Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction - 13/09/17

Doi : 10.1016/j.jaci.2017.06.024

Tracy J. Pitt, MD ^a, Allan B. Becker, MD ^b,^c, Moira Chan-Yeung, MD ^d, Edmond S. Chan, MD ^e, Wade T.A. Watson, MD ^f, Rishma Chooniedass, MN ^b,^c, Meghan B. Azad, PhD ^b,^c,^⁎
^a Humber River Hospital, Toronto, Ontario, Canada
^b Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
^c Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
^d Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
^e Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
^f Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

^∗Corresponding author: Meghan B. Azad, PhD, Children's Hospital Research Institute of Manitoba, 501G—715 McDermot Avenue, Winnipeg R3E 3P4, Manitoba, Canada.Children's Hospital Research Institute of Manitoba501G—715 McDermot AvenueWinnipegManitobaR3E 3P4Canada

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 September 2017
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Abstract

Background

Recent trials have shown that avoiding peanuts during infancy increases the risk of peanut allergy; however, these studies did not address maternal peanut consumption.

Objective

We sought to investigate the relationship between maternal peanut consumption while breast-feeding, timing of direct peanut introduction, and peanut sensitization at age 7 years.

Methods

Secondary analysis of a nested cohort within the 1995 Canadian Asthma Primary Prevention Study intervention study was performed. Breast-feeding and maternal and infant peanut consumption were captured by repeated questionnaires during infancy. Skin prick testing for peanut sensitization was performed at age 7 years.

Results

Overall, 58.2% of mothers consumed peanuts while breast-feeding and 22.5% directly introduced peanuts to their infant by 12 months. At 7 years, 9.4% of children were sensitized to peanuts. The lowest incidence (1.7%) was observed among children whose mothers consumed peanuts while breast-feeding and directly introduced peanuts before 12 months. Incidence was significantly higher (P < .05) if mothers consumed peanuts while breast-feeding but delayed introducing peanuts to their infant beyond 12 months (15.1%), or if mothers avoided peanuts themselves but directly introduced peanuts by 12 months (17.6%). Interaction analyses controlling for study group and maternal atopy confirmed that maternal peanut consumption while breast-feeding and infant peanut consumption by 12 months were protective in combination, whereas either exposure in isolation was associated with an increased risk of sensitization (P interaction = .003).

Conclusions

In this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.

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Graphical abstract

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Key words : Breast-feeding, lactation, maternal peanut consumption, peanut allergy, peanut sensitization, timing of peanut introduction

Abbreviations used : aOR, CAPPS, EAT, LEAP, OR

Plan

Methods

Study design and population

Main exposure: maternal and infant peanut consumption

Main outcome: peanut sensitization at age 7 years

Statistical analysis

Results

Discussion

	The study was funded by the Canadian Institutes of Health Research and the Allergy, Genes and Environment (AllerGen) Network of Centres of Excellence. These entities had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
	Disclosure of potential conflict of interest: E. S. Chan's institute received a grant from Canadian Institutes of Health Research for this work and grants from DBV Technologies for other works. M. B. Azad's institution received a grant from Canadian Institutes of Health Research for this work. The rest of the authors declare they have no conflicts of interest.