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Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses

Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses
Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses
Background: The Learning Early About Peanut allergy (LEAP) study has shown the effectiveness of early peanut introduction in prevention of peanut allergy (PA). In the Enquiring About Tolerance (EAT) study, a statistically significant reduction in PA was present only in per-protocol (PP) analyses, which can be subject to bias. Objective: The aim of this study was to combine individual-level data from the LEAP and EAT trials and provide robust evidence on the bias-corrected, causal effect of early peanut introduction. Method: As part of the European Union-funded iFAAM project, this pooled analysis of individual pediatric patient data combines and compares effectiveness and efficacy estimates of oral tolerance induction among different risk strata and analysis methods. Results: An intention-to-treat (ITT) analysis of pooled data showed a 75% reduction in PA (p <.0001) among children randomized to consume peanut from early infancy. A protective effect was present across all eczema severity groups, irrespective of enrollment sensitization to peanut, and across different ethnicities. Earlier age of introduction was associated with improved effectiveness of the intervention. In the pooled PP analysis, peanut consumption reduced the risk of PA by 98% (p <.0001). A causal inference analysis confirmed the strong PP effect (89% average treatment effect relative risk reduction p <.0001). A multivariable causal inference analysis approach estimated a large (100%) reduction in PA in children without eczema (p =.004). Conclusion: We demonstrate a significant reduction in PA with early peanut introduction in a large group of pooled, randomized participants. This significant reduction was demonstrated across all risk subgroups, including children with no eczema. Furthermore, our results point to increased efficacy of the intervention with earlier age of introduction.
causal inference analysis, early introduction, peanut allergy prevention
0105-4538
Logan, Kirsty
81ffe5c8-37fd-4e78-b311-9dc0a07cdc5e
Bahnson, Henry T
2ecc6945-97fd-46bc-8d46-42606d4ccfe0
Ylescupidez, Alyssa
dc6831ab-6bc0-40aa-a538-46bfa1000e5b
Beyer, Kirsten
9020c231-b5ed-4c6c-be7e-797db0f2ab1d
Bellach, Johanna
2ddc677f-170c-4e87-ae29-cca8c9cb0d3f
Campbell, Dianne E
89cf808a-4162-449c-89dd-500c491518f9
Craven, Joanna
9b366a28-49f9-4b92-8767-55b6f58984a0
Du Toit, George
7930b820-e6f7-4c4c-866c-4334017d1106
Mills, E N
cc44a635-190e-4d07-a2da-ef993f6db8d6
Perkin, Michael R
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Roberts, Graham
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van Ree, Ronald
f6c2aabb-0e67-4e24-b2ed-b9c30641aebc
Lack, Gideon
cac030a2-c358-4880-a91d-d67d06e8e321
et al.
Logan, Kirsty
81ffe5c8-37fd-4e78-b311-9dc0a07cdc5e
Bahnson, Henry T
2ecc6945-97fd-46bc-8d46-42606d4ccfe0
Ylescupidez, Alyssa
dc6831ab-6bc0-40aa-a538-46bfa1000e5b
Beyer, Kirsten
9020c231-b5ed-4c6c-be7e-797db0f2ab1d
Bellach, Johanna
2ddc677f-170c-4e87-ae29-cca8c9cb0d3f
Campbell, Dianne E
89cf808a-4162-449c-89dd-500c491518f9
Craven, Joanna
9b366a28-49f9-4b92-8767-55b6f58984a0
Du Toit, George
7930b820-e6f7-4c4c-866c-4334017d1106
Mills, E N
cc44a635-190e-4d07-a2da-ef993f6db8d6
Perkin, Michael R
8af1930f-5d70-4322-a75b-ad23e1f1c106
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
van Ree, Ronald
f6c2aabb-0e67-4e24-b2ed-b9c30641aebc
Lack, Gideon
cac030a2-c358-4880-a91d-d67d06e8e321

Logan, Kirsty, Bahnson, Henry T, Ylescupidez, Alyssa, Mills, E N and Roberts, Graham , et al. (2022) Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses. Allergy. (doi:10.1111/all.15597).

Record type: Article

Abstract

Background: The Learning Early About Peanut allergy (LEAP) study has shown the effectiveness of early peanut introduction in prevention of peanut allergy (PA). In the Enquiring About Tolerance (EAT) study, a statistically significant reduction in PA was present only in per-protocol (PP) analyses, which can be subject to bias. Objective: The aim of this study was to combine individual-level data from the LEAP and EAT trials and provide robust evidence on the bias-corrected, causal effect of early peanut introduction. Method: As part of the European Union-funded iFAAM project, this pooled analysis of individual pediatric patient data combines and compares effectiveness and efficacy estimates of oral tolerance induction among different risk strata and analysis methods. Results: An intention-to-treat (ITT) analysis of pooled data showed a 75% reduction in PA (p <.0001) among children randomized to consume peanut from early infancy. A protective effect was present across all eczema severity groups, irrespective of enrollment sensitization to peanut, and across different ethnicities. Earlier age of introduction was associated with improved effectiveness of the intervention. In the pooled PP analysis, peanut consumption reduced the risk of PA by 98% (p <.0001). A causal inference analysis confirmed the strong PP effect (89% average treatment effect relative risk reduction p <.0001). A multivariable causal inference analysis approach estimated a large (100%) reduction in PA in children without eczema (p =.004). Conclusion: We demonstrate a significant reduction in PA with early peanut introduction in a large group of pooled, randomized participants. This significant reduction was demonstrated across all risk subgroups, including children with no eczema. Furthermore, our results point to increased efficacy of the intervention with earlier age of introduction.

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More information

e-pub ahead of print date: 27 November 2022
Additional Information: Funding Information: The main components of this analysis were funded by the European Union (Integrated Approaches to Food Allergen and Allergy Risk Management (iFAAM), Grant Agreement No: 312147). The EAT Study was jointly funded by the UK Food Standards Agency (FSA, contract code T07051) and the Medical Research Council (MRC, grant MC_G1001205). Additionally, we would like to thank the Davis Foundation. The skin‐related aspects of the EAT study were supported by the UK National Institute for Health Research (NIHR). The LEAP Study was supported by grants from the National Institute of Allergy and Infectious Diseases (NO1‐AI‐15416, UM1AI109565 and HHSN272200800029C); Food Allergy Research and Education; the Medical Research Council and Asthma UK; the United Kingdom Department of Health, through a National Institute for Health Research comprehensive Biomedical Research Centre award to Guy's and St. Thomas's NHS Foundation Trust, in partnership with King's College London and King's College Hospital NHS Foundation Trust; the National Peanut Board; and the United Kingdom Food Standards Agency. Funding Information: HB reports grants from the National Institute of Allergy and Infectious Diseases (NIAID, NIH) and consulting fees from DBV Technologies, outside the submitted work. KB reports institutional grants from the European Union during the conduct of the study and lecture fees from Aimmune, Allergopharma, Bencard, Danone/Nutrica, Infectopharm, Meda Pharma/Mylan, Nestle, ThermoFisher as well as consulting fees from Aimmune, ALK, Bausch & Lomb, Bencard, Danone/Nutrica, DBV, Hipp, Hycor, Infectopharm, Mabylon, Meda Pharma/Mylan, Nestle, Novartis, outside the submitted work. DEC receives a part‐time salary from the DBV Technologies as VP Clinical Development and Medical Affairs, receives institutional funding from the National Health and Medical Research Council of Australia and is on the Advisory Board of AllerGenis. The BEAT study was supported by the Ilhan Food Allergy Foundation and the Children's Hospital at Westmead Allergy and Immunology Research Fund. GdT reports grants from the National Institute of Allergy and Infectious Diseases (NIAID, NIH), Food Allergy & Research Education (FARE), MRC & Asthma UK Centre, UK Dept of Health through NIHR, Action Medical Research and National Peanut Board. Scientific Advisory Board member Aimmune, investigator on pharma‐sponsored allergy studies (Aimmune and DBV Technologies), shareholder in DBV technologies, and scientific advisor to Aimmune, DBV and Novartis. ENM reports grants from European Union, during the conduct of the study; grants from Reacta Biotech Ltd, other from Reacta Biotech Ltd, outside the submitted work. In addition, ENM has a patent Patents pending and Founder shares in Reacta Biotech Ltd. GR reports a grant from the European Union during the conduct of the study. RvR reports grants from the Dutch Science Foundation, Health Holland and the European Commission, during the conduct of the study; consultancy for HAL Allergy BV, Citeq BV and Angany Inc., speaker's fees from HAL Allergy BV and ThermoFisher Scientific, outside the submitted work. GL reports grants from the National Institute of Allergy and Infectious Diseases (NIAID, NIH), Food Allergy & Research Education (FARE), MRC & Asthma UK Centre, UK Dept of Health through NIHR, National Peanut Board (NPB), UK Food Standards Agency (FSA), Action Medical Research, the Davis Foundation during the conduct of the study; shareholder in DBV Technologies and Mighty Mission Me, scientific advisor for Novartis, Sanofi‐Genyzme, Regeneron, ALK‐Abello, outside the submitted work. No other disclosures were reported. Publisher Copyright: © 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Keywords: causal inference analysis, early introduction, peanut allergy prevention

Identifiers

Local EPrints ID: 475622
URI: http://eprints.soton.ac.uk/id/eprint/475622
ISSN: 0105-4538
PURE UUID: e218c4cf-fefd-407c-b21d-7e045d857ace
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 22 Mar 2023 17:45
Last modified: 17 Mar 2024 03:02

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Contributors

Author: Kirsty Logan
Author: Henry T Bahnson
Author: Alyssa Ylescupidez
Author: Kirsten Beyer
Author: Johanna Bellach
Author: Dianne E Campbell
Author: Joanna Craven
Author: George Du Toit
Author: E N Mills
Author: Michael R Perkin
Author: Graham Roberts ORCID iD
Author: Ronald van Ree
Author: Gideon Lack
Corporate Author: et al.

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