Expecting Mothers' Study of Consumption or Avoidance of Peanut and Egg (ESCAPE)

项目摘要/摘要 花生(PN)过敏是老年人致命性和近乎致命性食物过敏反应的最常见原因 儿童和成人、鸡蛋和牛奶是婴儿时期最常见的食物过敏触发物。鸡蛋过敏 是最常见的儿童IgE介导的食物过敏，患病率一般在1.3-1.6%之间 高危婴儿的人口比例高达20%。鸡蛋致敏是PN过敏和早期的重要危险因素 空气过敏原敏化，可导致“特应性进行曲”。黑人儿童在儿童中的比例过高 鸡蛋过敏和哮喘在对鸡蛋过敏的儿童中比对其他食物过敏的儿童更常见。仅限 50%的人在学龄期对鸡蛋产生耐受性；PN过敏很少会消失。有一个关键的“窗口” 在大约4-6个月内引入致敏固体以降低食物过敏风险的机会 在使用鸡蛋和PN的随机对照试验中显示。然而，36%的婴儿已经对鸡蛋过敏。 在登记时，约9%的婴儿接受PN，不包括他们的早期介绍；20%的婴儿临床过敏， 甚至过敏，在他们第一次引入鸡蛋。为了更有效，初级预防战略必须 在敏感化建立之前就开始，甚至可能在怀孕或哺乳期间。 以前的研究在包括或不包括鸡蛋或PN的母亲饮食对婴儿发育的影响上相互矛盾。 婴儿期的食物过敏。根据美国儿科学会的说法，“目前的证据并不支持 孕妇在孕期或哺乳期的饮食限制“，但缺乏随机对照试验。 因此，迫切需要向母亲们提供基于良好喂养习惯的具体建议。 高质量的证据。本应用程序的总体目标是定义EGG和PN暴露在 通过妊娠和通过母乳在食物中致敏，并确定致敏或耐受的生物标志物。 我们将进行一项全国性的随机对照四臂平行试验。怀孕的母亲们 打算母乳喂养3个月的高危婴儿(有特应性疾病的一级亲属)将被视为 利用社交媒体和推荐进行登记，并随机选择服用或避免服用鸡蛋和PN 在怀孕和哺乳期间包含食物，以评估4岁时对鸡蛋和PN过敏的风险 在推出固体食品前几个月。在目标1中，我们将确定母亲日粮鸡蛋和PN的效果 避免孕期和哺乳期高危婴儿的卵子和PN致敏风险。在目标2中， 我们将评估婴儿口腔和环境中鸡蛋和PN的暴露水平。在目标3中，我们将确定 孕期和哺乳期由母体饮食引起的免疫反应，包括或不包括鸡蛋和PN。 从这些研究中获得的知识将揭示建立早期生命敏感性的必要机制 预防食物过敏和特应性进行曲中的母亲饮食指南。 1

PROJECT SUMMARY/ABSTRACT Whereas peanut (PN) allergy is the most common cause of fatal and near-fatal food-allergic reactions in older children and adults, egg and cow’s milk are the most common food triggers of anaphylaxis in infancy. Egg allergy is the most common childhood IgE-mediated food allergy with prevalence rates ranging from 1.3-1.6% in general population up to 20% in high-risk infants. Egg sensitization is a significant risk factor for PN allergy and early aeroallergen sensitization, which can lead to the “atopic march”. Black children are over-represented among children with egg allergy and asthma is more prevalent in children with allergy to egg than any other food. Only 50% develop tolerance to egg by school-age; PN allergy is rarely outgrown. There is a critical “window of opportunity” for the introduction of allergenic solids around 4-6 months in decreasing the risk of food allergy as shown in randomized controlled trials with egg and PN. However, 36% of infants were already sensitized to egg at enrollment and about 9% to PN, excluding them from early introduction; 20% infants were clinically allergic, even anaphylactic, on their first introduction of egg. To be more effective, primary prevention strategies must begin much earlier before sensitization is established, possibly even during pregnancy or breastfeeding. Prior studies are conflicting in the effect of maternal diet including or excluding egg or PN on development of food allergy in infancy. Per the American Academy of Pediatrics, “Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation”, but randomized controlled trials are lacking. Thus, there is an urgent need to provide mothers with concrete advice on feeding practices based on good quality evidence. The overall objective of this application is to define the role for egg and PN exposure during pregnancy and via human milk in food sensitization and to identify the biomarkers of sensitization or tolerance. We will conduct a nationally-enrolled, randomized controlled, four-arm parallel trial. Mothers pregnant with infants at high risk (with first degree relative with an atopic disease) who intend to breastfeed >3 months will be enrolled utilizing social media and referrals and randomized to either consumption or avoidance of egg and PN containing foods throughout pregnancy and lactation to assess the risk of sensitization to egg and PN at 4 months before introduction of solid foods. In Aim 1, we will determine the effect of maternal dietary egg and PN avoidance during pregnancy and lactation on the risk of egg and PN sensitization in high-risk infants. In Aim 2, we will assess the level of infant oral and environmental exposure to egg and PN. In Aim 3, we will identify the immune responses elicited by maternal diet including or excluding egg and PN during pregnancy and lactation. Knowledge gained from these studies will uncover mechanisms of early-life sensitization necessary to establish maternal dietary guidelines in prevention of food allergy and the atopic march. 1