title: S3-Guideline on allergy prevention: 2014 update: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Society for Pediatric and Adolescent Medicine (DGKJ).
abstract: The continued high prevalence of allergic diseases in Western industrialized nations combined with the limited options for causal therapy make evidence-based primary prevention necessary. The recommendations last published in the S3-guideline on allergy prevention in 2009 have been revised and a consensus reached on the basis of an up-to-date systematic literature search. Evidence was sought for the period between May 2008 and May 2013 in the Cochrane and MEDLINE electronic databases, as well as in the reference lists of recent review articles. In addition, experts were surveyed for their opinions. The relevance of retrieved literature was checked by means of two filter processes: firstly according to title and abstract, and secondly based on the full text of the articles. Included studies were given an evidence grade, and a bias potential (low/high) was specified for study quality. A formal consensus on the revised recommendations was reached by representatives of the relevant specialist societies and (self-help) organizations (nominal group process). Of 3,284 hits, 165 studies (one meta-analysis, 15 systematic reviews, 31 randomized controlled trials, 65 cohort studies, 12 case-control studies and 41 cross-sectional studies) were included and evaluated. Recommendations on the following remain largely unaltered: full breastfeeding for 4 months as a means of allergy prevention (hypoallergenic infant formula in the case of infants at risk); avoidance of overweight; fish consumption (during pregnancy/lactation and in the introduction of solid foods for infants); vaccination according to the recommendations of the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO); avoidance of air pollutants and tobacco exposure and avoidance of indoor conditions conducive to the development of mold. The assertion that a reduction in house-dust mite allergen content as a primary preventive measure is not recommended also remains unchanged. The introduction of solid foods into infant diet should not be delayed. In the case of children at risk cats should not be acquired as domestic pets. Keeping dogs is not associated with an increased risk of allergy. The updated guideline includes a new recommendation to consider the increased risk of asthma following delivery by cesarean section. Additional statements have been formulated on pre- and probiotic agents, psychosocial factors, medications, and various nutritional components. Revising the guideline by using an extensive evidence base has resulted not only in an endorsement of the existing recommendations, but also in modifications and in the addition of new recommendations. The updated guideline enables evidence-based and up-to-date recommendations to be made on allergy prevention.
  
  
  BACKGROUND
  Supplementary material is available for this article at 10.1007/s40629-014-0022-4 and is accessible for authorized users.
authors.affiliation: Kirchplatz 3, 87509 Immenstadt, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Schäfer
authors.affiliation: Gaißach Specialist Clinic, Berlin, Germany.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Bauer
authors.affiliation: Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
authors.affiliation: Department of Experimental Pneumology, Ruhr University Bochum, Bochum, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Bufe
authors.affiliation: Laurensberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Friedrichs
authors.affiliation: Dermatological Clinic, Gießen and Marburg University Clinic, Gießen site, Gießen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Gieler
authors.affiliation: Blankenfelde, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gronke
authors.affiliation: Clinic for Pediatric Medicine, Ruhr University Bochum, Bochum, Germany.
authors.forename: Eckard
authors.initials: E
authors.lastname: Hamelmann
authors.affiliation: Therapie Schwelmer Modell GmbH, Schwelm, Germany.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Hellermann
authors.affiliation: Dermatological Center, Elbe Clinics Stade/Buxtehude, Buxtehude, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kleinheinz
authors.affiliation: Center for Rhinology and Allergology, Wiesbaden, Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Klimek
authors.affiliation: Dr. von Haunersches Children's Hospital, Pediatric Clinic and Pediatric Polyclinic of the Ludwig Maximilian University, Munich, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
authors.affiliation: Clinic for Pediatric Medicine, Schleswig-Holstein University Clinic, Lübeck Campus, Lübeck, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kopp
authors.affiliation: Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lau
authors.affiliation: Bad Lippspringe, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Müsken
authors.affiliation: Nutrition Counseling and Therapy with Special Focus on Allergology, Munich, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Reese
authors.affiliation: Kinderumwelt GmbH, Osnabruck, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: German Allergy and Asthma Association, Monchengladbach, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schnadt
authors.affiliation: Institute for Theoretical Surgery, Marburg University, Marburg, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Sitter
authors.affiliation: Professional Association of German Dermatologists, Mönchengladbach, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Strömer
authors.affiliation: Dermatological Center, Elbe Clinics Stade/Buxtehude, Buxtehude, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vagts
authors.affiliation: Clinic and Polyclinic for Pediatric Medicine, Carl Gustav Carus University Clinic, Dresden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Vogelberg
authors.affiliation: Charité Allergy Center, Clinic for Pediatrics with Special Focus on Pneumology and Immunology, Charité University Hospital, Berlin, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahn
authors.affiliation: Clinic and Polyclinic for Dermatology and Venereology, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
authors.affiliation: Charité Allergy Center, Clinic for Dermatology, Venereology, and Allergology, Charité University Hospital, Charité Campus Mitte, Berlin, Germany.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
authors.affiliation: German Association of the Scientific Medical Societies, Marburg, Germany ; Institute for General Medicine, Hamburg-Eppendorf University Clinic, Germany, Germany.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Muche-Borowski
keywords: Allergy; S3-guidelines; evidence; primary prevention; revision