Table 2. Comparison of the German recommendations for the prevention of food allergy and possibly other allergic diseases with the EAACI recommendations for the prevention of food allergy in infants and young children.

Update Guideline Allergy Prevention DGAKI/ GPA 20/21	EAACI Recommendation 2020
Statement: During pregnancy and lactation, a balanced, varied diet that meets nutritional needs is recommended. This includes consumption of vegetables, milk/dairy products (including fermented dairy products such as yogurt), fruits, nuts, eggs, and fish. Recommendation: Dietary restrictions (avoidance of potent food allergen sources) during pregnancy or lactation should not occur for allergy prevention reasons. (A)	The EAACI Task Force suggests against restricting consumption of potential food allergens during pregnancy or breastfeeding in order to prevent food allergy in infants and young children.
Statement: Any breastfeeding has many benefits for mother and child. Recommendation: If possible, exclusive breastfeeding should be used for the first 4 – 6 months. (A) Breastfeeding should continue with the introduction of complementary foods. (A)	There is no recommendation for or against using breastfeeding to prevent food allergy in infants and young children, but breastfeeding has many benefits for infants and mothers and should be encouraged wherever possible.
Recommendation: Supplemental feeding of cow’s milk-based formula in the first days of life should be avoided if the mother wishes to breastfeed. (B)	The EAACI Task Force suggests avoiding supplementing with cow’s milk formula in breastfed infants in the first week of life to prevent cow’s milk allergy in infants and young children
Recommendation: If breastfeeding is not possible or not sufficient, infant formula should be given. For infants at risk, consider whether an infant formula with efficacy demonstrated in allergy prevention studies is available until complementary feeding is introduced. (B)	For infants who need a breastmilk substitute, there is no recommendation for or against the use of regular cow’s milk based infant formula after the first week of life to prevent food allergy. There is no recommendation for or against using partially or extensively hydrolysed formula to prevent food allergy in infants and young children. When exclusive breastfeeding is not possible many substitutes are available for families to choose from, including hydrolysed formulas.
Recommendation: Soy-based infant formulas are not suitable for the purpose of allergy prevention and consequently should not be given for this purpose. (A) Statement: Soy products can be given separately from the purpose of allergy prevention as part of complementary feeding. Recommendation: Since there is no evidence of an allergy-preventive effect of other animal milks, such as goat’s milk (not even as the basis of infant formula), sheep’s milk, or mare’s milk, these should also not be given for the purpose of allergy prevention. (B)	The EAACI Task Force suggests against introducing soy protein-based formula in the first six months of life to prevent cow’s milk allergy in infants and young children.
Statement: There is evidence that the diversity of the infant’s diet in the first year of life has a protective effect on the development of atopic diseases. A varied diet includes the introduction of fish and a limited amount (up to 200 ml per day) of milk or natural yogurt and hen’s egg as part of complementary feeding. Recommendation: Depending on the readiness of the infant, complementary feeding should begin no earlier than the beginning of the fifth month of life and no later than the beginning of the seventh month of life. (B) There is no evidence for a preventive effect of dietary restriction by avoiding potent food allergen sources in the first year of life. Therefore, it should not be done. (A)
Recommendation: For prevention of egg allergy, heated (e.g., baked or hard-boiled) but not „raw“ eggs (including scrambled eggs) should be introduced with complementary feeding and given regularly. (B)	The EAACI Task Force suggests introducing well-cooked hen’s egg, but not pasteurised or raw egg, into the infant diet as part of complementary feeding to prevent egg allergy in infants.
Recommendation: To prevent peanut allergy, consider introducing peanut products in an age-appropriate form (e.g., peanut butter) as part of complementary feeding in infants with atopic dermatitis in families with regular peanut consumption. (C) Recommendation: Peanut allergy should be ruled out first, especially in infants with moderate to severe AD. (A)	In populations where there is a high prevalence of peanut allergy, the EAACI Task Force suggests introducing peanuts into the infant diet in an age-appropriate form as part of complementary feeding in order to prevent peanut allergy in infants and young children.
Background: Due to the heterogeneity of studies, no conclusive recommendation can be made on the supplementation of Ω-3 LCPUFAs for pregnant women, breastfeeding women, and infants for allergy prevention. Statement: Some studies show that a low supply of Ω-3 LCPUFAs in pregnant women, breastfeeding women and infants is associated with a higher risk of allergic diseases in the child, especially asthma and wheezing, and that this risk can be reduced by supplementation of Ω-3 LCPUFAs (1++ to 2++).	There is no recommendation for or against vitamin supplementation or fish oil supplementation in healthy pregnant and/or breastfeeding women and/or infants to prevent food allergy in infants and young children.
Statement: Data from partly large, randomized, double-blind intervention studies consistently show no preventive effects of pre- and probiotics for the endpoints allergic rhinitis (AR) and bronchial asthma. The vast majority of current intervention studies also show no preventive effect for atopic eczema after administration of prebiotics and/or probiotics. Recommendation: Prebiotics and/or probiotics should not be given to pregnant women or infants, even as part of infant formula, for allergy prevention purposes. (A)	There is no recommendation for or against prebiotics, probiotics or synbiotics for pregnant and/or breastfeeding women and/or infants alone or in combination with other approaches to prevent food allergy in infants and young children.
Background: From the point of view of the guideline group, despite heterogeneous interventions in the different studies, it has not been shown that primary prevention in infants with atopic family history can be achieved by daily refatting whole body treatment of healthy skin. Statement: At the present time, based on the available evidence, no recommendation can be made for daily re-lubrication of healthy infant skin with the aim of primary prevention of eczema and allergies – even in families with an increased risk of allergies. Recommendation: Infants and children with visibly dry skin should be creamed regularly – also with the aim of preventing eczema and allergies. (Expert opinion)	There is no recommendation for or against using emollients as skin barriers to prevent food allergy in infants and young children.