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Effect of avoidance on peanut allergy after early peanut consumption

Effect of avoidance on peanut allergy after early peanut consumption
Effect of avoidance on peanut allergy after early peanut consumption
Background In a randomized trial, the early introduction of peanuts in infants at high risk for allergy was shown to prevent peanut allergy. In this follow-up study, we investigated whether the rate of peanut allergy remained low after 12 months of peanut avoidance among participants who had consumed peanuts during the primary trial (peanut-consumption group), as compared with those who had avoided peanuts (peanut-avoidance group).

Methods: At the end of the primary trial, we instructed all the participants to avoid peanuts for 12 months. The primary outcome was the percentage of participants with peanut allergy at the end of the 12-month period, when the participants were 72 months of age.

Results: We enrolled 556 of 628 eligible participants (88.5%) from the primary trial; 550 participants (98.9%) had complete primary-outcome data. The rate of adherence to avoidance in the follow-up study was high (90.4% in the peanut-avoidance group and 69.3% in the peanut-consumption group). Peanut allergy at 72 months was significantly more prevalent among participants in the peanut-avoidance group than among those in the peanut-consumption group (18.6% [52 of 280 participants] vs. 4.8% [13 of 270], P<0.001). Three new cases of allergy developed in each group, but after 12 months of avoidance there was no significant increase in the prevalence of allergy among participants in the consumption group (3.6% [10 of 274 participants] at 60 months and 4.8% [13 of 270] at 72 months, P=0.25). Fewer participants in the peanut-consumption group than in the peanut-avoidance group had high levels of Ara h2 (a component of peanut protein)-specific IgE and peanut-specific IgE; in addition, participants in the peanut-consumption group continued to have a higher level of peanut-specific IgG4 and a higher peanut-specific IgG4:IgE ratio.

Conclusions: Among children at high risk for allergy in whom peanuts had been introduced in the first year of life and continued until 5 years of age, a 12-month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy. Longer-term effects are not known. (Funded by the National Institute of Allergy and Infectious Diseases and others; LEAP-On ClinicalTrials.gov number, NCT01366846 .).
1435-1443
Du Toit, George
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Sayre, Peter H.
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Roberts, Graham
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Sever, Michelle L.
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Lawson, Kaitie
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Bahnson, Henry T.
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Brough, Helen A.
ad550b22-eed8-4a61-9703-bd16aea45873
Santos, Alexandra F.
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Harris, Kristina M.
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Radulovic, Suzana
8e9bce98-67a2-4999-9898-ccae71e55aa3
Basting, Monica
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Turcanu, Victor
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Plaut, Marshall
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Lack, Gideon
cac030a2-c358-4880-a91d-d67d06e8e321
The Immune Tolerance Network LEAP Study Team
Du Toit, George
7930b820-e6f7-4c4c-866c-4334017d1106
Sayre, Peter H.
d9839665-ad89-43ff-b4fd-1f048446a182
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Sever, Michelle L.
77ce753e-b94e-4304-8e98-01719887348e
Lawson, Kaitie
072d7e3a-a8b2-4cc8-890d-788eddba685c
Bahnson, Henry T.
2ecc6945-97fd-46bc-8d46-42606d4ccfe0
Brough, Helen A.
ad550b22-eed8-4a61-9703-bd16aea45873
Santos, Alexandra F.
f5b69586-7f5c-4972-88dd-c463990bda94
Harris, Kristina M.
a453c645-087b-4031-9c3a-037b45ffe31b
Radulovic, Suzana
8e9bce98-67a2-4999-9898-ccae71e55aa3
Basting, Monica
0b4bc8e4-88a3-46d5-80ee-40228ad58c17
Turcanu, Victor
8cfa4bfb-3ef3-484d-8211-3572a1754185
Plaut, Marshall
d6491653-2a2f-4a73-bbfa-cb9b541fac46
Lack, Gideon
cac030a2-c358-4880-a91d-d67d06e8e321

Du Toit, George, Sayre, Peter H., Roberts, Graham, Sever, Michelle L., Lawson, Kaitie, Bahnson, Henry T., Brough, Helen A., Santos, Alexandra F., Harris, Kristina M., Radulovic, Suzana, Basting, Monica, Turcanu, Victor, Plaut, Marshall and Lack, Gideon , The Immune Tolerance Network LEAP Study Team (2016) Effect of avoidance on peanut allergy after early peanut consumption. New England Journal of Medicine, 374 (15), 1435-1443. (doi:10.1056/NEJMoa1514209). (PMID:26942922)

Record type: Article

Abstract

Background In a randomized trial, the early introduction of peanuts in infants at high risk for allergy was shown to prevent peanut allergy. In this follow-up study, we investigated whether the rate of peanut allergy remained low after 12 months of peanut avoidance among participants who had consumed peanuts during the primary trial (peanut-consumption group), as compared with those who had avoided peanuts (peanut-avoidance group).

Methods: At the end of the primary trial, we instructed all the participants to avoid peanuts for 12 months. The primary outcome was the percentage of participants with peanut allergy at the end of the 12-month period, when the participants were 72 months of age.

Results: We enrolled 556 of 628 eligible participants (88.5%) from the primary trial; 550 participants (98.9%) had complete primary-outcome data. The rate of adherence to avoidance in the follow-up study was high (90.4% in the peanut-avoidance group and 69.3% in the peanut-consumption group). Peanut allergy at 72 months was significantly more prevalent among participants in the peanut-avoidance group than among those in the peanut-consumption group (18.6% [52 of 280 participants] vs. 4.8% [13 of 270], P<0.001). Three new cases of allergy developed in each group, but after 12 months of avoidance there was no significant increase in the prevalence of allergy among participants in the consumption group (3.6% [10 of 274 participants] at 60 months and 4.8% [13 of 270] at 72 months, P=0.25). Fewer participants in the peanut-consumption group than in the peanut-avoidance group had high levels of Ara h2 (a component of peanut protein)-specific IgE and peanut-specific IgE; in addition, participants in the peanut-consumption group continued to have a higher level of peanut-specific IgG4 and a higher peanut-specific IgG4:IgE ratio.

Conclusions: Among children at high risk for allergy in whom peanuts had been introduced in the first year of life and continued until 5 years of age, a 12-month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy. Longer-term effects are not known. (Funded by the National Institute of Allergy and Infectious Diseases and others; LEAP-On ClinicalTrials.gov number, NCT01366846 .).

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Accepted/In Press date: 3 February 2016
e-pub ahead of print date: 4 March 2016
Published date: 14 April 2016
Organisations: Human Development & Health

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Local EPrints ID: 390051
URI: http://eprints.soton.ac.uk/id/eprint/390051
PURE UUID: 22bec4b5-19d3-4849-ab77-83c6a30e34aa
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 21 Mar 2016 08:57
Last modified: 18 Feb 2021 17:04

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Contributors

Author: George Du Toit
Author: Peter H. Sayre
Author: Graham Roberts ORCID iD
Author: Michelle L. Sever
Author: Kaitie Lawson
Author: Henry T. Bahnson
Author: Helen A. Brough
Author: Alexandra F. Santos
Author: Kristina M. Harris
Author: Suzana Radulovic
Author: Monica Basting
Author: Victor Turcanu
Author: Marshall Plaut
Author: Gideon Lack
Corporate Author: The Immune Tolerance Network LEAP Study Team

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