Reduced peanut sensitization with maternal peanut consumption and early peanut introduction while breastfeeding

Abstract

New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother–child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14–0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01–0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this “triple exposure” hypothesis.

Maternal peanut and egg consumption during breastfeeding randomized pilot trial

“…In agreement with these peanut outcome findings, the CHILD birth cohort observational study, found a reduced risk of peanut sensitization if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01-0.25). 8 However, our egg allergy (but not egg sensitization) results appear to potentially favor lower maternal egg consumption during breastfeeding to reduce infant egg allergy. Hence, maternal consumption levels of different food allergens may lead to allergen-specific infant outcomes, which requires further investigation in larger future trials.…”

Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems

“…Allergens bound to IgG have been shown to induce more Tregs and more profound immune tolerance than free allergens [46], suggesting that exposure to IgG-complexed food antigens through breastmilk may contribute to food allergy prevention [47]. This hypothesis is supported by recent data from the CHILD Cohort Study, where infants who were introduced to peanut before weaning and breastfed by mothers who regularly consumed peanuts had a reduced risk of peanut sensitization and allergy through 5 years of age [48 ▪ ].…”

The future of food allergy: Challenging existing paradigms of clinical practice

“…Although some differences exist between different guidelines (Table 2), they all recommend not delaying the introduction of allergenic foods beyond 6–12 months. The remaining questions include the dose, frequency and duration required to achieve oral tolerance induction, the role of maternal dietary exposure (or the triple exposure hypothesis), what adjuncts may help with avoiding Th2 skewing (vitamin D, immunization) and the role of other environmental (e.g., detergents, pollution) and nutritional factors 60–65 …”