Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy.
A recent randomized trial (the Learning Early About Peanut Allergy [LEAP] study) provided evidence that earlier dietary peanut introduction reduces peanut allergy prevalence in high-risk infants. However, questions remain as to how to identify and target the "at-risk" population to facilitate timely introduction of peanut.



We sought to use population-based infant peanut allergy data to understand feasibility and implications of implementing the LEAP trial intervention.



Using the HealthNuts study cohort (n = 5276) of 1-year-old infants, we explored the impact of using various criteria to identify infants at high risk of developing peanut allergy, and the implications of skin prick test (SPT) screening before peanut introduction.



Screening all infants with early onset eczema and/or egg allergy could require testing 16% of the population and would still miss 23% of peanut allergy cases; 29% of screened infants would require clinical follow-up because of being SPT-positive. Around 11% of high-risk infants were excluded from the LEAP study because of an SPT wheal size of more than 4 mm to peanut at baseline; data from the HealthNuts study suggest that 80% of these would be peanut allergic on food challenge. There were no life-threatening events among either low- or high-risk infants whose parents chose to introduce peanut at home in the first year of life, or in 150 peanut-allergic infants during hospital-based challenges.



Based on this large epidemiological study, a population program aiming to identify and screen all infants at risk of peanut allergy would pose major cost and logistic challenges that need to be carefully considered. Further research might be required to provide data for low-risk infants.
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia.
Jennifer J
JJ
Koplin
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia.
Rachel L
RL
Peters
School of Population and Global Health, University of Melbourne, Parkville, Australia.
Shyamali C
SC
Dharmage
School of Population and Global Health, University of Melbourne, Parkville, Australia.
Lyle
L
Gurrin
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia.
Mimi L K
MLK
Tang
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia.
Anne-Louise
AL
Ponsonby
School of Population and Global Health, University of Melbourne, Parkville, Australia.
Melanie
M
Matheson
National Institute of Allergy and Infectious Diseases, Bethesda, Md.
Alkis
A
Togias
Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
Gideon
G
Lack
Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics and Department of Allergy and Clinical Immunology at the Royal Children's Hospital, Parkville, Australia; School of Inflammation and Repair, University of Manchester, Manchester, United Kingdom. Electronic address: katie.allen@rch.org.au.
Katrina J
KJ
Allen
D000367:Age Factors; D010367:Arachis; D004032:Diet; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D021183:Peanut Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors
Peanut allergy; guidelines; infant feeding; prevention; skin prick test; specific IgE