Effect of Avoidance on Peanut Allergy after Early Peanut Consumption

Toit, George Du; Sayre, Peter H.; Roberts, Graham; Sever, Michelle L.; Lawson, Kaitie; Bahnson, Henry T.; Brough, Helen A.; Santos, Alexandra; Harris, Kristina M.; Radulović, Suzana; Basting, Monica; Turcanu, Victor; Plaut, Marshall; Lack, Gideon

doi:10.1056/nejmoa1514209

Cited by 369 publications

(287 citation statements)

References 16 publications

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“…We identified that IgE-mediated reactions constituted half of all documented adverse reactions to foods, with a report of anaphylaxis in 1 in 6 reactions. These findings support the pressing need for more food allergy evaluations, as well as a call for more allergists/immunologists, especially given new recommendations for early food introductions, less reliance on isolated positive test results, [35][36][37][38] and more aggressive use of OFC to diagnose food allergy. Last, our findings support that the EHR allergy module may be helpful in determining the epidemiology and risk factors for food allergy, as well as identifying patients for prospective clinical studies and/or food allergy evaluations.…”

Section: Discussionsupporting

confidence: 61%

Prevalence of food allergies and intolerances documented in electronic health records

Acker

Plasek

Blumenthal

et al. 2017

Journal of Allergy and Clinical Immunology

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Background: Food allergy prevalence is reported to be increasing, but epidemiological data using patients' electronic health records (EHRs) remain sparse. Objective: We sought to determine the prevalence of food allergy and intolerance documented in the EHR allergy module. Methods: Using allergy data from a large health care organization's EHR between 2000 and 2013, we determined the prevalence of food allergy and intolerance by sex, racial/ethnic group, and allergen group. We examined the prevalence of reactions that were potentially IgE-mediated and anaphylactic. Data were validated using radioallergosorbent test and ImmunoCAP results, when available, for patients with reported peanut allergy. Results: Among 2.7 million patients, we identified 97,482 patients (3.6%) with 1 or more food allergies or intolerances (mean, 1.4 6 0.1). The prevalence of food allergy and intolerance was higher in females (4.2% vs 2.9%; P < .001) and Asians (4.3% vs 3.6%; P < .001). The most common food allergen groups were shellfish (0.9%), fruit or vegetable (0.7%), dairy (0.5%), and peanut (0.5%). Of the 103,659 identified reactions to foods, 48.1% were potentially IgE-mediated (affecting 50.8% of food allergy or intolerance patients) and 15.9% were anaphylactic. About 20% of patients with reported peanut allergy had a radioallergosorbent test/ImmunoCAP performed, of which 57.3% had an IgE level of grade 3 or higher. Conclusions: Our findings are consistent with previously validated methods for studying food allergy, suggesting that the EHR's allergy module has the potential to be used for clinical and epidemiological research. The spectrum of severity observed with

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Section: Discussionsupporting

confidence: 61%

Prevalence of food allergies and intolerances documented in electronic health records

Acker

Plasek

Blumenthal

et al. 2017

Journal of Allergy and Clinical Immunology

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“…The early introduction of peanut in a high-risk cohort (4-to 11-month-old children with severe atopic dermatitis and/or egg allergy and skin prick test (SPT) <4 mm to peanut) via integration of 6 g peanut three times a week into the diet resulted in an impressive reduction in peanut allergy after 60 months of therapy by 81.7% as compared to the avoidance group (19). Importantly, this effect persisted in the majority of the patients even after a prolonged avoidance period of 1 year (20).…”

Section: Tolerance Induction In the Prenatal/perinatal Periodmentioning

confidence: 99%

“…Recently, the LEAP study provided data for primary and secondary prevention of peanut allergy in a high-risk cohort (19,20), which will soon be reflected in new guidelines. Nevertheless, no therapies capable of restoring tolerance are available.…”

Section: Foxp3mentioning

confidence: 99%

Markers of tolerance development to food allergens

Ponce

Diesner

Szépfalusi

et al. 2016

Allergy

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IgE-mediated reactions to food allergens are the most common cause of anaphylaxis in childhood. Although allergies to cow's milk, egg, or soy proteins, in contrast to peanut and tree nut allergens, resolve within the first 6 years of life in up to 60% due to natural tolerance development, this process is not well understood. At present, there is no cure or treatment for food allergy that would result in an induction of tolerance to the symptom-eliciting food. Avoidance, providing an emergency plan and education, is the standard of treatment. Oral immunotherapeutic approaches have been proven reasonable efficacy; however, they are associated with high rates of side-effects and low numbers of patients achieving tolerance. Nevertheless, mechanisms that take place during oral immunotherapy may help to understand tolerance development. On the basis of these therapeutic interventions, events like loss of basophil activation and induction of regulatory lymphocyte subsets and of blocking antibodies have been described. Their functional importance at a clinical level, however, remains to be investigated in detail. Consequently, there is eminent need to understand the process of tolerance development to food allergens and define biomarkers to develop and monitor new treatment strategies for food allergy.IgE-mediated food allergy represents the most important cause of anaphylaxis in childhood. While milk and egg allergy are associated with a high rate of natural tolerance development within the first 6 years of life, this is less clear for other food allergies. Consequently, once it is communicated the diagnosis persists often lifelong severely impacting the quality of life of the patient and the environment despite the recommendation to reconsider clinical tolerance development from time to time.Currently, avoidance, providing an emergency plan and teaching, is the standard of treatment; however, there is no cure or treatment that has reached the level of recommendation to re-induce tolerance to the symptom-eliciting food. Tolerance assessment occurs either via oral food challenges or due to unintended exposure. Given the cost and time intensiveness of oral food challenges and its potential harmfulness, there is eminent need to understand the process of tolerance development and define markers thereof to develop and monitor new treatment strategies for food allergy. This review aimed to provide an overview on recent advances regarding markers and mechanisms of tolerance development to food allergens.Oral tolerance in the context of food allergy is considered to occur if the antigen/food can be ingested without problems despite prolonged periods of avoidance, while the status of desensitization is strictly dependent on regular ingestion of the respective food in order to confer protection from allergic reactions. Currently, there is no general consensus on the exact time frame of avoidance and re-exposure that would allow the usage of the terminus tolerance that is considered equivalent to cure in the context of or...

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“…Катамнез детей из исследования LEAP (Learning early about peanut allergy) показал, что в воз-расте 6 лет, после 12-месячного периода элимина-ции арахиса из рациона не наблюдалось увеличения частоты развития аллергических реакций на арахис в опытной группе [27,28]. В настоящее время на ос-новании данных, полученных от 10 международных педиатрических ассоциаций аллергологов, рекомен-дуется раннее введение арахиса детям из групп риска, но под контролем специалиста [29].…”

Section: оригинальные статьи в помощь практическому врачуunclassified

Updated European Recommendations on the Introduction of Complementary Food in Children – Subject for Thought

Камалова¹

2017

Ross. vestn. perinatol. pediatr.

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Effect of Avoidance on Peanut Allergy after Early Peanut Consumption

Cited by 369 publications

References 16 publications

Prevalence of food allergies and intolerances documented in electronic health records

Prevalence of food allergies and intolerances documented in electronic health records

Markers of tolerance development to food allergens

Updated European Recommendations on the Introduction of Complementary Food in Children – Subject for Thought

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