Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
J Dev Orig Health Dis. 2021 Oct;12(5):811-818. doi: 10.1017/S2040174420001129. Epub 2020 Dec 9.
New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother-child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14-0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01-0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this "triple exposure" hypothesis.
新的高风险婴儿花生过敏预防指南建议在婴儿期引入花生，但没有涉及母乳喂养或母亲花生食用情况。我们评估了这些因素在一般人群 CHILD 出生队列（N=2759 对母婴对子）中的独立和联合关联，以及它们与花生致敏的关系。母亲报告了怀孕期间的花生食用情况、婴儿首次食用花生的时间以及母乳喂养的持续时间。通过在 1、3 和 5 岁时进行皮肤点刺试验来确定儿童花生致敏情况。总体而言，69%的母亲经常食用花生，36%的婴儿在第一年食用花生（20%在母乳喂养期间，16%在停止母乳喂养后）。与未食用花生的婴儿相比，在停止母乳喂养后早期（<1 岁）引入花生的婴儿在 5 岁时致敏的风险降低了 66%（1.9%与 5.8%致敏；aOR 0.34，95%CI 0.14-0.68）。如果母亲在母乳喂养时早期引入花生并自己经常食用花生，则这种风险进一步降低（0.3%致敏；aOR 0.07，0.01-0.25）。在纵向分析中，这些关联是由早期致敏消退的几率增加和晚期致敏发生的几率降低驱动的。没有母乳喂养而母亲食用花生并没有明显的益处（或危害）。总之，这些结果表明，在婴儿期引入花生时，母亲花生食用和母乳喂养的结合可能有助于降低花生致敏的风险。需要进行机制和临床干预研究来证实和理解这种“三重暴露”假设。
