Can early peanut intake prevent peanut allergy in kids?

 

Two studies presented at AAAAI 2021 highlighted the benefit of early desensitization in children with peanut allergy – with one suggesting early introduction of peanuts into a child’s food regimen, and another through sublingual immunotherapy (SLIT).

 

Within 1 year of life

Studies have shown that introducing peanuts early in children may prevent the development of peanut allergy. Following updates in the 2016 infant feeding guidelines in Australia, a dramatic increase in peanut introduction within the first year of a child’s life was observed. [J Allergy Clin Immunol 2019;144:1327-1335]

 

“[In the EarlyNuts study,] while we did see a decrease in individuals with peanut allergy, the prevalence of peanut allergy overall continues to be high even with early introduction,” shared first author Victoria Soriano from the Murdoch Children’s Research Institute, Parkville, Australia.

 

Soriano and colleagues found that the adjusted prevalence of peanut allergy between 2018 and 2019 was 2.6 percent, which translates to a 16-percent drop from the 3.1-percent rate observed from 2007 to 2011. Further adjustment for eczema revealed a similar rate of peanut allergy (2.7 percent). [AAAAI 2021, abstract L5]

 

More than three-quarters (78 percent) of infants in the 2018–2019 cohort consumed peanuts within a year. Of these, about 3 percent had peanut allergy. For those who did not consume peanuts within the first year of life, nearly 5 percent were found to have peanut allergy.

 

The team compared the 2018–2019 sample of 1-year-old infants (n=1,933) against a sample recruited 10 years earlier (2007–2011; n=5,276). Demographic and infant feeding data were collected via questionnaires. Skin prick tests (SPTs) and food challenges were conducted on sensitized infants.

 

“More research must be done to look closer at these trends to help us understand how well early introduction to peanut works to prevent peanut allergies in real-life situations,” said Soriano.

 

At toddler age

In the peanut (PN)SLIT trial, researchers explored the potential of PNSLIT for early desensitization in 50 toddler-aged children (median age 2.2 years) with peanut allergy (positive peanut-specific IgE and SPT). Children were randomized 1:1 to receive PNSLIT (with a daily maintenance dose of 4 mg peanut protein) or placebo for 3 years. Desensitization to peanut protein was evaluated using DBPCFC*. Following PNSLIT withdrawal for 3 months, sustained unresponsiveness (SU) was evaluated by identical DBPCFC. [AAAAI 2021, abstract L2]

Thirty-six children completed desensitization DBPCFC (n=19 and 17 of PNSLIT and placebo recipients, respectively). Cumulative tolerated peanut protein dose ballooned from a median 143 to 4,443 mg in the PNSLIT arm and from 43 to 143 mg in the placebo arm (p<0.0001).

Fourteen participants in the PNSLIT arm passed the desensitization DBPCFC, whereas there were none in the placebo arm. Twelve PNSLIT recipients passed the SU DBPCFC as opposed to only two in the placebo arm. 

“We observed significant desensitization in toddlers with peanut allergy … with a treatment effect that appears stronger than previously seen in older children [and a strong potential for SU],” said first author Dr Edwin Kim from the University of North Carolina School of Medicine, Chapel Hill, North Carolina, US. “[These findings suggest that] PNSLIT may be a promising treatment option for early intervention in peanut allergy.”