Reactions to peanut at first introduction in infancy are associated with age ≥8 months and severity of eczema

Author:

Verhoeven Dirk H. J.12ORCID,Herpertz Irene C. E. M.3,Hol Jeroen4,Klok Ted5,Fleuren Suzanne P. M.6,Hendriks Tom7,Gerth van Wijk Roy2,de Groot Hans1

Affiliation:

1. Department of Pediatrics Reinier de Graaf Hospital Delft The Netherlands

2. Section of Allergology and Clinical Immunology, Department of Internal Medicine Erasmus Medical Center Rotterdam The Netherlands

3. Department of Pediatrics Martini Hospital Groningen The Netherlands

4. Department of Pediatrics NoordWest Hospital Group Alkmaar The Netherlands

5. Pediatrics Allergy Treatment Centre, Deventer Hospital Deventer The Netherlands

6. Department of Pediatrics Elkerliek Hospital Helmond The Netherlands

7. Department of Pediatrics Catharina Hospital Eindhoven The Netherlands

Abstract

AbstractBackgroundPrevious studies have shown the efficacy of the early introduction of peanut to prevent peanut allergy. Due to the exclusion of infants with sensitization to peanut, it remains unclear what the optimal timing of introduction is.MethodsThe PeanutNL study was performed in 6 pediatric allergology centers in the Netherlands. Infants referred for the clinical early introduction of peanut to prevent peanut allergy underwent skin prick tests for peanut and an oral peanut challenge at a median age of 6 months.ResultsOne hundred sixty two of 707 infants (23%) who had never eaten peanut before were sensitized to peanut, of which 80 (49%) had wheals of >4 mm. Sixty seven of 707 infants (9.5%) had a positive oral challenge to peanut at first introduction. Multivariate analysis revealed that age (p < .001) and SCORAD eczema severity scores (p = .001) were significant risk factors. Introduction of peanut at ≥8 months in infants with moderate and severe eczema resulted in an increased risk (odds ratio 5.24 (p = .013) and 3.61 (p = .019), respectively) of having reactions to peanut as compared to introduction before 8 months. A family history of peanut allergy and previous reactions to egg were not identified as independent risk factors.ConclusionThese results suggest that peanut should be introduced before the age of 8 months to reduce the risk of reactions at first exposure in infants with moderate and severe eczema. Furthermore, since children with severe eczema have the highest risk of reactions, the clinical introduction of peanut should be considered, at the latest at the age of 7 months.

Publisher

Wiley

Subject

Immunology,Immunology and Allergy,Pediatrics, Perinatology and Child Health

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