Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy

Early intervention and prevention of allergic diseases

“…65 Other risk factors have been associated with peanut allergy, including filaggrin mutations, severe infantile AD, environmental irritant exposures such as detergents and S. aureus colonization on the skin. [66][67][68] Skin dysbiosis, often observed among individuals with AD, is often characterized by reduced microbial diversity and the presence of one or few dominant microbes. The loss of commensal microbes is likely due to several factors including host genetics, local immune response, environmental factors such as pH, temperature, humidity, hygiene practice and exposure to antibiotics.…”

New ideas: Food allergy stems from food quality sensing

“…6 Keet et al recently reported on 321 infants (aged 4-11 months) with no known exposure or history of reaction to peanut but with elevated risk of peanut allergy (family history, eczema, and/or personal history of other food allergy). 7 Of the cohort, 21% had evidence of sensitization to peanut before any ingestion of peanut, and 18% of infants with eczema had clinical peanut allergy. Eczema and age were the largest risk factors for peanut allergy.…”

Leveraging shared decision making to discuss nonessential medical testing and prevent peanut allergy overdiagnosis during infancy

“…Previous health economic evaluations have shown that peanut allergy screening before early introduction is generally of low value, costing hundreds of millions of dollars to prevent (or delay) a small number of index reactions, while actually preventing fewer peanut allergy cases as a result of screening overdiagnosis. 4,5 Although Ara h 2-sIgE is a superior screening test versus peanut skin prick test or whole peanut sIgE, 1,2 an Ara h 2-sIgE screening strategy would likely remain dominated (eg, more costly and producing fewer health benefits) if used to presumptively diagnose peanut allergy. Consider the hundreds of thousands of infants with early-onset eczema, the annual cost of a peanut allergy misdiagnosis, and the impairment on quality of life if peanut allergy diagnosis is misapplied to approximately 8% of those with a positive Ara h 2-sIgE at 0.1 kU/L.…”

“…Consider the hundreds of thousands of infants with early-onset eczema, the annual cost of a peanut allergy misdiagnosis, and the impairment on quality of life if peanut allergy diagnosis is misapplied to approximately 8% of those with a positive Ara h 2-sIgE at 0.1 kU/L. 1,4,5 A population Ara h 2-sIgE screening strategy could still cost hundreds of millions of dollars and produce a population deficit of thousands of quality-adjusted life-years, if all infants with perceived moderate to severe eczema were screened. 4 Although screening could result in slightly fewer allergic reactions, it is unlikely to impact the overall peanut allergy fatality rate.…”

“…1,4,5 A population Ara h 2-sIgE screening strategy could still cost hundreds of millions of dollars and produce a population deficit of thousands of quality-adjusted life-years, if all infants with perceived moderate to severe eczema were screened. 4 Although screening could result in slightly fewer allergic reactions, it is unlikely to impact the overall peanut allergy fatality rate. 4 Furthermore, unless peanut allergy prevalence is far greater in the screened population, or families are willing to risk significant quality-of-life trade-offs to delay an index reaction and mitigate anaphylaxis risk, Ara h 2-sIgE screening is unlikely to be costeffective if used as a presumptive diagnostic tool without confirmatory oral food challenge.…”