# Methodological Quality and Content of Guidelines on Early Childhood Allergy Prevention: A Systematic Assessment and Content Analysis

## TL;DR

This study compares the quality and content of guidelines on preventing allergies in young children, finding that clinical guidelines are higher quality than dietary guidelines.

## Contribution

The study provides a systematic assessment and content analysis of guidelines on early childhood allergy prevention, comparing clinical and dietary guidelines.

## Key findings

- Clinical Practice Guidelines (CPGs) score higher than Food-Based Dietary Guidelines (FBDGs) in methodological quality.
- Most guidelines recommend introducing complementary foods between 4 and 6 months, with more variation in recommendations for allergens.
- Low methodological quality in FBDGs may affect their trustworthiness despite consistent recommendations.

## Abstract

Recommendations on Early Childhood Allergy Prevention (ECAP) are found in Clinical Practice Guidelines (CPG) and Food‐Based Dietary Guidelines (FBDG). This synthesis of guidelines aims to compare the methodological quality and content of recommendations in CPGs and FBDGs for ECAP. We searched MEDLINE, the FAO directory of FBDGs and other guideline databases, including the Association of the Scientific Medical Societies in Germany (AWMF), the WHO and the Guideline International Networks database on clinical guidelines (GIN) for CPGs and FBDGs about ECAP and child nutrition. Guidelines had to be published from 2010 onwards, target infants or pregnant/breastfeeding women and contain recommendations on primary preventative interventions to decrease the onset of IgE‐mediated allergies, including atopic eczema or asthma. We retrieved a sample of 36 guidelines (23 CPGs, 13 FBDGs) and assessed their methodological quality with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in‐depth analysis by the type of intervention for direction and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. CPGs score higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 287 recommendations on ECAP, with 70 addressing the introduction of complementary foods and common allergens. We found only slight differences between those recommendations in CPGs and FBDGs. FBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and common allergens but may compromise their trustworthiness.

Clinical Practice Guidelines and Food‐Based Dietary Guidelines differ in methodological quality, but their recommendations on Early Childhood Allergy Prevention are fairly consistent. However, low transparency in guideline development can still lead to reduced trust in the guideline, low implementation and insufficient adherence to the recommendations.

The methodological quality of guidelines on Early Childhood Allergy Prevention (ECAP), particularly Food‐Based Dietary Guidelines, is low, with deficiencies especially in the rigour of development, applicability, and editorial independence of the guidelines.Most guidelines on ECAP make recommendations on the introduction of complementary foods and recommend the introduction between 4 and 6 months, with little variation.Recommendations on the introduction of common allergens show comparably more variation.The slight differences in these recommendations may arise from the variations in methodological quality but also the time of publication of the guidelines, reflecting the evidence available at that time.

The methodological quality of guidelines on Early Childhood Allergy Prevention (ECAP), particularly Food‐Based Dietary Guidelines, is low, with deficiencies especially in the rigour of development, applicability, and editorial independence of the guidelines.

Most guidelines on ECAP make recommendations on the introduction of complementary foods and recommend the introduction between 4 and 6 months, with little variation.

Recommendations on the introduction of common allergens show comparably more variation.

The slight differences in these recommendations may arise from the variations in methodological quality but also the time of publication of the guidelines, reflecting the evidence available at that time.