Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy

Corinne Keet, Michael Pistiner, Mihaela Plesa, Daria Szelag, Wayne Shreffler, Robert Wood, Joan Dunlop, Roger Peng, Jennifer Dantzer, Alkis Togias

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Whether to screen high-risk groups before early peanut introduction is controversial. Objective: We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH). Methods: Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding. Results: A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA. Conclusions: PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.

Original languageEnglish (US)
Pages (from-to)984-991.e5
JournalJournal of Allergy and Clinical Immunology
Volume147
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Food allergy
  • early introduction
  • peanut allergy
  • prevention

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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