World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D

Juan José Yepes-Nuñez; Alessandro Fiocchi; Ruby Pawankar; Carlos A Cuello-Garcia; Yuan Zhang; Gian Paolo Morgano; Kangmo Ahn; Suleiman Al-Hammadi; Arnav Agarwal; Shreyas Gandhi; Kirsten Beyer; Wesley Burks; Giorgio W Canonica; Motohiro Ebisawa; Rose Kamenwa; Bee Wah Lee; Haiqi Li; Susan Prescott; John J Riva; Lanny Rosenwasser; Hugh Sampson; Michael Spigler; Luigi Terracciano; Andrea Vereda; Susan Waserman; Holger J Schünemann; Jan L Brożek

doi:10.1186/s40413-016-0108-1

World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D

World Allergy Organ J. 2016 May 17:9:17. doi: 10.1186/s40413-016-0108-1. eCollection 2016.

Authors

Juan José Yepes-Nuñez^{1

2}, Alessandro Fiocchi^#³, Ruby Pawankar^#⁴, Carlos A Cuello-Garcia^{1

5}, Yuan Zhang¹, Gian Paolo Morgano¹, Kangmo Ahn⁶, Suleiman Al-Hammadi⁷, Arnav Agarwal⁸, Shreyas Gandhi⁸, Kirsten Beyer⁹, Wesley Burks¹⁰, Giorgio W Canonica¹¹, Motohiro Ebisawa¹², Rose Kamenwa¹³, Bee Wah Lee¹⁴, Haiqi Li¹⁵, Susan Prescott¹⁶, John J Riva^{1

17}, Lanny Rosenwasser¹⁸, Hugh Sampson¹⁹, Michael Spigler²⁰, Luigi Terracciano²¹, Andrea Vereda²², Susan Waserman²³, Holger J Schünemann^{1

23}, Jan L Brożek^{1

23}

Affiliations

¹ Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Room 2C16 1280 Main Street West, Hamilton, L8N 4K1 ON Canada.
² University of Antioquia, School of Medicine, Medellín, Colombia.
³ Pediatric Hospital Bambino Gesù, Vatican City, Italy.
⁴ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁵ Tecnologico de Monterrey School of Medicine, Monterrey, Mexico.
⁶ Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁷ Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
⁸ Faculty of Medicine, University of Toronto, Toronto, ON Canada.
⁹ Charité Klinik für Pädiatrie, Berlin, Germany.
¹⁰ Department of Pediatrics, University of North Carolina, Chapel Hill, NC USA.
¹¹ University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
¹² Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
¹³ Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
¹⁴ Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
¹⁵ Department of Primary Child Care, Children's Hospital, Chongqing Medical University, Chongqing, China.
¹⁶ Department of Immunology, Perth Children's Hospital, Telethon KIDS Institute, School of Paediatrics and Child Health, University of Western Australia, Crawley, Australia.
¹⁷ Department of Family Medicine, McMaster University, Hamilton, ON Canada.
¹⁸ Allergy-Immunology Division, Children's Mercy Hospital & University of Missouri - Kansas City School of Medicine, Kansas City, MO USA.
¹⁹ Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA.
²⁰ Food Allergy Research & Education (FARE), McLean, VA USA.
²¹ Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy.
²² Allergology Department, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
²³ Department of Medicine, McMaster University, Hamilton, ON Canada.

^# Contributed equally.

Abstract

Background: The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20-30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases.

Objective: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases.

Methods: Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (up to January 2015, with an update on January 30, 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.

Results: Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel's recommendations are conditional and supported by very low certainty evidence.

Conclusions: WAO recommendations about vitamin D supplementation for the prevention of allergic diseases support parents, clinicians and other health care professionals in their decisions whether or not to use vitamin D in preventing allergic diseases in healthy, term infants.

Keywords: Allergic Diseases; GRADE; Practice guidelines; Prevention; Vitamin D.