Jennifer J Koplin1, Rachel L Peters2, Shyamali C Dharmage3, Lyle Gurrin3, Mimi L K Tang2, Anne-Louise Ponsonby2, Melanie Matheson3, Alkis Togias4, Gideon Lack5, Katrina J Allen6. 1. Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia. 2. Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia. 3. School of Population and Global Health, University of Melbourne, Parkville, Australia. 4. National Institute of Allergy and Infectious Diseases, Bethesda, Md. 5. Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 6. Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia; School of Inflammation and Repair, University of Manchester, Manchester, United Kingdom. Electronic address: katie.allen@rch.org.au.
Abstract
BACKGROUND: A recent randomized trial (the Learning Early About Peanut Allergy [LEAP] study) provided evidence that earlier dietary peanut introduction reduces peanut allergy prevalence in high-risk infants. However, questions remain as to how to identify and target the "at-risk" population to facilitate timely introduction of peanut. OBJECTIVE: We sought to use population-based infant peanut allergy data to understand feasibility and implications of implementing the LEAP trial intervention. METHODS: Using the HealthNuts study cohort (n = 5276) of 1-year-old infants, we explored the impact of using various criteria to identify infants at high risk of developing peanut allergy, and the implications of skin prick test (SPT) screening before peanut introduction. RESULTS: Screening all infants with early onset eczema and/or egg allergy could require testing 16% of the population and would still miss 23% of peanut allergy cases; 29% of screened infants would require clinical follow-up because of being SPT-positive. Around 11% of high-risk infants were excluded from the LEAP study because of an SPT wheal size of more than 4 mm to peanut at baseline; data from the HealthNuts study suggest that 80% of these would be peanut allergic on food challenge. There were no life-threatening events among either low- or high-risk infants whose parents chose to introduce peanut at home in the first year of life, or in 150 peanut-allergic infants during hospital-based challenges. CONCLUSIONS: Based on this large epidemiological study, a population program aiming to identify and screen all infants at risk of peanut allergy would pose major cost and logistic challenges that need to be carefully considered. Further research might be required to provide data for low-risk infants.
BACKGROUND: A recent randomized trial (the Learning Early About PeanutAllergy [LEAP] study) provided evidence that earlier dietary peanut introduction reduces peanutallergy prevalence in high-risk infants. However, questions remain as to how to identify and target the "at-risk" population to facilitate timely introduction of peanut. OBJECTIVE: We sought to use population-based infantpeanutallergy data to understand feasibility and implications of implementing the LEAP trial intervention. METHODS: Using the HealthNuts study cohort (n = 5276) of 1-year-old infants, we explored the impact of using various criteria to identify infants at high risk of developing peanutallergy, and the implications of skin prick test (SPT) screening before peanut introduction. RESULTS: Screening all infants with early onset eczema and/or egg allergy could require testing 16% of the population and would still miss 23% of peanutallergy cases; 29% of screened infants would require clinical follow-up because of being SPT-positive. Around 11% of high-risk infants were excluded from the LEAP study because of an SPT wheal size of more than 4 mm to peanut at baseline; data from the HealthNuts study suggest that 80% of these would be peanutallergic on food challenge. There were no life-threatening events among either low- or high-risk infants whose parents chose to introduce peanut at home in the first year of life, or in 150 peanut-allergicinfants during hospital-based challenges. CONCLUSIONS: Based on this large epidemiological study, a population program aiming to identify and screen all infants at risk of peanutallergy would pose major cost and logistic challenges that need to be carefully considered. Further research might be required to provide data for low-risk infants.
Authors: Alkis Togias; Susan F Cooper; Maria L Acebal; Amal Assa'ad; James R Baker; Lisa A Beck; Julie Block; Carol Byrd-Bredbenner; Edmond S Chan; Lawrence F Eichenfield; David M Fleischer; George J Fuchs; Glenn T Furuta; Matthew J Greenhawt; Ruchi S Gupta; Michele Habich; Stacie M Jones; Kari Keaton; Antonella Muraro; Marshall Plaut; Lanny J Rosenwasser; Daniel Rotrosen; Hugh A Sampson; Lynda C Schneider; Scott H Sicherer; Robert Sidbury; Jonathan Spergel; David R Stukus; Carina Venter; Joshua A Boyce Journal: J Allergy Clin Immunol Date: 2017-01 Impact factor: 10.793
Authors: Scott H Sicherer; Robert A Wood; Tamara T Perry; Stacie M Jones; Donald Y M Leung; Alice K Henning; Peter Dawson; A Wesley Burks; Robert Lindblad; Hugh A Sampson Journal: Allergy Date: 2019-07-15 Impact factor: 13.146