Study: earlier contact with peanuts and allergy risk

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Von: Natur.wiki Autoren-Team

Referenz Du Toit G, Sayre PH, Roberts G, et al. Wirkung der Meidung auf die Erdnussallergie nach frühem Erdnussverzehr. N Engl. J Med. 2016;374(15):1435-1443. Studienziel Diese Studie war eine Folgestudie der LEAP-Studie (Learning Early About Peanut), in der 640 Teilnehmer (4-11 Monate alt bei der Registrierung) mit schwerem Ekzem, Eierallergie oder beidem mit einem Haut-Prick-Test auf Erdnussallergie untersucht wurden ( SPT) zu Beginn. Sie wurden in 2 Gruppen eingeteilt: solche mit positivem SPT (Quaddel 1–4 mm; n=98) und solche mit negativem SPT (n=542). Jede Gruppe wurde dann weiter in 2 weitere Kohorten unterteilt; Einer wurde angewiesen, Erdnüsse zu konsumieren, und …
Reference du toit g, Sayre Ph, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl. J med. 2016; 374 (15): 1435-1443. The study destination This study was a follow-up study in the Leap study (Learning Early About Peanut), in which 640 participants (4-11 months old in registration) with severe eczema, egg allergy or both with a skin-prick test for peanut allergy were examined (SPT) at the beginning. They were divided into 2 groups: those with a positive SPT (whisper 1–4 mm; n = 98) and those with negative SPT (n = 542). Each group was then divided into 2 other cohorts; One was instructed to consume peanuts, and ... (Symbolbild/natur.wiki)

Reference

du toit g, Sayre Ph, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumption. n Engl. J med . 2016; 374 (15): 1435-1443.

Study goal

This study was a follow-up study in the Leap study (Learning Early About Peanut), in which 640 participants (4-11 months old when registering) with severe eczema, egg allergy or both with a skin-prick test for peanut allergy were examined (SPT) at the beginning. They were divided into 2 groups: those with a positive SPT (whisper 1–4 mm; n = 98) and those with negative SPT (n = 542). Each group was then divided into 2 other cohorts; One was instructed to consume peanuts, and the other was instructed to avoid peanuts until the children were 60 months old. 1 The primary endpoint was the presence of peanut allergy after 60 months. The current study should examine the frequency of peanut allergies in the peanut consumption group compared to the peanut avoidance group after all participants had dispensed with the peanut consumption for 12 months (up to the 72nd month of life).

Design

randomized, open, controlled study

participant

The participants were recruited from the primary LEAP study group. The data was fully available for 550 participants. Of these, 515 were selected to carry out the oral peanut challenge. In the primary study, these participants had gone through the baseline (4-11 months) until the age of 60 months either avoiding peanut avoidance or peanut consumption.

study parameters and primary result measurements

All participants should avoid peanuts for 12 months after completing the original LEAP study. The primary result of the result was the percentage of the participants, who had an peanut allergy at the end of this 12-month peanut avoidance period. Since the primary study ended when the children were 60 months old, this result was measured when the children were 72 months old. The participants (n = 515) were subjected to an oral peanut provocation after 72 months in order to determine the presence of an earth's allergy. The immunological parameters included IGE antibodies against the peanut protein ARA H2 and peanut-specific immunoglobulin (IG) G- and IGG4 levels. The IGG4: IGE ratio has been calculated (higher conditions mean immune modulation).
Further research continues to support the early introduction of allergenic foods in order to avoid allergies later in childhood.

important knowledge

peanut allergy was significantly more common after 72 months in the original peanut avoidance group (18.6 %) than in the peanut consumption group (4.8 %) ( p <0.001). The IGE antibodies against the peanut protein ARA H2 were less common after 72 months in the peanut consumption group than in the peanut avoidance group ( p <0.001). Those in the consumption group continued to have increased values ​​of peanut-specific IgG4 and higher peanut-specific IgG4: IGE relationships ( p <0.001). More participants in the peanut avoidance group had side effects such as eczema, gastroenteritis and respiratory infections (89.4 %) than in the peanut consumption group (80.7 %) during follow -up. The concentrations of ARA H2 IGE antibodies remained low in the peanut consumption group after 72 months, while the concentrations were significantly higher after 72 months in the peanut avoidance group ( p <0.001). The average wholesale size was in the group, which consumed peanuts, also smaller at 72 months than in the group, which avoids peanuts ( p <0.001)
Interestingly, a new peanut allergy developed in 3 participants in the peanut consumption group and 3 participants in the peanut avoidance group between the ages of 60 and 72 months. The IGG4: IGE-Erdnuss ratio decreased by these 6 participants during this time.

practice implications

In this study, the incidence of peanut allergies in infants that were previously introduced to peanuts in life was lower than in infants that avoided the peanuts in infants, and this effect lasted 12 months after the introductory phase. Those infants who consumed peanuts in their first year of life and up to the age of 60 months had a 74 % lower peanut-allergy prevalence at the age of 72 months after 1 year after 1 year. This study did not find a significant increase in the incidence of new peanut allergies among those who avoided peanuts after consuming them until the age of 60 months. The authors conclude that an earlier and longer peanut consumption should be recommended to reduce peanut gigs.
Further research continues to support the early introduction of allergenic foods in order to avoid allergies later in childhood. A study from February 2016 with 300 children showed that children with peanut allergies had a significantly older age than they were exposed to peanuts for the first time than children without peanut allergies. 2 A further recently carried out study of breastfed infants assessed the effect of an early exposure to allergenic foods. The infants were treated with peanut, cooked egg, cow's milk, sesame, sesame, felches and wheat or the standard matters for the sole breastfeeding up to the age of 6 months. 3 The prevalence of all food allergies was significantly lower in the group of early infants than in the control group. The prevalence of peanut and egg allergy was significantly lower in the group with early introduction. However, these results were only found in the Per Protocol analysis and not in the intention-to-treat analysis. While it seems practical to give so many allergy -causing foods, according to a recent study, the early introduction is possible and does not seem to affect breastfeeding infants. 4 Finally, a review of the current literature from April 2016 supports these results and comes to the conclusion that the early introduction of allergenic foods is the risk of food allergic Reduced. 5
This current study is not the only study that shows that when children consume frequent allergens in the past, their allergen-specific IGE seems to decrease while the allergen-specific IgG increases. A study from 2013 found the same result in the event of an exposure to egg cells earlier. However, 6 Other studies showed opposing results. A prospective study with 239 children accompanied from birth to the age of 5 showed that those with positive peanut-gantisons that avoided the consumption of peanuts had high values ​​of peanut-specific IgG and IgG4 antibodies. (that those with a lower peanut-like have higher peanut igg antibodies). However, overview work came to the conclusion that oral peanut immunotherapy, i.e. h. The introduction of peanut in low doses over a longer period of time that suppresses IGE response and increases the IGG4 antibodies when the immune system moves away from a type 2-T helper (TH2)-dominant model. 8 It seems that IGG4 antique is used as an indicator of tolerance or as a marker for IGE Suppression can. 9
The early consumption of peanuts seems to lead to higher concentrations of peanut-specific IgG4 antibodies, which leads to a certain immune modulation of the IGE-based open allergic reaction. Small quantities of antigen exposure will slowly cause B cells over time to produce IGG4 via IGE, which signals a shift of TH2 dominance to TH1 dominance. 10 Excessive antigen-specific IgG4 antibodies can, however, represent other unknown health risks. For example, there is an established correlation between the early inclusion of cow's milk and TH1-dominant type 1 diabetes mellitus (T1DM). It is unclear whether possibly excessive cow milk-specific IgG antibodies from the past could play a role in the Etiology of T1DM in a genetically predisposed population. A study of children with a genetic predisposition for T1DM showed that the children who later developed T1DM, increased IgG levels against beta-lactogulin, a main protein of the cow's milk. And the incidence of TH1-dominant autoimmune diseases. A recently carried out animal study found correlations between increased milk and ice-specific IgG antibodies for rats of a model for rheumatoid arthritis. 12 This study indicates that food-specific IgG antibodies can contribute to the development of certain autoimmune diseases. Of course, the cause of autoimmunity has not yet been fully clarified, and further research is required to contribute to the contribution of food and its effects on immune function.
Based on this current study and other recent research results, clinicists should consider changing the current recommendations by proposing that children without current peanut allergy status earlier with the introduction of peanuts in infancy to prevent peanut allergies in later life. Infants should first be tested for an peanut allergy, and if positive, with a protocol -controlled, slow introduction of peanuts under professional guidance should be aware of great caution.

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