Household almond and peanut consumption is related to the development of sensitization in young children

Abstract

those without S aureus colonization (70% vs 48%, P < .0001). Diagnostic code for anaphylaxis, prescription for an epinephrine autoinjector, or both were also found to be significantly more prevalent in patients with S aureus colonization versus those without S aureus colonization (53% vs 44%, P 5 .04; see Tables E1 and E2 in this article's Online Repository at www.jacionline.org).These data suggest there is an association between S aureus colonization and food allergy to peanut, egg white, and cow's milk in patients with AD. S aureus is a pathogenic microbe that produces multiple virulence factors (eg, superantigens, cytolysins, proteases, lipases, protein A, and microbial surface components recognizing adhesive matrix molecules) that can lead to break down of the epithelial barrier. 9 Additionally, exposure of murine models to S aureus toxin leads to increased T H 2-mediated responses 4,5 and decreased regulatory T-cell function, 4 both of which are described in patients with food allergy. 10 We propose that the skin microbiome plays an important role in skin barrier function and directs immune responses. Aberrancies in the skin microbiome, including S aureus colonization, lead to skin barrier dysfunction and immune dysregulation, ultimately contributing to the development of food allergy through topical exposure of antigen.Furthermore, these findings show a unique association between peanut allergy and MRSA because peanut sIgE levels were higher in patients with MRSA colonization compared with those with MSSA. These findings support the theory that S aureus causes skin breakdown, leading to epicutaneous absorption of peanut. MRSA produces more superantigens than MSSA 9 and might be contributing to more significant skin barrier breakdown. Additionally, studies have demonstrated that peanut allergy, in particular, occurs through epicutaneous allergen absorption. 2,3 These results are of particular relevance to the events that predispose subjects to food allergy. Recent studies have demonstrated that environmental peanut drives sensitization and peanut allergy in patients with AD. 2 Further studies looking at peanut protein and S aureus in house dust could shed new light on the effect of S aureus and food allergy. The clinical relevance to our findings are suggested by increased diagnostic codes for anaphylaxis, epinephrine autoinjector prescription, or both in patients with S aureus colonization, indicating there was physician concern for clinically relevant food allergy.In the future, studies are needed to assess the association between S aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations open up the possibility that therapy directed at eradicating S aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. REFERENCES 1. Leung DY, Guttman-Yassky E. Deciphering the compl...

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

“…Household peanut consumption was ten times higher in households with infants with peanut allergy vs children with egg allergy without peanut allergy but was only 3 times higher in non‐atopic controls, highlighting that household peanut consumption was more likely to be associated with peanut allergy in high‐risk children . Household peanut consumption and peanut sensitization have also been associated in other studies . Peanut antigen in the infant's bed dust and play‐area‐dust is highly positively correlated with household peanut consumption and stimulates basophils from peanut allergic children, thus has the potential to also sensitize individuals …”

Almond Allergy: An Overview on Prevalence, Thresholds, Regulations and Allergen Detection

“…A recent study reported that household consumption of almond and peanut was related to development of sensitization to peanuts [ 28 ].…”

Ara h2 levels in dust from homes of individuals with peanut allergy and individuals with peanut tolerance

“…A published letter to the editor showed that a clear relationship was found between nut consumption by relatives and IgE-mediated sensitization in children Ͻ18 months old. 22 In our study, we did not assess the age of diagnosis, but, in 40% of our restricted homes, the eating practices of family members changed after receiving a peanut allergy diagnosis. This could explain why individuals in our study had a peanut allergy despite no current consumption in the home.…”