婴儿饮食中引入过敏性食物的时间和过敏或自身免疫性疾病的风险:系统性审查和元分析
Despo Ierodiakonou1, Vanessa Garcia-Larsen2, Andrew Logan3
1Section of Paediatrics, Imperial College London, London, England2Respiratory Epidemiology, Imperial College London, London, England.
JAMA
|September 23, 2016
概括
在婴儿期 (4至11个月) 开始食用蛋和花生等过敏性食物, 会降低对这些特定食物的过敏风险. 这一发现支持早期的过敏预防.
科学领域:
- 过敏和免疫学
- 儿童营养
- 证据综合
背景情况:
- 在婴儿的饮食中介绍过敏性食物的时间是可能影响过敏和自身免疫疾病的关键因素.
- 有关这一主题的现有证据需要全面综合,以指导临床实践和公共卫生建议.
研究的目的:
- 系统地审查和对婴儿期过敏性食物引入时间对过敏或自身免疫疾病风险的影响进行元分析.
- 提供综合证据基础,以了解早期食物引入与疾病风险之间的关系.
主要方法:
- 对1946年1月至2016年3月期间发表的研究进行了多个数据库 (MEDLINE,EMBASE,Web of Science,CENTRAL,LILACS) 的全面搜索.
- 包括的研究包括干预试验和观察性研究,评估在生命的第一年引入过敏性食物的时间,评估过敏性/自身免疫性疾病或敏感性.
- 使用随机效应模型的元分析技术提取和合成数据,并使用GRADE评估证据的确定性.
主要成果:
- 来自5项试验的中等确定性证据表明,早期引入蛋 (4-6个月) 将蛋过敏的风险降低了44% (RR,0.56;95% CI,0.36- 0.87).
- 从2项试验中获得的中等确定性证据表明,早期引入花生 (4至11个月) 将花生过敏的风险降低了71% (RR,0. 29;95% CI,0. 11至0. 74).
- 鱼类的早期引入显示了对过敏敏感性和鼻炎的潜在降低 (确定性低至非常低). 高确定性证据没有发现谷蛋白引入时间与腹腔疾病风险之间的联系.
结论:
- 早期将蛋和花生加入婴儿饮食中, 显著降低了对这些特定食物过敏的风险.
- 虽然这些发现是有希望的,但应考虑到初级研究中的局限性,包括潜在的不准确性和间接性.
- 引入过敏性食物的时间与其他食物过敏或其他自身免疫/过敏结果的风险无关.
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