Methodological Quality and Content of Guidelines on Early Childhood Allergy Prevention: A Systematic Assessment and...

Recommendations on Early Childhood Allergy Prevention (ECAP) are found in Clinical Practice Guidelines (CPG) and Food-Based Dietary Guidelines (FBDG). This synthesis of guidelines aims to compare the methodological quality and content of recommendations in CPGs and FBDGs for ECAP. We searched MEDLINE, the FAO directory of FBDGs and other guideline databases, including the Association of the Scientific Medical Societies in Germany (AWMF), the WHO and the Guideline International Networks database on clinical guidelines (GIN) for CPGs and FBDGs about ECAP and child nutrition. Guidelines had to be published from 2010 onwards, target infants or pregnant/breastfeeding women and contain recommendations on primary preventative interventions to decrease the onset of IgE-mediated allergies, including atopic eczema or asthma. We retrieved a sample of 36 guidelines (23 CPGs, 13 FBDGs) and assessed their methodological quality with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by the type of intervention for direction and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. CPGs score higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 287 recommendations on ECAP, with 70 addressing the introduction of complementary foods and common allergens. We found only slight differences between those recommendations in CPGs and FBDGs. FBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and common allergens but may compromise their trustworthiness.