Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses.

Autor: Logan K; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK., Bahnson HT; Immune Tolerance Network, Benaroya Research Institute, Seattle, Washington, USA., Ylescupidez A; Immune Tolerance Network, Benaroya Research Institute, Seattle, Washington, USA., Beyer K; Charité Universitätsmedizin Berlin, Berlin, Germany., Bellach J; Charité Universitätsmedizin Berlin, Berlin, Germany., Campbell DE; Children's Hospital at Westmead, Westmead, New South Wales, Australia., Craven J; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK., Du Toit G; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK., Clare Mills EN; School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK., Perkin MR; The Population Health Research Institute, St George's University of London, London, UK., Roberts G; University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, UK., van Ree R; Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, Netherlands., Lack G; Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Jazyk: angličtina
Zdroj: Allergy [Allergy] 2023 May; Vol. 78 (5), pp. 1307-1318. Date of Electronic Publication: 2022 Dec 11.
DOI: 10.1111/all.15597
Abstrakt: Background: The Learning Early About Peanut allergy (LEAP) study has shown the effectiveness of early peanut introduction in prevention of peanut allergy (PA). In the Enquiring About Tolerance (EAT) study, a statistically significant reduction in PA was present only in per-protocol (PP) analyses, which can be subject to bias.
Objective: The aim of this study was to combine individual-level data from the LEAP and EAT trials and provide robust evidence on the bias-corrected, causal effect of early peanut introduction.
Method: As part of the European Union-funded iFAAM project, this pooled analysis of individual pediatric patient data combines and compares effectiveness and efficacy estimates of oral tolerance induction among different risk strata and analysis methods.
Results: An intention-to-treat (ITT) analysis of pooled data showed a 75% reduction in PA (p < .0001) among children randomized to consume peanut from early infancy. A protective effect was present across all eczema severity groups, irrespective of enrollment sensitization to peanut, and across different ethnicities. Earlier age of introduction was associated with improved effectiveness of the intervention. In the pooled PP analysis, peanut consumption reduced the risk of PA by 98% (p < .0001). A causal inference analysis confirmed the strong PP effect (89% average treatment effect relative risk reduction p < .0001). A multivariable causal inference analysis approach estimated a large (100%) reduction in PA in children without eczema (p = .004).
Conclusion: We demonstrate a significant reduction in PA with early peanut introduction in a large group of pooled, randomized participants. This significant reduction was demonstrated across all risk subgroups, including children with no eczema. Furthermore, our results point to increased efficacy of the intervention with earlier age of introduction.
(© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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