PURPOSE OF THE STUDY.
Peanut allergy seems to be increasing among children in Hong Kong. The authors of this study report suggested that this increase might be a result of changes in edible oils. Crude peanut oil (protein content: 100–300 μg/mL) was “ubiquitous in maternal and infant diet in Hong Kong in the past” but has now largely been replaced by olive oil.
The consumption of various oils was estimated from data on imports. Per-capita consumption was calculated on the basis of population over time.
Per capita consumption of crude peanut oil fell ∼30-fold over the last 15 years, whereas consumption of olive oil increased ∼30-fold over the same time period.
It is gaining consensus that avoiding consumption of peanut abrogates development of oral tolerance and increases risk of hypersensitivity through cutaneous exposure. The timing and perhaps the dosage and the balance of cutaneous and oral exposure determine whether a child will have allergy or tolerance. Crude edible peanut oil contains immunogenicity-competent protein fractions that might deserve further studies on its implication on peanut-allergy prevention.
The authors suggested that oral consumption of crude peanut oil (contaminated with peanut protein) might have been protecting infants in Hong Kong from peanut allergy by tolerizing them and that now, without this early enteral exposure, more are becoming sensitized through cutaneous or respiratory routes. This concept is consistent with data from other studies that suggest that early feeding of food proteins is protective against the development of allergy and that early feeding avoidance (which leaves only cutaneous or respiratory exposure) might actually cause allergy. The American Academy of Pediatrics no longer advocates delayed introduction of any food past 4 months of age. Prospective, blinded, randomized trials are underway to better characterize the relationship between route, timing, and dose of food exposure and subsequent development of allergy.
- Copyright © 2011 by the American Academy of Pediatrics