Food, drug, insect sting allergy, and anaphylaxis
Household peanut consumption as a risk factor for the development of peanut allergy

https://doi.org/10.1016/j.jaci.2008.12.014Get rights and content

Background

Most children with peanut allergy (PA) react on first known oral exposure to peanut. Recent data suggest cutaneous exposure as a route of sensitization.

Objectives

This study aimed to establish the relevant route of peanut exposure in the development of allergy.

Methods

Questionnaires were administered to children with PA and to high-risk controls (with egg allergy) and controls without allergy. Questionnaires were completed before subjects were aware of their PA status, avoiding recall bias. Questionnaires recorded maternal peanut consumption during pregnancy, breast-feeding, and the first year of life. Peanut consumption was determined among all household members, allowing quantification of environmental household exposure (household peanut).

Results

Median weekly household peanut in the 133 PA cases was significantly elevated (18.8 g) compared with 150 controls without allergy (6.9 g) and 160 high-risk controls (1.9 g). There were no differences in infant peanut consumption between groups. Differences in maternal peanut consumption during pregnancy (and lactation) were significant but become nonsignificant after adjusting for household peanut. A dose-response relationship was observed between environmental (nonoral) peanut exposure and the development of PA, which was strongest for peanut butter. Early oral exposure to peanut in infants with high environmental peanut exposure may have had a protective effect against the development of PA.

Conclusions

High levels of environmental exposure to peanut during infancy appear to promote sensitization, whereas low levels may be protective in atopic children. No effect of maternal peanut consumption during pregnancy or lactation is observed, supporting the hypothesis that peanut sensitization occurs as a result of environmental exposure.

Section snippets

Study design

This was a questionnaire-based case-control study including children with PA and both high-risk and low-risk controls, conducted between September 2004 and September 2005 within 1 large London pediatric department. To avoid differential recall bias, parents of cases and high-risk controls completed the questionnaire before knowing whether their child had PA. All children were younger than 48 months at recruitment. The power calculation detailed in our protocol called for 150 children in each of

Study population

The groups were similar for age, sex, socioeconomic status, and breast-feeding (not shown). Eczema in the first year of life was very prevalent among both cases (91.7%) and high-risk controls (88.1%) but significantly less so among normal controls (42%), in whom the eczema was also significantly later in onset and less severe (P < .0001).

Maternal peanut protein consumption during pregnancy and lactation

Weekly maternal peanut consumption during pregnancy was compared. The median for cases was 2.4 g peanut protein per week, which was significantly higher than

Discussion

An understanding of routes of exposure leading to either allergic sensitization or immunologic tolerance is required for the development of effective prevention strategies.17

Recently, we showed that exposure to preparations containing Arachis oil was a risk factor for the development of PA.12 Almost 91% of the children with PA had been exposed topically to creams containing Arachis oil in the first 6 months of life. Moreover, children with PA were exposed to significantly more preparations

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  • Cited by (0)

    Supported by a research grant from the Food Standards Agency (United Kingdom; T07043). This grant supported the project costs, including the salary of A.T.F. over the study duration. G.L.'s salary was supported in part by the Aimwell Foundation.

    Disclosure of potential conflict of interest: G. Lack has provided consultation for the advisory boards of Synovate, Novartis Xolair, and ALK-Abelló; has served as an academic lecturer for SHS Nutricia, Nestlé, and SHS International; has received research support from the Immune Tolerance Network, the National Peanut Board, the Food Standards Agency, the Medical Research Council, the Food Allergy and Anaphylaxis Network, and the Food Allergy Initiative; and has served as a scientific advisor for the Anaphylaxis Campaign and the National Peanut Board. A. T. Fox has served as a consultant for SHS Nutricia and has attended a conference for Nestlé. P. Sasieni has received research support from Cancer Research, United Kingdom. G. du Toit has received research support from the National Peanut Board, USA, and the Immune Tolerance Network, National Institutes of Health. The other author has declared that she has no conflict of interest.

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