Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy

被引:1474
作者
Du Toit, George [1 ,2 ]
Roberts, Graham [3 ,4 ,5 ]
Sayre, Peter H. [6 ]
Bahnson, Henry T. [8 ]
Radulovic, Suzana [1 ,2 ]
Santos, Alexandra F. [1 ,2 ]
Brough, Helen A. [1 ,2 ]
Phippard, Deborah [7 ]
Basting, Monica [1 ,2 ]
Feeney, Mary [1 ,2 ]
Turcanu, Victor [1 ,2 ]
Sever, Michelle L. [8 ]
Lorenzo, Margarita Gomez [9 ]
Plaut, Marshall [9 ]
Lack, Gideon [1 ,2 ]
机构
[1] Kings Coll London, Div Asthma Allergy & Lung Biol, Dept Pediat Allergy, London WC2R 2LS, England
[2] Guys & St Thomas Natl Hlth Serv Fdn Trust, London, England
[3] Univ Southampton, Southampton, Hants, England
[4] Natl Inst Hlth Res, Resp Biomed Res Unit, Southampton, Hants, England
[5] David Hide Ctr, Newport, Wight, England
[6] Univ Calif San Francisco, Div Hematol Oncol, Dept Med, San Francisco, CA 94143 USA
[7] Univ Calif San Francisco, Immune Tolerance Network, San Francisco, CA 94143 USA
[8] Rho Fed Syst Div, Chapel Hill, NC USA
[9] NIAID, Bethesda, MD 20892 USA
关键词
FOOD ALLERGY; ORAL IMMUNOTHERAPY; CHILDREN; PREVALENCE; RESPONSES; PROTEIN;
D O I
10.1056/NEJMoa1414850
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test - one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P = 0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4: IgE were associated with peanut allergy. CONCLUSIONS The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts.
引用
收藏
页码:803 / 813
页数:11
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