Environmental peanut exposure increases the risk of peanut sensitization in high‐risk children

Abstract

Higher levels of environmental exposure to peanut in the first few months of life appear to increase the probability of developing school-age peanut sensitization in atopic children (based on egg sensitization and parental atopy).

Report from the National Institute of Allergy and Infectious Diseases workshop on “Atopic dermatitis and the atopic march: Mechanisms and interventions”

“…Although there is a well-recognized clinical association between AD and FA and evidence that sensitization to peanut in human subjects can occur through the skin after exposure to peanut oils and peanut-containing house dust, the immunologic mechanisms underlying epicutaneous sensitization to allergens and the communication routes between the skin and other mucosal surfaces are incompletely understood. [123][124][125][126] Skin barrier defects, which are discussed in the previous sections, are thought to be important in both the initial local events that lead to AD and the systemic sensitization to allergens that predisposes to atopic diseases at other mucosal sites, such as the gastrointestinal tract and airway. Skin damage caused by scratching in response to the persistent skin itchiness characteristic of AD can also contribute to allergen entry and sensitization.…”

A complicated relationship between peanut environmental exposure and the development of allergic sensitization to peanuts

“…So, Brough et al have looked at whether post-natal environmental peanut exposure is associated with later allergic sensitization to peanut in a population-based cohort. 3 Maternal bed dust was collected post-natally in the BAMSE cohort. There was a significant association between peanut exposure and sensitization at age 4 years (odds ratio 1.41, 95% confidence interval: 1.05-1.90, P = .02) and 8 years (2.11, 1.38-3.22, P = .001) compared to sex and parental atopy-matched controls ( Figure 1).…”

“…Case‐control studies are though very vulnerable to unrecognized confounding. So, Brough et al have looked at whether post‐natal environmental peanut exposure is associated with later allergic sensitization to peanut in a population‐based cohort . Maternal bed dust was collected post‐natally in the BAMSE cohort.…”

Indoor dust acts as an adjuvant to promote sensitization to peanut through the airway

“…Biologically active peanut is detectable in dust collected from homes, and the levels of peanut allergen in indoor dust directly correlate with rates of peanut sensitization and probable PA in children at high risk for PA . However, environmental peanut exposure was not associated with peanut sensitization in children without atopic risk factors, suggesting that other indoor environmental factors may influence the risk of peanut sensitization. Understanding the environmental determinants of peanut sensitization will be essential for creating effective interventions aimed at preventing PA development.…”

“…5,6 How peanut sensitization develops during early infancy is unclear, but there is growing evidence that environmental peanut exposure plays an important role. [7][8][9][10] Biologically active peanut is detectable in dust collected from homes, 9,11,12 and the levels of peanut allergen in indoor dust directly correlate with rates of peanut sensitization and probable PA in children at high risk for PA. 8,9,13 However, environmental peanut exposure was not associated with peanut sensitization in children without atopic risk factors, 13 suggesting that other indoor environmental factors may influence the risk of peanut sensitization.…”