Early‐life predictors and risk factors of peanut allergy, and its association with asthma in later‐life: Population‐based birth cohort study

Abstract

Background: Understanding risk factors for peanut allergy (PA) is essential to develop effective preventive measures. Objective:The objective was to ascertain associates and predictors of PA, and the relationship between PA and asthma severity. Methods:In a population-based birth cohort, we investigated the association between objectively confirmed PA with early-life environmental exposures, filaggrin (FLG)-lossof-function mutations and other atopic disease. We then examined the association of PA with longitudinal trajectories of sensitization, wheeze and allergic comorbidities, which were previously derived using machine learning. Finally, we ascertained the relationship between PA and asthma severity.Results: PA was confirmed in 30/959 participants with evaluable data. In the multivariate analysis, eczema in infancy (OR = 4.4, 95% CI 1.5-13.2, p = 0.007), egg sensitization at age 3 years (OR = 9.7, 95% CI 3.3-29.9, p < 0.001) and early-life cat ownership (OR = 3.0, 95% CI 1.1-8.4, p = 0.04) were independent associates of PA.In the stratified analysis among 700 participants with genetic information, in children with early-life eczema there was no difference in FLG mutations between children with and without PA (3/18 [16.7%] vs. 42/220 [19.1%], p = 1.00). In contrast, among children without eczema, those with PA were almost eight times more likely to have FLG mutations (2/6 [33.3%] vs. 27/456 [5.9%], p = 0.049). We observed associations between PA and multiple allergic sensitization profiles derived using machine learning, with ~60-fold increase in risk among individuals assigned to multiple early sensitization. PA was significantly associated with persistent wheeze (but not other wheeze phenotypes), and with trajectories of atopic disease characterized by co-morbid persistent eczema and wheeze (but not with transient phenotypes). Children with PA were more likely to have asthma, but among asthmatics we found no evidence of an association between PA and asthma severity.

Risk Factors for Anaphylaxis in Children Allergic to Peanuts

“…Risk factors for peanut allergy, such as family history of peanut allergy, atopic dermatitis, allergic airway disease, allergy to other foods or airborne allergens, late introduction of peanuts [4][5][6][7][8][9], were not associated with the severity of peanut allergy in our study.…”

“…MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content. hypersensitivity to several other food and/or airborne allergens, chicken egg allergy, vitamin D deficiency, impaired skin barrier in patients with atopic dermatitis and late introduction of peanuts [6][7][8][9][10].…”

Oral immunotherapy using boiled peanuts for treating peanut allergy: An open‐label, single‐arm trial

“…The study participants were drawn from a population attending an allergy clinic to request OIT, with a high reluctance to participate in a placebo‐ or nocebo‐controlled trial in the presence of an existing peanut allergy. Thirdly, in applying rigid criteria which excluded those with severe peanut allergies or poorly controlled co‐morbidities such as asthma (common among those with peanut allergies), 23 this does limit the potential generalizability of study findings. Fourthly, there was a high loss to follow‐up for assessing longer‐term outcomes and follow‐up assessments were only conducted in those who originally completed the OIT protocol, meaning we cannot compare longer‐term outcomes between those who did and did not complete peanut OIT.…”

Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy

“…Peanut is a common cause of food allergy. Peanut allergy can occur in infancy, with existing atopic dermatitis being an important risk factor [ 46 , 47 ]. Because natural development of tolerance is rare and remission occurs in only ~ 20% [ 48 ], allergic reactions can occur at any age.…”