Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia.
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia.
J Allergy Clin Immunol. 2016 Oct;138(4):1131-1141.e2. doi: 10.1016/j.jaci.2016.04.011. Epub 2016 May 2.
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.
We sought to use population-based infant peanut allergy data to understand feasibility and implications of implementing the LEAP trial intervention.
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.
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.
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.
最近一项随机试验（学习早期食用花生过敏研究，即 LEAP 研究）提供了证据，表明早期食用花生可降低高危婴儿花生过敏的发生率。然而，如何识别和确定“高危”人群，以促进及时引入花生，仍存在一些问题。
我们试图利用基于人群的婴儿花生过敏数据，了解实施 LEAP 试验干预的可行性和影响。
我们使用了 1 岁婴儿的 HealthNuts 研究队列（n=5276），探讨了使用各种标准来识别有发生花生过敏高风险的婴儿的影响，以及在食用花生前进行皮肤点刺试验（SPT）筛查的意义。
对所有早期出现特应性皮炎和/或鸡蛋过敏的婴儿进行筛查，可能需要对 16%的人群进行检测，但仍会漏诊 23%的花生过敏病例；29%的筛查阳性婴儿需要进行临床随访。约 11%的高危婴儿因基线时花生 SPT 风团直径大于 4 毫米而被排除在 LEAP 研究之外；HealthNuts 研究的数据表明，这些婴儿中有 80%在食物挑战时会对花生过敏。在生命的第一年，选择在家中给低危或高危婴儿食用花生，或在 150 名花生过敏婴儿进行医院挑战时，都没有发生危及生命的事件。
基于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群计划，将带来重大的成本和后勤挑战，需要仔细考虑。可能需要进一步研究，为低危婴儿提供数据。
