Effect of Avoidance on Peanut Allergy after Early Peanut Consumption

Jordan Alava, Mercer University College of Pharmacy

The Australian Society of Clinical Immunology and Allergy’s guidelines for allergy prevention in infants suggest there is good evidence that introducing peanut into the diet of infants who already have severe eczema and/or egg allergy before 12 months of age can reduce the risk of these infants developing peanut allergies.  [1]

According to the Food Allergy Research and Education’s facts and statistics for the United States, eight foods account for 90% of all food-allergic reactions.  It is also reported that peanut allergies are responsible for the majority of these cases with an estimated prevalence between 0.6 and 1.3%.  [2]

Title: Effect of Avoidance on Peanut Allergy after Early Peanut Consumption
Design Randomized, follow-up; N= 550
Objective To investigated whether the rate of peanut allergy remained low after 12 months of peanut avoidance among participants who had consumed peanuts during the primary trial (peanut-consumption group), as compared with those who had avoided peanuts (peanut-avoidance group)
Study Groups Peanut-avoidance (n= 280); peanut-consumption (n= 270)
Methods All the participants in the primary trial who were in the intention-to-treat population were eligible for inclusion in the follow-up study.  All the participants in the follow-up study were asked to avoid dietary consumption of peanut for 12 months.  Among the 550 participants in the intention-to-treat population, determination of peanut allergy was made by means of an oral peanut challenge in 515 (93.6%).  Among the 41 participants who did not undergo an oral challenge, we determined on the basis of a diagnostic algorithm that 28 participants had a peanut allergy and 7 were tolerant.   A determination could not be made for 6 participants
Duration May 26, 2011 to May 29, 2014
Primary Outcome Measure Percentage of participants with peanut allergy after 12 months of peanut avoidance
Baseline Characteristics There was no significant difference between groups at baseline.  The mean age of the participants at enrollment was 61.3 months.  Of the 64 participants in the primary trial who had peanut allergy, 63 enrolled in the follow-up study.
Results   Peanut-avoidance (n= 280) Peanut-consumption (n= 270) p value
Peanut allergy after 12 months of peanut avoidance, No. (%) 52 (18.6%) 13 (4.8%) < 0.001
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Among children at high risk for allergy in whom peanuts had been introduced in the first year of life and continued until 5 years of age, a 12-month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy.  Longer-term effects are not known.

Results of this study demonstrated that the reduction in peanut allergies from consuming peanut during the first five years of life still applies even after a 12-month abstinence from peanut desensitization.  A limitation of this study was the inability to determine if an allergic reaction to peanuts was due to the development of a new allergy or the loss of tolerance.  Future studies are needed to address this question and to evaluate the approximate duration of peanut exposure required to develop tolerance.

References

  1. Guidelines for allergy prevention in infants. Australian Society of Clinical Immunology and Allergy. 2016. Available at:http://www.allergy.org.au/images/pcc/ASCIA_PCC_ Guidelines_Allergy_Prevention_Infants_2016.pdf. Accessed March 18, 2016.
  2. Food Allergy Facts and Statistics for the U.S. Food Allergy Research & Education. 2016. Available at: http://www.foodallergy.org/file/facts-stats.pdf. Accessed March 18, 2016.
  3. Du toit G, Sayre PH, Roberts G, et al. Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. N Engl J Med. 2016.
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