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Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut
Jennifer J Koplin1, Rachel L Peters2, Shyamali C Dharmage3
1Murdoch 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.
Insights
Implementing early peanut introduction for infants requires careful consideration of identification strategies. Identifying high-risk infants for peanut allergy prevention poses significant logistical and cost challenges.
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Epidemiology
Background:
- The Learning Early About Peanut Allergy (LEAP) study demonstrated that early dietary peanut introduction reduces peanut allergy prevalence in high-risk infants.
- Identifying and targeting this at-risk population for timely peanut introduction remains a challenge.
Purpose of the Study:
- To assess the feasibility and implications of implementing the LEAP trial intervention using population-based infant peanut allergy data.
- To explore criteria for identifying high-risk infants and the impact of skin prick test (SPT) screening.
Main Methods:
- Analysis of the HealthNuts study cohort (n=5276) of 1-year-old infants.
- Exploration of various criteria for identifying high-risk infants for peanut allergy.
- Evaluation of the implications of SPT screening prior to peanut introduction.
Main Results:
- Screening infants with early-onset eczema and/or egg allergy would test 16% of the population, miss 23% of peanut allergy cases, and require clinical follow-up for 29% of screened infants.
- Approximately 11% of high-risk infants excluded from the LEAP study due to SPT results were likely peanut allergic.
- No life-threatening events occurred during home introduction or hospital-based challenges.
Conclusions:
- Population-wide programs to identify and screen infants at risk for peanut allergy present significant cost and logistical challenges.
- Further research is needed to inform strategies for low-risk infants.
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.
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