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Allergy. 2017 Aug;72(8):1254-1260. doi: 10.1111/all.13100. Epub 2017 Mar 22.

LEAPing through the looking glass: secondary analysis of the effect of skin test size and age of introduction on peanut tolerance after early peanut introduction.

Author information

1
Department of Pediatrics, Section of Allergy, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
2
Division of Allergy and Immunology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
3
Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4
Department of Pediatrics, Section of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
5
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Medicine, Chicago, IL, USA.
6
Division of Allergy-Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.

Abstract

BACKGROUND:

In the Learning Early About Peanut Allergy (LEAP) study, early peanut introduction in high-risk 4- to 11-month-olds was associated with a significantly decreased risk of developing peanut allergy. However, the influences of key baseline high-risk factors on peanut tolerance are poorly understood.

METHODS:

Secondary analysis was conducted on the publically available LEAP dataset, exploring relationships between peanut tolerance, baseline peanut/egg sensitization, eczema severity/duration, age of introduction, gender, and race.

RESULTS:

A multiple logistic regression model predicting odds of successful oral food challenge (OFC) at 60 months noted higher odds with early introduction (OR 9.2, P < 0.001, 95% CI 4.2-20.3), white race (OR 2.1, P = 0.04, 95% CI 1.1-3.9), and advancing age (OR 4.8, P = 0.04, 95% CI 1.1-20.8). Odds of peanut tolerance were lower with increasing peanut wheal size (OR 0.58, P < 0.001, 95% CI 0.46-0.74), increased baseline SCORAD score (OR 0.98, P = 0.04, 95% CI 0.97-1), and increased kUA /l of egg serum IgE (sIgE) (OR 0.99, P = 0.04, 95% CI 0.98-1). The probability of peanut tolerance in the early introduction group was 83% vs 43% in the avoidance group with SPT wheal of <4 mm. The probability of a successful OFC was significantly higher with peanut introduction between 6 and 11 months than at 4-6 months. Increasing eczema severity had limited impact on the probability of peanut tolerance in the early introduction arm.

CONCLUSION:

Increasing peanut wheal size predicted peanut tolerance only in the avoidance arm. Peanut introduction between 6 and 11 months of age was associated with the highest rates of peanut tolerance, questioning the 'urgency' of introduction before 6 months.

KEYWORDS:

Learning Early about Peanut; allergy prevention; complementary feeding; early peanut introduction; peanut allergy

PMID:
27896827
PMCID:
PMC5447487
DOI:
10.1111/all.13100
[Indexed for MEDLINE]
Free PMC Article

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