Helen R Fisher1, George Du Toit2, Henry T Bahnson3, Gideon Lack4. 1. Paediatric Allergy Group, Department of Women and Children's Heath, School of Life Course Sciences, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom. 2. Paediatric Allergy Group, Department of Women and Children's Heath, School of Life Course Sciences, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 3. Immune Tolerance Network, Benaroya Research Institute, Seattle, Washington. 4. Paediatric Allergy Group, Department of Women and Children's Heath, School of Life Course Sciences, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: gideon.lack@kcl.ac.uk.
Abstract
OBJECTIVE: To highlight challenges associated with this novel preventive strategy. DATA SOURCES: The Learning Early About Peanuts (LEAP) and Enquiring About Tolerance (EAT) Studies, with reference to other oral tolerance induction studies. STUDY SELECTIONS: Randomized clinial trials seeking to prevent food allergy through allergen introduction in infancy. RESULTS: Oral tolerance induction programs that use a regimen of consumption of 2 g/week of protein are effective in preventing peanut and egg allergy. LEAP findings suggest oral tolerance induction is allergen specific. Adding peanut and other common food allergens (egg, fish, sesame, milk) to the infant diet has no adverse nutritional or growth effects and does not increase rates of food allergy. Breastfeeding rates are not adversely affected by these interventions. In the Western world, nonwhite children have the highest risk of food allergy, but their families are the least likely to participate in oral tolerance induction programs. CONCLUSION: Many challenges must be overcome to implement successful food allergy prevention strategies. Allergy testing of high-risk infants (those with moderate to severe eczema and/or egg allergy) before commencing oral tolerance induction is desirable, but access is not universal. Dietary interventions would ideally be implemented in infancy before allergic sensitization and allergy occur, using a program that provides protection against multiple common allergens. Further research and consensus with regard to food preparations, target populations, dosing regimens, and preparations and clearly defined adherence are now required.
OBJECTIVE: To highlight challenges associated with this novel preventive strategy. DATA SOURCES: The Learning Early About Peanuts (LEAP) and Enquiring About Tolerance (EAT) Studies, with reference to other oral tolerance induction studies. STUDY SELECTIONS: Randomized clinial trials seeking to prevent food allergy through allergen introduction in infancy. RESULTS: Oral tolerance induction programs that use a regimen of consumption of 2 g/week of protein are effective in preventing peanut and egg allergy. LEAP findings suggest oral tolerance induction is allergen specific. Adding peanut and other common food allergens (egg, fish, sesame, milk) to the infant diet has no adverse nutritional or growth effects and does not increase rates of food allergy. Breastfeeding rates are not adversely affected by these interventions. In the Western world, nonwhite children have the highest risk of food allergy, but their families are the least likely to participate in oral tolerance induction programs. CONCLUSION: Many challenges must be overcome to implement successful food allergy prevention strategies. Allergy testing of high-risk infants (those with moderate to severe eczema and/or egg allergy) before commencing oral tolerance induction is desirable, but access is not universal. Dietary interventions would ideally be implemented in infancy before allergic sensitization and allergy occur, using a program that provides protection against multiple common allergens. Further research and consensus with regard to food preparations, target populations, dosing regimens, and preparations and clearly defined adherence are now required.
Authors: Ruchi S Gupta; Lucy A Bilaver; Jacqueline L Johnson; Jack W Hu; Jialing Jiang; Alexandria Bozen; Jennifer Martin; Jamie Reese; Susan F Cooper; Matthew M Davis; Alkis Togias; Samuel J Arbes Journal: JAMA Netw Open Date: 2020-07-01