation might protect against FA development. Dietary Ω-3 fatty acids are found mainly in fish and vegetable oils. They are beneficial for human health, playing a role in the immune system as anti-inflammatory agents, and providing cell membrane stabilization with inhibition of antigen presentation. It is documented that maternal supplementation with Ω-3 during pregnancy may protect from allergic sensitization in the children. The aim of this literature review was to explore the potential preventive role of maternal supplementation during pregnancy with Vitamin D and Ω-3 in the development of FA in the offspring. With the prevalence of FA rising, all the possible protective mechanisms and measures for FA prevention need to be explored, starting with those that can be modified. [ABSTRACT FROM AUTHOR]

Abstract Objective: To identify a brand, key messages and resources to underpin a public health approach to food allergy prevention. Methods: A focus group design was used to explore perceptions and opinions of potential brands, infant feeding messages and resources for providing standardised food allergy prevention information. Focus groups were conducted in February 2018 using interview guides and were transcribed verbatim. A content analysis of the transcripts was undertaken using thematic analysis software. The University of Western Australia provided ethics approval: RA/4/20/4280. Results: Seven focus groups with 39 participants were conducted. Four slogans and styles of imagery were considered. ‘Nip Allergies in the Bub’ was the most favoured slogan and images of babies with food were most favoured. Participant feedback was sought regarding messages and supporting messages were considered important. Participants were consulted about useful resources and a website was identified. Conclusions: Conducting focus groups assisted the selection of a brand, messages and resources to underpin a public health approach to implementing allergy prevention guidelines. Implications for public health: This is the first focus group research undertaken for food allergy prevention. Identification of a meaningful brand, key messages and resources will support a public health approach to implementing allergy prevention guidelines.

The LEAP (Learning Early About Peanut allergy) trial established that early introduction of peanuts in high-risk infants prevents the childhood development of peanut allergy for most. LEAP-Trio, a 12-year follow up of the LEAP participants, published in this issue of NEJM Evidence, demonstrates long-term protection from peanut allergy. In comparison with the 80% reduction of peanut allergy in LEAP, LEAP-Trio found a 75% reduction in the early peanut consumption group compared with the avoidance group, despite ad libitum consumption of peanuts in children who were originally peanut-tolerant. Clinically, LEAP-Trio demonstrates that early introduction of peanuts in high-risk children results in long-lived tolerance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Multiple systematic reviews examine the introduction of foods in relation to individual health outcomes, but the balance of harms and benefits has not been overviewed systematically. OBJECTIVES: We aimed to perform an overview of systematic reviews on age of introduction of complementary and allergenic foods to the infant diet and long and short-term health outcomes. DATA SOURCES: We searched Medline, Embase, Cochrane, and PubMed (July 25, 2022). STUDY SELECTION: Included systematic reviews examining the introduction of complementary or allergenic foods before age 1. Outcomes included allergic, autoimmune, and inflammatory diseases, neurodevelopment, nutrition, and weight. DATA EXTRACTION: Extraction and quality assessment were performed in duplicate (A Measurement Tool to Assess Systematic Reviews) and strength of evidence was assessed. RESULTS: We screened 4015 articles and included 32 systematic reviews. There was moderate evidence that peanut and egg should be introduced from 4 to 11 months to prevent food allergy (6 of 10 reviews). Complementary food introduction was not associated with food allergy. Moderate certainty evidence suggested age of complementary food introduction was not associated with eczema. Age at introduction of gluten was not associated with celiac disease (high certainty evidence; 3 of 4 reviews). Low certainty evidence indicated that introducing solids before 4 months may increase the risk of childhood obesity, but not growth. There was insufficient evidence regarding an association between any food introduction and bone health, gastrointestinal diseases, autoimmune disorders, asthma, or allergic rhinitis. LIMITATIONS: Gray literature was not included. CONCLUSIONS: Current evidence supports introducing complementary foods around 6 months and allergenic foods before 11 months. [ABSTRACT FROM AUTHOR]

Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them. [ABSTRACT FROM AUTHOR]

Food allergy prevalence in the United States has been increasing among school-aged children. Many community-based pediatric caregivers (e.g., camp staff, sports coaches) are not trained to prevent, recognize, or manage allergic reactions due to a lack of available training and standard policies on this topic. Epinephrine is the first-line of treatment for severe allergic reactions and delayed administration of this medication can result in poor health outcomes and death. School nurses may use their knowledge and expertise to educate community-based pediatric caregivers on allergy topics. Professional practice projects can be utilized by school nurses to help improve allergy and anaphylaxis confidence and knowledge among community-based pediatric caregivers. By educating community members on anaphylaxis management, it can improve health outcomes for children of the school community and result in saved lives. [ABSTRACT FROM AUTHOR]

Breast milk is the optimal feeding, which meets all the newborn’s body needs. For nutritional support and development of the baby, at certain periods of life it is required to introduce complementary foods into the diet, which is an important intermediate link between the milk nutrition and the general diet. In addition, complementary foods contribute to the development of taste habits, introduce a baby to a variety of foods and tastes, to a more complex food texture, and contribute to the development of such important physiological skills as chewing and swallowing. Nutrition in infancy may influence eating behaviour and eating habits at a later age. The babies become familiar with scents in the mother’s womb via amniotic fluid and then during breastfeeding when scents and flavours from the mother’s diet are tasted.The article provides evidence in support of the recommended age when complementary foods should be introduced, the main factors affecting the eating behaviour of babies: exposure to sweet, salty, sour, bitter, or specific tastes. The impact of sweet foods on the health of babies in the future is of great importance, for example, it may increase a risk of developing overweight/obesity as compared to those who had the lowest intake of sweet foods. Attention is paid to the most important risk factor for developing early sensitization, namely the nature of feeding babies in the early period, and the immunogenicity evaluation of the first complementary foods. The article provides a rich selection of commercial first complementary foods that contribute to the correct development of eating habits in babies from an early age.

The article discusses a study published in "Allergy," which found that peanut allergies may resolve by age ten, beginning at six years of age.

The intestinal barrier is essential in early life to prevent infection, inflammation, and food allergies. It consists of microbiota, a mucus layer, an epithelial layer, and the immune system. Microbial metabolites, the mucus, antimicrobial peptides, and secretory immunoglobulin A (sIgA) protect the intestinal mucosa against infection. The complex interplay between these functionalities of the intestinal barrier is crucial in early life by supporting homeostasis, development of the intestinal immune system, and long-term gut health. Exclusive breastfeeding is highly recommended during the first 6 months. When breastfeeding is not possible, milk-based infant formulas are a safe alternative. Breast milk contains many bioactive components that help to establish the intestinal microbiota and influence the development of the intestinal epithelium and the immune system. Importantly, breastfeeding lowers the risk for intestinal and respiratory tract infections. Here we review all aspects of intestinal barrier function and the nutritional components that impact its functionality in early life, such asmicronutrients, bioactive milk proteins, milk lipids, and human milk oligosaccharides. These components are present in breast milk and can be added to milk-based infant formulas to support gut health and immunity. [ABSTRACT FROM AUTHOR]

Importance: Randomized clinical trials showed that earlier peanut introduction can prevent peanut allergy in select high-risk populations. This led to changes in infant feeding guidelines in 2016 to recommend early peanut introduction for all infants to reduce the risk of peanut allergy.Objective: To measure the change in population prevalence of peanut allergy in infants after the introduction of these new guidelines and evaluate the association between early peanut introduction and peanut allergy.Design: Two population-based cross-sectional samples of infants aged 12 months were recruited 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Infants were recruited from immunization centers around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate (eligible age range, 11-15 months), regardless of history of peanut exposure or allergy history.Exposures: Questionnaires collected data on demographics, food allergy risk factors, peanut introduction, and reactions.Main Outcome and Measures: All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time.Results: This study included 7209 infants (1933 in 2018-2019 and 5276 in 2007-2011). Of the participants in the older vs more recent cohort, 51.8% vs 50.8% were male; median (IQR) ages were 12.5 (12.2-13.0) months vs 12.4 (12.2-12.9) months. There was an increase in infants of East Asian ancestry over time (16.5% in 2018-2019 vs 10.5% in 2007-2011), which is a food allergy risk factor. After standardizing for infant ancestry and other demographics changes, peanut allergy prevalence was 2.6% (95% CI, 1.8%-3.4%) in 2018-2019, compared with 3.1% in 2007-2011 (difference, -0.5% [95% CI, -1.4% to 0.4%]; P = .26). Earlier age of peanut introduction was significantly associated with a lower risk of peanut allergy among infants of Australian ancestry in 2018-2019 (age 12 months compared with age 6 months or younger: adjusted odds ratio, 0.08 [05% CI, 0.02-0.36]; age 12 months compared with 7 to less than 10 months: adjusted odds ratio, 0.09 [95% CI, 0.02-0.53]), but not significant among infants of East Asian ancestry (P for interaction = .002).Conclusions and Relevance: In cross-sectional analyses, introduction of a guideline recommending early peanut introduction in Australia was not associated with a statistically significant lower or higher prevalence of peanut allergy across the population. [ABSTRACT FROM AUTHOR]

The National Academies of Sciences, Engineering, and Medicine (NASEM) has identified food allergies as a critical public health issue that significantly affects quality of life for patients and their families. Despite the crisis-level status of food allergies, especially in children, there are currently no curative treatments. As a result, impacted families must learn how to carry the burden of disease management. Using an expanded application of the concept of communication work, this study features data from interviews with 26 parents of food allergic children and explores how parents navigate the nuances of food allergy maintenance while negotiating and preserving valued relationships and identities through everyday talk. Results revealed that parents used communication to legitimate food allergy, balance potential face-threats with identity and relational goals, and coordinate care with spouses. Due to the lack of therapeutic treatment options, we found that parents utilize communication work, which is both demanding and effortful, as a form of disease management. [ABSTRACT FROM AUTHOR]

Background: Primary prevention of food allergy by early introduction of allergenic foods seems promising. We aimed 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.Methods: This 2 × 2 factorial, cluster-randomised trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway, and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine 18-week ultrasound examination were cluster-randomised at birth to the following groups: (1) no intervention group; (2) the skin intervention group (skin emollients; bath additives and facial cream; from age 2 weeks to <9 months, both at least four times per week); (3) the food intervention group (early complementary feeding of peanut, cow's milk, wheat, and egg from age 3 months); or (4) combined intervention group (skin and food interventions). Participants were randomly assigned (1:1:1:1) using computer-generated randomisation based on clusters of 92 geographical areas and eight 3-month time blocks. Study personnel performing clinical assessments were masked to group allocation. The primary outcome was allergy to any interventional food at 36 months of age. The primary efficacy analysis was done by intention-to-treat analysis, which included all participants who were randomly assigned, apart from three individuals who withdrew their consent. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). This study is registered as ClinicalTrials.gov, NCT02449850.Findings: We 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. One participant in each of the no intervention, food intervention, and skin intervention groups withdrew consent and were therefore not included in any analyses. 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, and 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 (risk difference -1·6% [95% CI -2·7 to -0·5]; odds ratio [OR] 0·4 [95% CI 0·2 to 0·8]), but not compared with the skin intervention group (0·4% [95% CI -0·6 to 1· 5%]; OR 1·3 [0·7 to 2·3]), with no significant interaction effect (p=1·0). Preventing food allergy in one child required early exposure to allergenic foods in 63 children. No serious adverse events were observed.Interpretation: Exposure to allergenic foods from 3 months of age reduced food allergy at 36 months in a general population. Our results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy.Funding: Full funding sources listed at end of paper (see Acknowledgments). [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; EAACI; early allergen exposure; food allergy; food allergy prevention EN anaphylaxis EAACI early allergen exposure food allergy food allergy prevention 476 480 5 04/04/22 20220401 NES 220401 BACKGROUND Given that food allergy (FA) is often lifelong and results in a significant reduction in quality of life for children and families, parents often ask "How can I stop my child developing FA?" Anaphylaxis, EAACI, early allergen exposure, food allergy, food allergy prevention. [Extracted from the article]

Background: For young children with peanut allergy, dietary avoidance is the current standard of care. We aimed to assess whether peanut oral immunotherapy can induce desensitisation (an increased allergic reaction threshold while on therapy) or remission (a state of non-responsiveness after discontinuation of immunotherapy) in this population.Methods: We did a randomised, double-blind, placebo-controlled study in five US academic medical centres. Eligible participants were children aged 12 to younger than 48 months who were reactive to 500 mg or less of peanut protein during a double-blind, placebo-controlled food challenge (DBPCFC). Participants were randomly assigned by use of a computer, in a 2:1 allocation ratio, to receive peanut oral immunotherapy or placebo for 134 weeks (2000 mg peanut protein per day) followed by 26 weeks of avoidance, with participants and study staff and investigators masked to group treatment assignment. The primary outcome was desensitisation at the end of treatment (week 134), and remission after avoidance (week 160), as the key secondary outcome, were assessed by DBPCFC to 5000 mg in the intention-to-treat population. Safety and immunological parameters were assessed in the same population. This trial is registered on ClinicalTrials.gov, NCT03345160.Findings: Between Aug 13, 2013, and Oct 1, 2015, 146 children, with a median age of 39·3 months (IQR 30·8-44·7), were randomly assigned to receive peanut oral immunotherapy (96 participants) or placebo (50 participants). At week 134, 68 (71%, 95% CI 61-80) of 96 participants who received peanut oral immunotherapy compared with one (2%, 0·05-11) of 50 who received placebo met the primary outcome of desensitisation (risk difference [RD] 69%, 95% CI 59-79; p<0·0001). The median cumulative tolerated dose during the week 134 DBPCFC was 5005 mg (IQR 3755-5005) for peanut oral immunotherapy versus 5 mg (0-105) for placebo (p<0·0001). After avoidance, 20 (21%, 95% CI 13-30) of 96 participants receiving peanut oral immunotherapy compared with one (2%, 0·05-11) of 50 receiving placebo met remission criteria (RD 19%, 95% CI 10-28; p=0·0021). The median cumulative tolerated dose during the week 160 DBPCFC was 755 mg (IQR 0-2755) for peanut oral immunotherapy and 0 mg (0-55) for placebo (p<0·0001). A significant proportion of participants receiving peanut oral immunotherapy who passed the 5000 mg DBPCFC at week 134 could no longer tolerate 5000 mg at week 160 (p<0·001). The participant receiving placebo who was desensitised at week 134 also achieved remission at week 160. Compared with placebo, peanut oral immunotherapy decreased peanut-specific and Ara h2-specific IgE, skin prick test, and basophil activation, and increased peanut-specific and Ara h2-specific IgG4 at weeks 134 and 160. By use of multivariable regression analysis of participants receiving peanut oral immunotherapy, younger age and lower baseline peanut-specific IgE was predictive of remission. Most participants (98% with peanut oral immunotherapy vs 80% with placebo) had at least one oral immunotherapy dosing reaction, predominantly mild to moderate and occurring more frequently in participants receiving peanut oral immunotherapy. 35 oral immunotherapy dosing events with moderate symptoms were treated with epinephrine in 21 participants receiving peanut oral immunotherapy.Interpretation: In children with a peanut allergy, initiation of peanut oral immunotherapy before age 4 years was associated with an increase in both desensitisation and remission. Development of remission correlated with immunological biomarkers. The outcomes suggest a window of opportunity at a young age for intervention to induce remission of peanut allergy.Funding: National Institute of Allergy and Infectious Disease, Immune Tolerance Network. [ABSTRACT FROM AUTHOR]

There is no defined standard of care around tree nut introduction in a peanut‐allergic child, and the role of screening prior to tree nut introduction is controversial. There is some evidence that peanut‐allergic children are at increased risk of tree nut allergy, with approximately 23–68% of children with co‐existent peanut/tree nut allergy. In some studies, it has been shown that tree nut allergy in children has the potential to be a severe allergy. However, this appears to be age‐specific as infant anaphylaxis in general tends to be milder, and there has been no fatality reported on the first ingestion of an allergen in infancy. Familial hesitancy has been identified as a possible condition for undertaking screening tests prior to allergen introduction. Indeed, there has been limited evidence that caregiver hesitancy may exist in peanut‐allergic families with tree nut introduction. However, pre‐emptive screening has the potential to overdiagnose tree nut allergy and delay introduction (which could paradoxically increase risk). As a result, the decision is best made in the context of shared decision‐making and patient preference‐sensitive care. [ABSTRACT FROM AUTHOR]

Background: Pediatric food allergies (FAs) present significant health and economic problems. Currently, there are no cures for FAs. Recent studies suggest that early introduction (EI), between 4 and 6 months of age, of commonly allergenic foods (CAFs) may reduce the risk of developing FAs. This contradicts the current standard of care, food avoidance. Local problem: A federally qualified health center saw 894 patients aged 0–24 months during a 12-month period with only 18.9% receiving nutrition education. New dietary recommendations to prevent FA were not in place. Methods: A retrospective chart review was used to evaluate use of an order set with patient education on EI to CAFs in the electronic medical record (EMR). Interventions: Providers attended training on EI to CAFs and use of the EMR order set. Data were collected on the use of the order set over a 3-month period. Results: Provider training significantly improved knowledge of FA as well as EI guidelines. After 3 months of implementation, 25.95% of eligible encounters contained the EI order set; 52% of patients received the order set during the measurement period. In the impact population, patients 4–12 months of age, 74.55% of patients received the order set. Conclusions: Evidence-based clinical content in EMR order sets coupled with provider training ensure clinical decision support in identifying, monitoring, and optimizing quality care standards. [ABSTRACT FROM AUTHOR]

Objective: To characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce., Study Design: Pediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines., Results: A total of 250 pediatricians, 250 family physicians, 504 APPs, and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis., Conclusions: Although pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Food allergy prevention has undergone a significant transformation over the past 3 decades. This review provides an overview of the evolution of food allergy prevention, highlighting changes in guidance, cost-effectiveness of prevention, the role of shared decision-making, and the emergence of oral immunotherapy for those in whom primary prevention fails. Changes to food allergy prevention over recent decades can be conceptualized into five epochs, which have followed a general trend of loosening restrictions on the allergen introduction timeline. These epochs are characterized by significant maternal and infant dietary restrictions in the "universal avoidance epoch"(-1990), loosened maternal diet restrictions in the "infant avoidance epoch" (1990-2000), a time-bound allergen introduction schedule in the "stratified avoidance epoch" (2000-2010), retraction of recommendations in the "corrective retraction epoch" (2010-2015), and endorsement of early allergen introduction in the "early introduction epoch" (2015-present), the start of which is marked by the 2015 Learning Early About Peanut study. In hindsight, it is clear that certain recommendations from previous decades were not the best course of action. A no-screening early introduction approach to food allergy prevention is both cost-effective and beneficial to patient quality of life., (Copyright © 2024, The Author(s). Published by OceanSide Publications, Inc., U.S.A.)