Related Experiment Video
Updated: May 16, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study
George Du Toit1, Graham Roberts, Peter H Sayre
1King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Insights
Early introduction of peanuts may prevent peanut allergy (PA). Infants with severe eczema or egg allergy were identified as high-risk for PA in a screening study. Race impacts peanut sensitization risk and presentation.
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Clinical Trial Screening
Background:
- Peanut allergy (PA) prevalence is inversely related to early dietary peanut introduction.
- The Learning Early About Peanut Allergy (LEAP) study investigates oral tolerance induction for PA prevention.
Purpose of the Study:
- To characterize infants screened for a peanut allergy prevention trial.
- To identify risk factors for peanut sensitization in infants.
Main Methods:
- Screening of 834 infants (4-10 months old) for the LEAP study.
- Categorization into four groups based on eczema severity, egg allergy, and peanut skin prick test (SPT) responses.
- Assessment of peanut-specific IgE sensitization and association with clinical factors and race.
Main Results:
- Significant peanut-specific IgE sensitization was found in infants with severe eczema/egg allergy and intermediate SPT responses (17-56%).
- Severe eczema and egg allergy were associated with increased peanut sensitization (SPT and IgE).
- Black infants showed higher IgE sensitization but paradoxically lower cutaneous sensitization for a given IgE level.
Conclusions:
- Egg allergy and severe eczema are useful criteria for identifying high-risk infants for PA prevention studies.
- Race influences the relationship between peanut-specific IgE levels and skin prick test sensitization.
Background:
Peanut allergy (PA) is rare in countries in which peanuts are introduced early into infants' diets. Learning Early About Peanut Allergy (LEAP) is an interventional study aiming to assess whether PA can be prevented by oral tolerance induction.
Objective:
We sought to characterize a population screened for the risk of PA.
Methods:
Subjects screened for the LEAP interventional trial comprise the LEAP screening study cohort. Infants were aged 4 to 10 months and passed a prescreening questionnaire.
Results:
This analysis includes 834 infants (mean age, 7.8 months). They were split into the following: group I, patients with mild eczema and no egg allergy (n = 118); group II, patients with severe eczema, egg allergy, or both but 0-mm peanut skin prick test (SPT) wheal responses (n = 542); group III, patients with severe eczema, egg allergy, or both and 1- to 4-mm peanut wheal responses (n = 98); and group IV, patients with greater than 4-mm peanut wheal responses (n = 76). Unexpectedly, many (17%) in group II had peanut-specific IgE sensitization (≥ 0.35 kU/L); 56% of group III were similarly sensitized. In contrast, none of the patients in group I and 91% of those in group IV had peanut-specific IgE sensitization. Sensitization on skin testing to peanut (SPT response of 1-4 mm vs 0 mm) was associated with egg allergy and severe eczema (odds ratio [OR], 2.31 [95% CI, 1.39-3.86] and 2.47 [95% CI, 1.14-5.34], respectively). Similar associations were observed with specific IgE sensitization. Black race was associated with a significantly higher risk of peanut-specific IgE sensitization (OR, 5.30 [95% CI, 2.85-9.86]). Paradoxically, for a given specific IgE level, black race was protective against cutaneous sensitization (OR, 0.15 [95% CI, 0.04-0.61]).
Conclusion:
Egg allergy, severe eczema, or both appear to be useful criteria for identifying high-risk infants with an intermediate level of peanut sensitization for entry into a PA prevention study. The relationship between specific IgE level and SPT sensitization needs to be considered within the context of race.
