Allergy Asthma Immunol Res.  2014 Nov;6(6):525-534. 10.4168/aair.2014.6.6.525.

The Importance of Allergen Avoidance in High Risk Infants and Sensitized Patients: A Meta-analysis Study

• Huiyan W
• Yuhe G
• Juan W
• Junyan Z
• Shan W
• Xiaojun Z
• Ailin T

• KMID: 2260175
• DOI: http://doi.org/10.4168/aair.2014.6.6.525

Abstract

PURPOSE
At this time, there is uncertainty regarding whether allergen avoidance is the most appropriate strategy for managing or preventing allergies. The purpose of this study was to evaluate the effectiveness of allergen avoidance in the prevention of allergic symptoms in previously sensitized patients and newborns that have the potential to develop allergies.
METHODS
We performed online searches of articles published from January 1980 to December 2012 in PubMed and The Cochrane Central Register of Controlled Trials, and selected articles involving randomized controlled trials (RCTs) and allergen avoidance. The parameters used to determine allergenic potential in newborns included the risk ratio (RR) of eczema, asthma, rhinitis, wheeze, and cough. The methods employed to evaluate previously sensitized patients were the standardized mean difference (SMD) of forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR). Data quality was assessed using the Jadad scale.
RESULTS
A total of 14 RCTs were identified. Meta-analysis demonstrated that allergen avoidance for newborns did not reduce the subsequent incidence of allergic diseases (eczema, P=0.21; rhinitis, P=0.3; cough, P=0.1) but significantly reduced the incidence of asthma and wheezing in high-risk infants (asthma, P=0.03; wheeze, P=0.0004). However, previously sensitized patients who reduced their exposure to known allergens did not show improvement in their lung functions (FEV1, P=0.3; PEFR morning, P=0.53; PEFR evening, P=0.2; PEFR, P=0.29).
CONCLUSIONS
Allergen avoidance may not always be successful in preventing allergic symptoms. However, rigorous methodological studies are required to confirm this hypothesis.

Keyword

Meta-analysis; allergen avoidance; allergenic potential newborns; previously sensitized patients; allergic diseases

MeSH Terms

Allergens
Asthma
Cough
Eczema
Forced Expiratory Volume
Humans
Hypersensitivity
Incidence
Infant*
Infant, Newborn
Lung
Methods
Odds Ratio
Peak Expiratory Flow Rate
Data Accuracy
Respiratory Sounds
Rhinitis
Uncertainty
Allergens

Figure

• 

  Fig. 1 Flow chart of the trial selection process. A total of 14 randomized controlled trials (RCTs) related to allergen avoidance were included in this study. In total, 4,132 subjects participated in these trials.

• 

  Fig. 2 Forest plot showing the risk ratio for the incidence of eczema comparing allergen avoidance to the control in newborns with the potential to develop allergies. There was no significant difference between the experimental and control groups (P=0.21). Allergen avoidance did not improve the prevalence of eczema in high-risk infants.

• 

  Fig. 3 Forest plot showing the risk ratio for the incidence of rhinitis comparing allergen avoidance to the control in newborns with the potential to develop allergies. There was no significant difference between the experimental and control groups (P=0.30). Allergen avoidance did not improve the prevalence of rhinitis in high-risk infants.

• 

  Fig. 4 Forest plot showing the risk ratio for the incidence of cough comparing allergen avoidance to the control in newborns with the potential to develop allergies. There was no significant difference between the experimental and control groups, demonstrating that allergen avoidance had no effect on the development of cough in infants with allergenic potential (P=0.10).

• 

  Fig. 5 Forest plot showing the risk ratio for the incidence of asthma comparing allergen avoidance to the control in newborns with the potential to develop allergies. There was a significant difference between the experimental and control groups (P=0.03), indicating the effectiveness of allergen avoidance in high-risk infants.

• 

  Fig. 6 Forest plot showing the risk ratio for the incidence of wheezing comparing allergen avoidance to control in newborns with the potential to develop allergies. Similar to the above asthma analyses, the overall analysis of the prevalence of wheezing in the experimental group when compared to control infants showed a significant improvement (P=0.0004).

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