S3 guideline Allergy Prevention.

Area of Science:

• Immunology and Allergy Prevention
• Public Health Guidelines
• Pediatric Medicine

Background:

• Persistent high prevalence of allergic diseases in Western nations necessitates evidence-based primary prevention strategies.
• Limited causal therapies underscore the importance of preventative measures.
• Previous S3 guideline (2014) required updating based on current evidence.

Purpose of the Study:

• To revise and update evidence-based recommendations for the primary prevention of allergic diseases, including asthma and atopic dermatitis.
• To incorporate the latest scientific findings from a systematic literature search (2013-2020).
• To provide consensus-based guidance for healthcare professionals and organizations.

Main Methods:

• Systematic literature search conducted in Cochrane and MEDLINE (06/2013 - 11/2020).
• Screening of 5,681 identified studies, with 286 included and assessed for relevance and quality.
• Revised recommendations developed through a nominal group process involving professional societies and patient organizations.

Main Results:

• Confirmed importance of exclusive breastfeeding (4-6 months) and continued breastfeeding with complementary foods.
• New recommendation to avoid cow's milk-based formula in the first days if breastfeeding is desired; evidence for hydrolyzed formula in high-risk infants is insufficient.
• Recommendations for early introduction of thoroughly heated egg and cautious introduction of peanut for infants with atopic dermatitis; insufficient evidence for prebiotics, probiotics, or vitamin D supplementation.
• Growing up on a farm is associated with reduced allergy risk due to microbial biodiversity.
• Differentiated advice on pet keeping and dust mite allergen avoidance.
• Caesarean birth slightly increases asthma risk; avoidance of tobacco smoke and air pollutants (nitrogen oxides, ozone, PM2.5) is crucial.
• Vaccinations do not increase allergy risk and may reduce it; recommended for all children.

Conclusions:

• The updated guideline provides evidence-based and current recommendations for preventing allergic diseases.
• The consensus is built upon an extensive evidence base, ensuring reliable guidance.
• Addresses key areas including maternal and infant nutrition, environmental factors, and vaccinations.