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Risk subgroups and intervention effects among infants at high risk for peanut allergy: A model for clinical decision
Yuxiang Li1,2, Ashley Devonshire3,4, Bin Huang1,3
1Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Early peanut introduction significantly reduces allergy risk in infants. Higher risk infants experienced greater absolute risk reduction, informing personalized allergy prevention strategies.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Computational Biology
Background:
- The Learning Early About Peanut Allergy (LEAP) trial demonstrated that early peanut introduction lowers allergy risk in high-risk infants.
- This secondary analysis aimed to identify specific infant risk subgroups for peanut allergy.
- The study also estimated the intervention effects of early peanut introduction within these subgroups.
Purpose of the Study:
- To identify distinct risk subgroups for peanut allergy development in infants.
- To quantify the effectiveness of early peanut introduction across these identified risk subgroups.
- To provide data for personalized risk assessment and clinical decision-making in peanut allergy prevention.
Main Methods:
- Utilized LEAP trial data, retrieving raw data from ITNTrialShare.org.
- Applied conditional random forest and classification and regression tree (CART) analysis to baseline data (4-11 months).
- Estimated intervention effects by comparing peanut introduction vs. avoidance arms across risk subgroups, adjusting for IgE levels.
Main Results:
- Infants with higher predicted peanut allergy probability showed similar relative but greater absolute risk reduction from early introduction.
- Participants with baseline peanut specific IgE (sIgE) ≥0.22 kU/L had a 40.4% absolute risk reduction.
- Infants with lower sIgE (<0.22 kU/L) and low Ara h 2 sIgE (<0.10 kU/L) had a 6.5% absolute risk reduction.
Conclusions:
- Risk subgroups for peanut allergy were identified within the LEAP cohort.
- Early peanut introduction demonstrated significant intervention effects across all identified risk subgroups.
- Findings support personalized approaches to peanut allergy prevention based on individual risk assessment.
Background:
The Learning Early About Peanut Allergy (LEAP) trial showed that early dietary introduction of peanut reduced the risk of developing peanut allergy by age 60 months in infants at high risk for peanut allergy. In this secondary analysis of LEAP data, we aimed to determine risk subgroups within these infants and estimate their respective intervention effects of early peanut introduction.
Methods:
LEAP raw data were retrieved from ITNTrialShare.org. Conditional random forest was applied to participants in the peanut avoidance arm to select statistically important features for the classification and regression tree (CART) analysis to group infants based on their risk of peanut allergy at 60 months of age. Intervention effects were estimated for each derived risk subgroup using data from both arms. Our main model was generated based on baseline data when the participants were 4-11 months old. Specific IgE measurements were truncated to account for the limit of detection commonly used by laboratories in clinical practice.
Results:
The model found infants with higher predicted probability of peanut allergy at 60 months of age had a similar relative risk reduction, but a greater absolute risk reduction in peanut allergy with early introduction of peanut, than those with lower probability. The intervention effects were significant across all risk subgroups. Participants with baseline peanut sIgE ≥0.22 kU/L (n = 78) had an absolute risk reduction of 40.4% (95% CI 27.3, 51.9) whereas participants with baseline peanut sIgE<0.22 kU/L and baseline Ara h 2 sIgE <0.10 kU/L (n = 226) had an absolute risk reduction of 6.5% (95% CI 2.6, 11.0). These findings were consistent in sensitivity analyses using alternative models.
Conclusion:
In this study, risk subgroups were determined among infants from the LEAP trial based on the probability of developing peanut allergy and the intervention effects of early peanut introduction were estimated. This may be relevant for further risk assessment and personalized clinical decision-making.
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