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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

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Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy? A systematic review

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Review published: .

CRD summary

This review investigated the association between caesarean delivery and development of sensitisation to food allergens and immunoglobulin E (IgE) mediated food allergy. The authors concluded that there was evidence that caesarean delivery increased risks of development of IgE-mediated sensitisation to food allergens. Potential bias and error and methodological limitations of the included studies suggest these conclusions may not be reliable.

Authors' objectives

To determine whether there is an association between delivery by caesarean section and the development of sensitisation to food allergens and immunoglobulin E (IgE) mediated food allergy.

Searching

MEDLINE and PubMed were searched for studies published before July 2007. Search terms were reported. Reference lists were searched for additional studies.

Study selection

Studies that provided details if the relationship between mode of delivery and either IgE-mediated sensitisation to food allergens or that confirmed food allergy at any age were eligible for inclusion. Diagnosis of food allergy was defined as confirmation using a double-blind placebo-controlled food challenge (DBPCFC) or reports of symptoms after ingestion of a specific food. Individuals with detectable levels of IgE specific to food allergens (measured by skin prick testing or in vitro methods) were considered to be sensitised to that food.

The included studies were cohort studies (mainly prospective) conducted in Norway, Germany and USA. Ages at follow-up ranged between one and 10 years. Methods of diagnosis of food allergy varied; this was reported as parent-reported food allergy, specific IgE levels and diagnosis of food allergy in the included studies.

The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection.

Assessment of study quality

Methodological quality was assessed in terms of subject selection, sample size, loss to follow-up and measurement and inclusion of potential confounding variables in analyses.

The authors did not state how many reviewers performed the validity assessment.

Data extraction

Data were extracted for mode of delivery and sensitivity to food allergens or confirmed food allergy. The total number of children positive to food allergy were presented alongside the odds ratio (and 95% confidence intervals) of food allergy for caesarian section deliveries compared with vaginal births.

The authors stated neither how data were extracted for the review nor how many reviewers performed the data extraction.

Methods of synthesis

Studies were pooled in a narrative synthesis, grouped by outcome as either sensitisation to food allergens or confirmed food allergy. Individual study details were presented in a table.

Results of the review

Four cohort studies were included in the review (n=15,121): three prospective birth cohort studies (n=6,168) and one retrospective cohort (n=8,953). Study size ranged from 865 to 8,953 participants. Follow-up ranged from 77 to 97%.

Two prospective studies assessed levels of food allergen-specific IgE. Both found that babies born by caesarean section were more likely to be sensitised to food allergens (using IgE measurement; different cutoff for each study). Adjustment for possible confounding factors did not affect this association.

Two studies assessed the relationship between delivery by caesarean section and symptomatic food allergy; one (retrospective) study reported no difference in food allergy diagnoses between those born by caesarean compared with vaginal birth (but did not adjust for confounders); the other (prospective) study found parent-reported food allergy was greater in those born by caesarean section.

Authors' conclusions

There was evidence that the risk of development of IgE-mediated sensitisation to food allergens was increased with delivery by caesarean section. Further studies with objectively diagnosed food allergy as an outcome were needed to verify whether this equated to an increase in confirmed food allergy.

CRD commentary

The research question was supported by inclusion criteria for intervention and outcome. But there were none for participants and study design, which increased the likelihood of subjective decisions during study selection. There was no indication of language restrictions, so it was not known whether language bias was possible. The authors did not search for unpublished studies, which increased the possibility of publication bias. The processes of study selection, validity assessment and data extraction were not reported, so it was unknown whether steps were taken to reduce the possibility of bias and error. Some aspects of study quality were assessed, but limited parameters were investigated. Confounding factors and adjustment for these varied between studies and some subjective outcomes were also used in the primary studies. A retrospective study was included (a weaker study design). The potential for bias and error and methodological limitations of the included studies suggests that the authors' conclusions may not be reliable.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further large studies, which would ideally use food challenges to establish diagnosis of food allergy, were needed to confirm whether there was a relationship between mode of delivery and confirmed food allergy. Future studies that assessed environmental risk factors for food allergy should ensure mode of delivery was included in adjustment models using multi-variable analysis.

Funding

Not stated.

Bibliographic details

Koplin J, Allen K, Gurrin L, Osborne N, Tang ML, Dharmage S. Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy? A systematic review Pediatric Allergy and Immunology 2008; 19(8): 682-687. [PubMed: 19076564]

Indexing Status

Subject indexing assigned by NLM

MeSH

Allergens /immunology; Cesarean Section; Child, Preschool; Female; Food Hypersensitivity /etiology /immunology; Humans; Immunoglobulin E /blood; Infant; Risk Factors

AccessionNumber

12009101627

Database entry date

13/01/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Copyright © 2014 University of York.
Bookshelf ID: NBK76549

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