Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy
Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy
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DOI：
10.1016/j.jaci.2016.04.011
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发表时间：
2016-10-01
影响因子：
14.2
通讯作者：
Allen, Katrina J.
中科院分区：
文献类型：
--
作者：
Koplin, Jennifer J.;Peters, Rachel L.;Allen, Katrina J.
背景资料：最近的一项随机试验（早期了解花生过敏[LEAP]研究）提供的证据表明，早期饮食中引入花生可以降低高危婴儿的花生过敏患病率。然而，问题仍然是如何识别和针对“高危”人群，以促进及时引入peanut.Objective：我们试图使用基于人群的婴儿花生过敏数据，以了解实施LEAP试验干预的可行性和影响。使用HealthNuts研究队列（n = 5276）的1岁婴儿，我们探讨了使用各种标准来识别花生过敏高风险婴儿的影响，结果：筛选所有婴儿早发性湿疹和/或鸡蛋过敏可能需要测试16%的人口，仍然会错过23%的花生过敏的情况下，29%的筛选婴儿将需要临床随访，因为是SPT阳性。大约11%的高危婴儿被排除在LEAP研究之外，因为基线时SPT风团大小超过4 mm; HealthNuts研究的数据表明，其中80%的婴儿对食物过敏。在父母选择在出生后第一年在家中引入花生的低风险或高风险婴儿中，或在医院挑战期间的150名花生过敏婴儿中，没有危及生命的事件。根据这项大型流行病学研究，一项旨在识别和筛查所有有花生过敏风险的婴儿的人口计划将带来重大的成本和后勤挑战，需要仔细研究。考虑了可能需要进一步的研究来提供低风险婴儿的数据。
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.