Defining the window of opportunity and target populations to prevent peanut allergy - 04/05/23
Abstract |
Background |
Peanut allergy affects 1% to 2% of European children. Early introduction of peanut into the diet reduces allergy in high-risk infants.
Objective |
We aimed to determine the optimal target populations and timing of introduction of peanut products to prevent peanut allergy in the general population.
Methods |
Data from the Enquiring About Tolerance (EAT; n = 1303; normal risk; 3-year follow-up; ISRCTN14254740) and Learning Early About Peanut Allergy study (LEAP; n = 640; high risk; 5-year follow-up; NCT00329784) randomized controlled trials plus the Peanut Allergy Sensitization (PAS; n = 194; low and very high risk; 5-year follow-up) observational study were used to model the intervention in a general population. Peanut allergy was defined by blinded peanut challenge or diagnostic skin prick test result.
Results |
Targeting only the highest-risk infants with severe eczema reduced the population disease burden by only 4.6%. Greatest reductions in peanut allergy were seen when the intervention was targeted only to the larger but lower-risk groups. A 77% reduction in peanut allergy was estimated when peanut was introduced to the diet of all infants, at 4 months with eczema, and at 6 months without eczema. The estimated reduction in peanut allergy diminished with every month of delayed introduction. If introduction was delayed to 12 months, peanut allergy was only reduced by 33%.
Conclusions |
The preventive benefit of early introduction of peanut products into the diet decreases as age at introduction increases. In countries where peanut allergy is a public health concern, health care professionals should help parents introduce peanut products into their infants’ diet at 4 to 6 months of life.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Peanut allergy, prevention, diet, early introduction, population
Abbreviations used : EAT, ITT, LEAP, PAS, RCT, SCORAD, SPT
Plan
| The first 2 authors contributed equally to this article, and both should be considered first author. |
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| The LEAP study was supported by grants (NO1-AI-15416, UM1AI109565, HHSN272200800029C, and UM2AI117870) from the US National Institute of Allergy and Infectious Diseases of the National Institutes of Health and by Food Allergy Research and Education, the Medical Research Council and Asthma UK Centre, and the UK Department of Health through a National Institute for Health Research comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust, in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. The UK Food Standards Agency provided additional support for the costs of phlebotomy. The EAT study was supported by grants from the Food Standards Agency and the Medical Research Council, by the NIHR Biomedical Research Centre and Comprehensive Biomedical Research Centre plus a NIHR Clinician Scientist Award (NIHRCS/01/2008/009) to Flohr. The clinical trials unit is supported in part by the National Peanut Board, Atlanta, Ga. G.R., H.T.B., G.D.T., C.O.R., M.L.S., and G.L. received institutional funding from these funders for undertaking the LEAP and EAT studies. |
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| Disclosure of potential conflict of interest: G. Roberts reports being employed by the University of Southampton plus honorary contracts at University Hospital Southampton NHS Foundation Trust and the Isle of Wight Trust; the position of president of British Society of Allergy and Clinical Immunology; and authorship of the European Academy of Allergy and Clinical Immunology food allergy and anaphylaxis guidelines. H. T. Bahnson reports consultancy fees from King’s College London, DBV Technologies, and MyOR diagnostics. G. Lack reports grants from the Davis Foundation during the conduct of the study plus personal fees from DBV Technologies, Mighty Mission Me, Novartis, Sanofi-Genyzme, Regeneron, ALK-Abello, and Lurie Children’s Hospital outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 151 - N° 5
P. 1329-1336 - mai 2023 Retour au numéro
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