Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction

Pitt, Tracy; Becker, Allan B.; Chan‐Yeung, Moira; Chan, Edmond S.; Watson, Wade; Chooniedass, Rishma; Azad, Meghan B.

doi:10.1016/j.jaci.2017.06.024

Cited by 50 publications

(35 citation statements)

References 30 publications

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“…Interestingly enough, the lowest incidence at 1.7% was found in children whose mothers ate peanuts while breast-feeding and were introduced to peanuts before 12 months of age. If a mother did not do one of these actions, there was an increase in incidence of peanut sensitization [59]. This study further supports the American Academy of Pediatrics newly revised statement [60].…”

Section: Preventionsupporting

confidence: 77%

IgE-Mediated Food Allergy

Anvari

Miller

Yeh

et al. 2018

Clinic Rev Allerg Immunol

258

197

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Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. IgE-mediated food-allergic disease differs from non-IgE-mediated disease because the pathophysiology results from activation of the immune system, causing a T helper 2 response which results in IgE binding to F c ε receptors on effector cells like mast cells and basophils. The activation of these cells causes release of histamine and other preformed mediators, and rapid symptom onset, in contrast with non-IgE-mediated food allergy which is more delayed in onset. The diagnosis of IgE-mediated food allergy requires a history of classic clinical symptoms and evidence of food-specific IgE by either skin-prick or serum-specific IgE testing. Symptoms of IgE-mediated food allergies range from mild to severe. The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. Diagnosis is excluded when a patient can ingest the suspected food without clinical symptoms and may require an in-office oral food challenge if testing for food-specific IgE by serum or skin testing is negative or low. Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. Management of food allergies requires strict avoidance measures, counseling of the family about constant vigilance, and prompt treatment of allergic reactions with emergency medications. Guidelines have changed recently to include early introduction of peanuts at 4-6 months of life. Early introduction is recommended to prevent the development of peanut allergy. Future treatments for IgE-mediated food allergy evaluated in clinical trials include epicutaneous, sublingual, and oral immunotherapy.

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Section: Preventionsupporting

confidence: 77%

IgE-Mediated Food Allergy

Anvari

Miller

Yeh

et al. 2018

Clinic Rev Allerg Immunol

258

197

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“…In the last 5 years, several studies have demonstrated allergen-specific oral tolerance induction to allergenic foods in highrisk children. [23][24][25][26][27] related allergic diseases, particularly food allergy. We present the experimental and human studies that have evaluated this approach and discuss various factors which may influence the success of these approaches, such as the type of emollient chosen for the intervention, the role of managing skin inflammation, and differences between primary and secondary prevention of atopic dermatitis to achieve the desired outcome.…”

Section: Pathog Ene S Is Of Food Allergymentioning

confidence: 99%

Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented?

Brough

Nadeau

Sindher

et al. 2020

Allergy

181

168

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There is increasing evidence regarding the importance of allergic sensitization through the skin. In this review, we provide an overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy. We present experimental models and human data that support the concept of epicutaneous sensitization and how this forms one half of the dual‐allergen exposure hypothesis. We discuss specific important elements in the skin (FLG and other skin barrier gene mutations, Langerhans cells, type 2 innate lymphoid cells, IL‐33, TSLP) that have important roles in the development of allergic responses as well as the body of evidence on environmental allergen exposure and how this can sensitize an individual. Given the link between skin barrier impairment, atopic dermatitis, food allergy, allergic asthma, and allergic rhinitis, it is logical that restoring the skin barrier and prevention or treating atopic dermatitis would have beneficial effects on prevention of related allergic diseases, particularly food allergy. We present the experimental and human studies that have evaluated this approach and discuss various factors which may influence the success of these approaches, such as the type of emollient chosen for the intervention, the role of managing skin inflammation, and differences between primary and secondary prevention of atopic dermatitis to achieve the desired outcome.

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“…Likewise, a study called LEAP (Learning Early about Peanut Allergy) demonstrated that introducing a potential allergen (in this case: peanuts) at small doses into the diet early (at the age of 4–6 months) reduced the incidence of allergy to this allergen by 80% [ 63 ]. Recent studies confirmed that allergen introduction reduced peanut allergy incidence most effectively when peanuts were introduced into the mother’s diet during pregnancy and lactation and then into the infant’s diet [ 64 ]. Thus, dietary interventions during gestation and lactation period include a balanced diet without elimination of potential allergens ( Table 1 ).…”

Section: The Effect Of Nutritional Programming On Allergy Developmmentioning

confidence: 99%

Microbial and Nutritional Programming—The Importance of the Microbiome and Early Exposure to Potential Food Allergens in the Development of Allergies

Cukrowská

2018

Nutrients

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The “microbiota hypothesis” ties the increase in allergy rates observed in highly developed countries over the last decades to disturbances in the gut microbiota. Gut microbiota formation depends on a number of factors and occurs over approximately 1000 days of life, including the prenatal period. During this period the microbiota helps establish the functional immune phenotype, including immune tolerance. The development of immune tolerance depends also on early exposure to potential food allergens, a process referred to as nutritional programming. This article elaborates on the concepts of microbial and nutritional programming and their role in the primary prevention of allergy.

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Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction

Abstract: In this secondary analysis, maternal peanut consumption while breast-feeding paired with direct introduction of peanuts in the first year of life was associated with the lowest risk of peanut sensitization, compared with all other combinations of maternal and infant peanut consumption.

Cited by 50 publications

References 30 publications

IgE-Mediated Food Allergy

IgE-Mediated Food Allergy

Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented?

Microbial and Nutritional Programming—The Importance of the Microbiome and Early Exposure to Potential Food Allergens in the Development of Allergies

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