PEDIATRICS Vol. 114 No. 2 August 2004, pp. 523
FACTORS ASSOCIATED WITH THE DEVELOPMENT OF PEANUT ALLERGY IN CHILDHOOD
Jordan Scott, MD and
Lynda C. Schneider, MD
Boston, MA
Lack G, Fox D, Northstone K, Golding J. N Engl J Med. 2003;348:977–985
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Purpose of the Study.
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Because peanut allergy has increased in prevalence and is an
important cause of life-threatening reactions, the authors sought
to investigate possible determinants of peanut allergy.
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Study Population.
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Data were obtained from the Avon Longitudinal Study of Parents
and Children. This geographically defined cohort included 13
971 preschool-aged children. Forty-nine of those children had
a history of peanut allergy. Thirty-six of those 49 underwent
skin testing, and 29 demonstrated positive results. Peanut allergy
was confirmed for 23 children with double-blind, placebo-controlled,
food challenge.
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Methods.
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Pregnant women were enrolled and questioned about their allergy
history before delivery and were given serial questionnaires
throughout their children’s infancy and childhood. The
authors prospectively identified 49 children with a history
of reactions to peanuts. Twenty-three children were then confirmed
as being allergic to peanuts with skin testing and double-blind,
placebo-controlled, food challenge. There were 2 control groups,
including children with eczema in the first 6 months of life
whose mothers also had eczema and 140 children without peanut
allergy who were randomly selected from the cohort. Cord blood
samples stored at birth were retrieved and analyzed for peanut-specific
and total immunoglobulin E (IgE) for the children with peanut
allergy. Retrospective data on maternal consumption of peanuts
during pregnancy and lactation, family history of peanut allergy,
and the use of specific lotions and creams (the interviewer
was not aware of which products contained peanut oil) were then
obtained.
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Results.
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Peanut allergy was found to be independently associated with
eczematous dermatitis (rash over joints and creases or oozing
crusted rash) in the first 6 months of life, intake of soy products,
family history of peanut allergy, and the use of skin preparations
containing peanut oil. Neither maternal peanut consumption during
pregnancy and lactation nor duration of breastfeeding was found
to be associated with the development of peanut allergy. Additional
evidence not supporting previous concepts of in utero sensitization
came from undetectable peanut-specific IgE and normal total
IgE levels in cord blood.
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Conclusions.
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Sensitization to peanut antigens appeared to be through inflamed
atopic skin, rather than via the gastrointestinal tract, possibly
from the use of skin preparations with even trace amounts of
peanut oil. With respect to the independent association between
intake of soy products and peanut allergy, soy protein fractions
have shown homology to major peanut proteins and cross-sensitization
could result from exposure to a common T cell epitope.
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Reviewers’ Comments.
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With the increase in peanut allergy and other food allergies,
elucidation of risk factors for prevention of sensitization
offers new strategies to combat this food allergy epidemic.
Allergic sensitization through the skin has also been proposed
for the development of asthma and has been demonstrated in mouse
models of atopic dermatitis. Additional studies are needed to
determine whether topical peanut oil treatment is definitely
a risk factor for peanut allergy; however, it seems prudent
to avoid the topical use of peanut oil-containing products among
children with atopic dermatitis. The finding of soy consumption
being associated with peanut allergy may be attributable to
the increased likelihood of food-allergic children receiving
soy products, rather than a specific association with peanut
allergy. Confirmation of this association is needed.
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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Purpose of the Study.
Study Population.
