University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, and the David Hide Centre, Isle of Wight, United Kingdom.
Benaroya Research Institute and the Immune Tolerance Network, Seattle, Wash.
J Allergy Clin Immunol. 2023 May;151(5):1329-1336. doi: 10.1016/j.jaci.2022.09.042. Epub 2022 Dec 12.
Peanut allergy affects 1% to 2% of European children. Early introduction of peanut into the diet reduces allergy in high-risk infants.
We aimed to determine the optimal target populations and timing of introduction of peanut products to prevent peanut allergy in the general population.
Data from the Enquiring About Tolerance (EAT; n = 1303; normal risk; 3-year follow-up; ISRCTN14254740) and Learning Early About Peanut Allergy study (LEAP; n = 640; high risk; 5-year follow-up; NCT00329784) randomized controlled trials plus the Peanut Allergy Sensitization (PAS; n = 194; low and very high risk; 5-year follow-up) observational study were used to model the intervention in a general population. Peanut allergy was defined by blinded peanut challenge or diagnostic skin prick test result.
Targeting only the highest-risk infants with severe eczema reduced the population disease burden by only 4.6%. Greatest reductions in peanut allergy were seen when the intervention was targeted only to the larger but lower-risk groups. A 77% reduction in peanut allergy was estimated when peanut was introduced to the diet of all infants, at 4 months with eczema, and at 6 months without eczema. The estimated reduction in peanut allergy diminished with every month of delayed introduction. If introduction was delayed to 12 months, peanut allergy was only reduced by 33%.
The preventive benefit of early introduction of peanut products into the diet decreases as age at introduction increases. In countries where peanut allergy is a public health concern, health care professionals should help parents introduce peanut products into their infants' diet at 4 to 6 months of life.
花生过敏影响了欧洲 1%至 2%的儿童。在高危婴儿中早期引入花生可以减少过敏。
我们旨在确定最佳的目标人群和引入花生制品的时间，以预防普通人群中的花生过敏。
来自 Enquiring About Tolerance（EAT；n=1303；正常风险；3 年随访；ISRCTN64525060）和 Learning Early About Peanut Allergy 研究（LEAP；n=640；高风险；5 年随访；NCT00329784）的随机对照试验的数据，加上 Peanut Allergy Sensitization（PAS；n=194；低和极高风险；5 年随访）观察性研究，用于对普通人群中的干预进行建模。花生过敏通过盲法花生挑战或诊断性皮肤点刺试验结果定义。
仅针对严重特应性皮炎的高危婴儿进行靶向治疗，仅减少了 4.6%的人群疾病负担。当干预措施仅针对风险较高但较低的人群时，花生过敏的减少幅度最大。当所有婴儿在 4 个月有特应性皮炎时，在 6 个月没有特应性皮炎时，将花生引入饮食中，估计可以减少 77%的花生过敏。延迟引入的每个月，估计减少的花生过敏都会减少。如果延迟到 12 个月引入，花生过敏只会减少 33%。
早期引入花生制品到饮食中的预防益处随着引入年龄的增加而降低。在花生过敏是公共卫生关注的国家，医疗保健专业人员应帮助父母在婴儿 4 至 6 个月大时将花生制品引入其婴儿饮食中。
