Study: Is the solution to an earth's allergy solution an early exposure to peanuts?

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Reference du Toit G., Roberts G., Sayre Ph, et al.; Leap study team. Randomized study on eating peanuts in infants with a risk of peanut allergy. N Engl. J med. 2015; 372 (9): 803-813. Design randomized, open, controlled study participants 640 infants between the ages of 4 and 11 months with severe eczema, egg allergy or both study parameters and primary results. Each group was then divided into 2 groups: 1 group was instructed to consume 6 g peanut snack a week, and the other group was advised ...
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Reference

du toit G., Roberts G., Sayre Ph, et al.; Leap study team. Randomized study on eating peanuts in infants with a risk of peanut allergy. n Engl. J med . 2015; 372 (9): 803-813.

Design

randomized, open, controlled study

participant

640 infants between the ages of 4 and 11 months with severe eczema, egg allergy or both

study parameters and primary results

The participants were examined for peanut allergy at the beginning of the study using the skin-prick test and randomized in 2 groups based on this finding. Each group was then divided into 2 groups: 1 group was instructed to consume 6 g peanut snack a week, and the other group was advised to avoid peanuts. The peanut intake was maximized to 3.9 g among those who had a positive skin-prick test. The peanut snack was distributed over 3 meals a week until the children were 60 months old.
clinical examinations were carried out at the beginning of the course (at the age of 4–11 months) and again when the child was 12 months, 30 months and 60 months old. The reviews included skin-prick tests; Serum level of peanut immununglobulin (IG) e, IGG and Igg4; and peanut-igg4: ige ratio. The primary endpoint was the proportion of patients with a peanut allergy at the age of 60 months, which was secondarily determined after an oral food provocation.

important knowledge

of 640 infants had a negative skin-prick test at the beginning of the course. For those with a negative output surge test, 13.7 % of the avoidance group and 1.9 % of the consumption group were allergic to peanuts after 60 months. This statistically significant difference corresponds to a reduction in peanut allergy prevalence by 86.1 %.
At the beginning of the course, 98 children had positive skin-prick tests. In this group, 35.3 % of the avoidance group and 10.6 % of the consumption group were allergic to peanuts after 60 months. This statistically significant difference corresponds to a reduction in peanut allergy prevalence by 70.0 %.
A significant increase in the quaddle size was only found in the peanut avoidance group. At that time, patients who were allergic to peanuts in the 60th month also had higher peanut-like levels. Over time, the peanut-gig levels rose both in the peanut avoidance and in the consumption group, but there were only a few participants in the consumption group that had very high peanut-gel levels. The peanut and IGG4 values ​​were higher in the consumption group than in the avoidance group.

practice implications

peanut allergies are on the rise and doctors, parents and patients want to know why. A theory is the delayed consumption of peanuts in children. A 2008 study showed that Jewish children in the United Kingdom have a statistically significantly higher prevalence of peanut allergies than Jewish children in Israel. The authors state that the main difference between the children in the two regions is the time the introduction of peanuts. Exposure to peanuts is avoided in British infants. However, infants in Israel have a high puproke exposure. 1 until 2008, the American Academy of Pediatrics asked parents not to feed babies with allergy risk.
One of the implications of the present study on peanut allergies is the realization that the introduction of peanuts at an early age seems to be safe and well tolerated, even with people who have a positive prick test on peanuts and no side effects when eating.
Many studies have questioned the validity of avoiding food allergens in infancy. A study evaluated the connection between the time of the introduction of fixed food in infants and the existence of an atopia at the age of 6 at 2,073 children. 2 The authors found that a delay in the introduction of fixed food over 4 or 6 months did not reduce the incidence of the development of atopic conditions and that children who were treated with a delayed introduction Had food allergies. A prospective study from 2007 examined the connection between exposure to solid food and eczema. 3 under 4,753 infants existed an increased risk of eczemic for those who did without eggs in the first year of life. The authors of this study rejected the idea of ​​a delayed introduction of solid food and found that allergens should not be postponed beyond the age of 6 months to prevent atopia. A publication by Palmer et al. From 2013 it came to the conclusion that the trend towards a lower prevalence of egg allergies in infants that were fed early in life with eggs early in comparison to a control group is scattered that the early introduction of allergenic foods is an increased risk of allergies. found an early age. In addition, the study showed that the early introduction of eggs significantly increases the IGG4 antibody levels of the eggs.
One of the implications of the present study on peanut allergies is the realization that the introduction of peanuts at an early age seems to be safe and well tolerated, even with people who have a positive prick test on peanuts and no side effects when eating. In these patients it is recommended to limit the peanut recording to 3.9 g a week. In contrast to the aforementioned egg study, a drastic protective effect was determined among those who consumed peanuts, regardless of whether there was or not an initial reaction in the skin-prick test.
Another interesting result of this study is the significantly higher increase in the peanut -specific IgG4 in the consumption group compared to the avoidance group. This confirms the results of Palmer, which also showed a significant increase in the ice-specific IGG4 in early egg exposure. The mechanism can similar to that of oral peanut immunotherapy (POIT). Poit leads to the suppression of mast cells, basophils and IGE-positive B cells through exposure to allergens in small doses over long periods. Th1-Dominance indicates. 6 While this immune shift can explain the reduction in atopia and food allergies, excessive antigen-specific IgG4 antibodies can 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 (TIDM). An article from 2013 explains that TIDM occurs in infants under 3 months that were exposed to cow's milk at an earlier age of around 4 years and the overall risk for TIDM is highest when milk is given before a child is 4 months old. 7 Further research should be on the effect of an early introduction to the TH1 dominance and the occurrence of TH1 dominant Autoimmune diseases are carried out.
In addition to promoting the production of IGG4 antibodies, oral immunotherapy can also achieve a clinical effect through the induction of regulatory T cells (TREGs) that dampen allergic reactions. A study examined participants with peanut allergy who underwent oral immunotherapy with peanut protein for 24 months, followed by a 3-month waiting time and an oral food provocation after 27 months. The study showed that those who underwent oral immunotherapy had a higher number of peanut -specific tregs 12 months after the start of therapy. In addition to the number of tregs, epigenetic changes were observed in those who achieved a tolerance towards peanuts and then maintained. This implies that not only the number of Tregs, but also their function gives immune tolerance or their absence. 8 This implication can also dispel some of our concerns that an increased autoimm warehouse could exist through an increased production of antigen-specific IGG4 antibodies.
[ editors' Note: For Additional Information on the Health Benefits of Peanuts, Read " Heart-Health Benefits of Peanuts "in this issue of Natural Medicine Journal.]

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  2. Zutavern a, Brockow I, Schaaf B, et al. At the time of the introduction of solid food in terms of eczema, asthma, allergic rhinitis and food and inhalation sensitization at the age of 6: Results of the prospective cohort birthday Lisa. Pediatrics. 2008; 121 (1): 44-52.
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