Identifying infants at high risk of peanut allergy: The Learning Early About Peanut Allergy (LEAP) screening study.
J Allergy Clin Immunol. 2012 Nov 19;
Authors: Du Toit G, Roberts G, Sayre PH, Plaut M, Bahnson HT, Mitchell H, Radulovic S, Chan S, Fox A, Turcanu V, Lack G, Learning Early About Peanut Allergy (LEAP) Study Team
Abstract
BACKGROUND: Peanut allergy (PA) is rare in countries in which peanuts are introduced early into infants’ diets. Learning Early About Peanut Allergy (LEAP) is an interventional study aiming to assess whether PA can be prevented by oral tolerance induction. OBJECTIVE: We sought to characterize a population screened for the risk of PA. METHODS: Subjects screened for the LEAP interventional trial comprise the LEAP screening study cohort. Infants were aged 4 to 10 months and passed a prescreening questionnaire. RESULTS: This analysis includes 834 infants (mean age, 7.8 months). They were split into the following: group I, patients with mild eczema and no egg allergy (n = 118); group II, patients with severe eczema, egg allergy, or both but 0-mm peanut skin prick test (SPT) wheal responses (n = 542); group III, patients with severe eczema, egg allergy, or both and 1- to 4-mm peanut wheal responses (n = 98); and group IV, patients with greater than 4-mm peanut wheal responses (n = 76). Unexpectedly, many (17%) in group II had peanut-specific IgE sensitization (?0.35 kU/L); 56% of group III were similarly sensitized. In contrast, none of the patients in group I and 91% of those in group IV had peanut-specific IgE sensitization. Sensitization on skin testing to peanut (SPT response of 1-4 mm vs 0 mm) was associated with egg allergy and severe eczema (odds ratio [OR], 2.31 [95% CI, 1.39-3.86] and 2.47 [95% CI, 1.14-5.34], respectively). Similar associations were observed with specific IgE sensitization. Black race was associated with a significantly higher risk of peanut-specific IgE sensitization (OR, 5.30 [95% CI, 2.85-9.86]). Paradoxically, for a given specific IgE level, black race was protective against cutaneous sensitization (OR, 0.15 [95% CI, 0.04-0.61]). CONCLUSION: Egg allergy, severe eczema, or both appear to be useful criteria for identifying high-risk infants with an intermediate level of peanut sensitization for entry into a PA prevention study. The relationship between specific IgE level and SPT sensitization needs to be considered within the context of race.
PMID: 23174658 [PubMed – as supplied by publisher]
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A new patch could potentially build tolerance in patients with peanut allergies, announced the American Academy of Allergy, Asthma and Immunology. Based on the principle of epicutaneous immunotherapy (EPIT), the patch, called Viaskin Peanut, delivers small doses of peanut proteins when placed on patients’ skin. A team of researchers has just completed a double-blind, placebo-controlled randomized Phase IIb trial in which 221 individuals with peanut allergies underwent the therapy for a year. “After one year of therapy, half of the patients treated with the 250 ug patch tolerated at least 1 gram of peanut protein — about four peanuts — which is 10 times the dose that they tolerated in their entry oral peanut challenge,” said Hugh A. Sampson, MD, FAAAAI, Director of the Jaffe Food Allergy Institute at the Kravis Children's Hospital at Mount Sinai and first author of the late-breaking abstract.