Although there is robust evidence suggesting early introduction of peanut is beneficial for children, knowledge gaps remain about the age of introduction and whether to target high-risk or normal populations, explains Gideon Lack, MBBCh. Most recently, he adds, the European Academy of Allergy and Clinical Immunology (EAACI) presented guidelines for the introduction of peanut to all infants. However, “these recommendations were limited to countries with a high prevalence of peanut allergy.”
Previously, guidelines from the United Kingdom and the United States suggested that to prevent peanut allergy, peanut in infancy should be avoided, Dr. Lack notes. “Despite these guidelines, the prevalence of peanut allergy continued to increase,” he says.
To enhance their knowledge base for future guidelines, Dr. Lack and colleagues performed a pooled analysis of individual participation data from all available randomized controlled trials of peanut introduction. The Learning Early About Peanut allergy (LEAP) study focused on the effectiveness of early peanut introduction in prevention of peanut allergy (PA). A second study, Enquiring About Tolerance (EAT), showed a considerable reduction in PA, but only in per-protocol (PP) analysis, which is subject to bias.
For a study published in Allergy, Dr. Lack and colleagues analyzed the LEAP and EAT studies with the aim of providing convincing evidence on the bias corrected effect of early introduction of peanut. The LEAP study was limited to high-risk individuals, while the EAT study included those with varying risks. Baseline eczema, ethnicity, baseline IgE, and egg allergy were included to account for these differences.
Protective Effect Observed Across All Ethnicities, Eczema Groups
The researchers examined peanut allergy status in 1,796 children from the LEAP and EAT studies. They compared efficacy and effectiveness estimates of oral tolerance of peanut across analysis methods and different risk levels.
Among children randomly assigned to ingest peanut from early infancy, an intention-to-treat analysis demonstrated a 75% decline in PA, according to the study team. They also observed a protective effect across all ethnicities and eczema severity groups, regardless of sensitization to peanut at enrollment. Improved effectiveness of the intervention was linked with earlier age of introduction. Peanut consumption decreased the risk for PA by 98% in the pooled PP analysis (P<0.0001). Finally, in children without eczema, a multi-variable causal inference analysis approach estimated a 100% drop in PA (P=0.004).
Dr. Lack and colleagues also assessed the link between age of introduction of peanut and the incidence of peanut allergy. “Our results point to increased efficacy of the intervention with an age of introduction below 6 months,” the study team wrote.
The findings, the study team noted, offer new evidence for the efficacy of early introduction of peanut in children with all degrees of eczema severity and indicate efficacy in children without eczema. Furthermore, the efficacy was observed regardless of peanut sensitization status, ethnicity, and presence of egg allergy. This study, therefore, suggests “that recommending early consumption of peanut as a prevention strategy be broadly applied to the entire population, rather than targeting selected high-risk groups.”
The researchers concurred that these new analyses bolster existing evidence based on the EAACI guidelines advocating early introduction of peanut to the general pediatric population.
