Clinical Guidelines for the avoidance of Allergy in Germany

Deutsches Ärzteblatt International;Dtsch Arztebl Int 2009; 106(39): 625–31


Background: Evidence-based primary prevention of allergic conditions is important in view of their increasing prevalence in Western industrialized countries.

Methods: The Cochrane and Medline databases were searched for relevant scientific publications that appeared from February 2003 to May 2008. Articles in the reference lists of recent reviews were also considered, and experts were directly asked for their opinions. The retrieved publications were screened for relevance by evaluation of the title and abstract, and then by evaluation of the entire text.

Each study chosen for inclusion was assigned an evidence grade as well as a grade for study quality relating to its potential for bias (low or high). The revised recommendations were then formally accepted by a consensus of representatives of medical specialist societies and other organizations, including a patient self-help group.

Results: The search initially yielded 4556 results out of which 217 articles (4 Cochrane reviews, 14 meta-analyses, 19 randomized clinical trials, 135 cohort studies, and 45 case-control studies) were chosen for inclusion and critical appraisal. No major changes ensued in the existing recommendations to avoid exposure to tobacco smoke, breast-feed for 4 months (or use hypoallergenic formulas), avoid a mould-promoting indoor climate, avoid exposure to furry pets (particularly cats), and vaccinate according to the current recommendations of the Standing Committee on Vaccination of the Robert Koch Institute. Neither the delayed introduction of solid food nor the avoidance of potent dietary allergens is recommended as a means of primary prevention. New recommendations were issued regarding fish consumption (by the mother while breastfeeding and nursing, and by the infant as solid food), avoidance of overweight, and reduction of exposure to air pollutants.

Conclusions: This updated guideline serves as an aid in giving patients current, evidence-based recommendations for allergy prevention.

Participating experts, specialist societies, and institutions
 Dr. hum. biol. Cathleen Muche-Borowski
 Prof. Dr. med. Matthias Kopp, German Society for Pediatrics and Adolescent Medicine
 Dr. med. Imke Reese, Task Force on Dietetics in Allergology
 PD Dr. rer. nat. Helmut Sitter, Association of Scientific Medical Societies in Germany
 Prof. Dr. med. Thomas Werfel, German Society of Allergology and Clinical Immunology
 Prof. Dr. med. Torsten Schäfer, Coordinator, German Dermatological Society
 Dr. med. Kirsten Beyer
 Dr. med. Frank Friedrichs
 Prof. Dr. med. Eckard Hamelmann
 Mechthild Hellermann
 PD Dr. med. Johannes Huss-Marp
 PD Dr. med. Susanne Lau
 Dr. med. Ernst Rietschel
 Dr. med. Sabine Schmidt
 Sabine Schnadt
 Dr. med. Andreas Kleinheinz
 Prof. Dr. med. Claudia Rudack
 Dr. med. Sylvia Schnitzer

For the full report click here

First published in 2009

If this article was of interest you will find many other articles on unlikely allergies and allergy connections here – and links to many relevant research studies here.

For more on the more 'mainstream' allergies check in to our 'allergy and intolerance home page' – and for ideas on alternative foods go here.

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