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Defining the window of opportunity and target populations to prevent peanut allergy
Graham Roberts1, Henry T Bahnson2, George Du Toit3
1University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, and the David Hide Centre, Isle of Wight, United Kingdom.
Insights
Introducing peanut products early, between 4-6 months, significantly reduces peanut allergy risk in infants. Delaying introduction diminishes this protective effect, highlighting the importance of timely dietary intervention for prevention.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health Nutrition
- Epidemiology
Background:
- Peanut allergy affects 1-2% of European children, posing a significant public health concern.
- Early dietary introduction of peanut has shown promise in preventing allergy, particularly in high-risk infants.
Purpose of the Study:
- To identify optimal target populations and timing for peanut product introduction to prevent peanut allergy in the general infant population.
- To model the impact of early peanut introduction on population-level peanut allergy prevalence.
Main Methods:
- Utilized data from three studies: Enquiring About Tolerance (EAT), Learning Early About Peanut Allergy (LEAP), and Peanut Allergy Sensitization (PAS).
- Employed randomized controlled trials and observational study data to model intervention effects in a general population.
- Defined peanut allergy using blinded peanut challenges or diagnostic skin prick tests.
Main Results:
- Targeting only high-risk infants (e.g., with severe eczema) yielded a minimal 4.6% reduction in population disease burden.
- Greatest peanut allergy reductions were observed when targeting broader, lower-risk infant groups.
- Introducing peanut to all infants at 4 months (with eczema) or 6 months (without eczema) estimated a 77% reduction in peanut allergy.
Conclusions:
- The preventive benefit of early peanut introduction wanes significantly with increasing age at introduction.
- Delayed introduction to 12 months reduced peanut allergy by only 33%, underscoring the critical window for intervention.
- Healthcare professionals should guide parents to introduce peanut products between 4-6 months in countries with high peanut allergy prevalence.
Background:
Peanut allergy affects 1% to 2% of European children. Early introduction of peanut into the diet reduces allergy in high-risk infants.
Objective:
We aimed to determine the optimal target populations and timing of introduction of peanut products to prevent peanut allergy in the general population.
Methods:
Data from the Enquiring About Tolerance (EAT; n = 1303; normal risk; 3-year follow-up; ISRCTN14254740) and Learning Early About Peanut Allergy study (LEAP; n = 640; high risk; 5-year follow-up; NCT00329784) randomized controlled trials plus the Peanut Allergy Sensitization (PAS; n = 194; low and very high risk; 5-year follow-up) observational study were used to model the intervention in a general population. Peanut allergy was defined by blinded peanut challenge or diagnostic skin prick test result.
Results:
Targeting only the highest-risk infants with severe eczema reduced the population disease burden by only 4.6%. Greatest reductions in peanut allergy were seen when the intervention was targeted only to the larger but lower-risk groups. A 77% reduction in peanut allergy was estimated when peanut was introduced to the diet of all infants, at 4 months with eczema, and at 6 months without eczema. The estimated reduction in peanut allergy diminished with every month of delayed introduction. If introduction was delayed to 12 months, peanut allergy was only reduced by 33%.
Conclusions:
The preventive benefit of early introduction of peanut products into the diet decreases as age at introduction increases. In countries where peanut allergy is a public health concern, health care professionals should help parents introduce peanut products into their infants' diet at 4 to 6 months of life.
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