Pediatric Allergy - What We Learned in 2021

This year brought about some revolutionary data in pediatric allergy. Here is a summary of the most interesting research to emerge:

1. Diet Diversity is Critical: Data continues to demonstrate increased diet diversity in early childhood is inversely associated with atopic diseases. The PASTURE study group published new research showing inverse associations between food diversity in early childhood and allergic diseases, reinforcing data from Venter et al. in 2020.
2. Choose Skin Emollients Carefully: Additional data analyzed from the EAT study by Perkins et al. suggest that regular application of moisturizers to the skin of infants may lead to developing food allergies through either transcutaneous sensitization or moisturizers potentially damaging the skin barrier. Early data suggests using trilipid-based emollients over petrolatum-based emollients for infants may avoid such risks.
3. What We Eat Impacts Our Microbiome: Data continues to unfold demonstrating the important impact diet and nutrition has on the gut microbiome, which may play a role in food allergies, along with environmental factors. 
4. Consensus Guidelines Clarify Food Allergy Prevention Recommendations: The North American Allergy Societies (AAAAI/ACAAI/CSACI) have put out crisp and clear guidance on the recommendations for introducing and feeding common allergens to infants. Read about the new guidelines here. 
5. Guidelines Still Not Reaching Parents: In a survey of pediatricians around the US about the adoption of the Early Peanut Introduction Guidelines, most pediatricians (68%) expressed the need for more education/training and materials to provide parents with the early introduction recommendations.

References: 

1. Stampfli M, Frei R, Divaret-Chauveau A, et al. Inverse associations between food diversity in the second year of life and allergic diseases. Annals of Allergy, Asthma & Immunology. 2022;128(1):39-45

2. Venter C, Maslin K, Holloway JW, et al. Different Measures of Diet Diversity During Infancy and the Association with Childhood Food Allergy in a UK Birth Cohort Study. J Allergy Clin Immunol Pract. 2020;8(6):2017-2026. doi:10.1016/j.jaip.2020.01.029

3. Perkin MR, Logan K, Marrs T, et al. Association of frequent moisturizer use in early infancy with the development of food allergy. J Allergy Clin Immunol. 2021;147(3):967-976.e1. doi:10.1016/j.jaci.2020.10.044

4. Venter C, O'Mahony L. Immunonutrition: The importance of a new European Academy of Allergy and Clinical Immunology working group addressing a significant burden and unmet need. Allergy. 2021;76(7):2303-2305. doi:10.1111/all.14781

5. Fleischer DM, Chan ES, Venter C, et al. A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. J Allergy Clin Immunol Pract. 2021;9(1):22-43.e4. doi:10.1016/j.jaip.2020.11.002

6. Gupta RS, Bilaver LA, Johnson JL, et al. Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States. JAMA Netw Open. 2020;3(7):e2010511. Published 2020 Jul 15. doi:10.1001/jamanetworkopen.2020.10511