Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy

Publication date: Available online 2 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Jennifer J. Koplin, Rachel L. Peters, Shyamali C. Dharmage, Lyle Gurrin, Mimi LK. Tang, Anne-Louise Ponsonby, Melanie Matheson, Alkis Togias, Gideon Lack, Katrina J. Allen
BackgroundA recent randomized trial (the 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 peanutObjectiveTo use population-based infant peanut allergy data to understand feasibility and implications of implementing the LEAP trial interventionMethodsUsing the HealthNuts cohort (n=5,300) 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 prior to peanut introductionResultsScreening 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 due to being SPT positive. Around 11% of high-risk infants were excluded from LEAP due to SPT wheal size >4mm to peanut at baseline; data from HealthNuts suggest 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.ConclusionsBased 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.

Teaser

Using data from a large epidemiological study, we explore potential criteria for identifying infants at high risk of developing peanut allergy and the implications of skin prick test screening prior to peanut introduction at the population level.


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