Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy - 04/03/21
, Michael Pistiner, MD, MMSc c, Mihaela Plesa, BA a, Daria Szelag, DNP, CRNP a, Wayne Shreffler, MD, PhD c, Robert Wood, MD a, Joan Dunlop, MD a, Roger Peng, PhD d, Jennifer Dantzer, MD a, Alkis Togias, MD eAbstract |
Background |
Whether to screen high-risk groups before early peanut introduction is controversial.
Objective |
We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH).
Methods |
Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding.
Results |
A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA.
Conclusions |
PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Key words : Food allergy, peanut allergy, prevention, early introduction
Abbreviations used : LEAP, NIAID, OFC, OR, SCORAD, SPT
Mappa
| Disclaimer: Dr Togias’ authorship of this report does not constitute endorsement by the US National Institute of Allergy and Infectious Diseases or any other US government agency. |
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| This study was funded by the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (grant no. 1U01AI125290). This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by the National Center for Advancing Translational Sciences (NCATS) (grant no. UL1 TR003098), a component of the NIH, and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH. The project described was supported by grant number 1UL1TR002541-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources, the NCATS, or the NIH. J.D. is funded by the Pearl M. Stetler Fund. |
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| Disclosure of potential conflict of interest: C. Keet receives royalties from Up to Date. M. Pistiner has served as a consultant for AAFA, kaléo, and DBV Technologies; received funding from kaléo, DBV Technologies, and National Peanut Board; and is cofounder of AllergyHome and Allergy Certified Training. W. Shreffler has served on the Scientific Advisory Board of Aimmune Therapeutics, and as an advisor to Food Allergy Research and Education (FARE), Buhlmann Laboratories AG, and Sanofi Pasteur. R. Wood receives research support from FARE, Aimmune, DBV, Astellas, Regeneron, Sanofi, and HAL-Allergy, and royalties from Up to Date. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 3
P. 984 - Marzo 2021 Ritorno al numero
Articolo precedente
- Ara h 2–specific IgE is superior to whole peanut extract–based serology or skin prick test for diagnosis of peanut allergy in infancy
- Corinne Keet, Mihaela Plesa, Daria Szelag, Wayne Shreffler, Robert Wood, Joan Dunlop, Roger Peng, Jennifer Dantzer, Robert G. Hamilton, Alkis Togias, Michael Pistiner
- Epicutaneous immunotherapy for treatment of peanut allergy: Follow-up from the Consortium for Food Allergy Research
- Amy M. Scurlock, A. Wesley Burks, Scott H. Sicherer, Donald Y.M. Leung, Edwin H. Kim, Alice K. Henning, Peter Dawson, Robert W. Lindblad, M. Cecilia Berin, Christine B. Cho, Wendy F. Davidson, Marshall Plaut, Hugh A. Sampson, Robert A. Wood, Stacie M. Jones, Consortium for Food Allergy Research (CoFAR)
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