S3-leitlinie allergieprävention - Update 2009

The further increase of allergies in industrialised countries demands evidence-based measures of primary prevention. The recommendations as published in the Guideline of 2004 were updated and consented on the basis of a systematic literature search. Evidence was searched for the period February 2003 - May 2008 in the electronic databases Cochrane and MEDLINE as well as in reference lists of recent reviews and by contacting experts. The retrieved citations were screened for relevance first by title and abstract in a second step as full paper. Levels of evidence were assigned to each included study and the methodological quality of the studies was assessed as high or low. Finally, the revised recommendations were formally consented (nominal group process) by representatives of relevant societies and organisations including a self-help group. Of originally 4.556 hits, 217 studies (4 Cochrane Reviews, 14 Metaanalyses, 19 RCTs, 115 cohort- and 35 case-control studies) were included and critically appraised. Grossly unchanged remained the recommendations on avoiding environmental tobacco smoke, breast feeding over 4 months (alternatively hypoallergenic formulas for risk babies), avoiding a mould-promoting indoor climate, vaccination according to current recommendations, and avoidance of furry pets (especially cats) in risk babies. The recommendation on reducing the house dust mite allergen exposure as a measure of primary prevention was omitted.Aprolonged introduction of solid foods and a dietary restriction of potent food allergens for primary prevention cannot be recommended due to insufficient evidence. New recommendations were passed concerning fish consumption (during pregnancy/breast feeding and as solid food in the first year), avoidance of overweight and reducing the exposure to indoor and outdoor air pollutants. The revision of this guideline on a profound evidence basis led to a conformation of existing recommendations, substantial revisions, and new recommendations. Thereby it is possible to give evidence-based and up-to-date recommendations of primary prevention of allergies.