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Peanut Consumption and Resolution of Eczema

J Allergy Clin Immunol; ePub 2017 Oct 30; du Toit, et al

Early consumption of peanut in infants at high risk of peanut allergy is allergen-specific and does not prevent the development of other allergic disease, sensitization to other foods and aeroallergens, or reported allergic reactions to tree nuts and sesame, according to the recent Learning Early About Peanut (LEAP) Study. Furthermore, peanut consumption does not hasten the resolution of eczema or egg allergy. Asthma, eczema, and rhinoconjunctivitis were diagnosed by clinical assessment. Reported allergic reactions and consumption of tree nuts and sesame were recorded by questionnaire. Sensitization to food and aeroallergens was determined by skin prick testing and specific IgE measurement. Researchers found:

  • A high and increasing burden of food and aeroallergen sensitization and allergic disease was noted across study time points; 76% of LEAP participants had at least 1 allergic disease at 60 months of age.
  • There were no differences in allergic disease between LEAP groups.
  • Significant resolution of eczema and sensitization to egg and milk occurred in LEAP participants; this was not affected by peanut consumption.
Citation:

Du Toit G, Sayre PH, Roberts G, et al. The allergen-specificity of early peanut consumption and the impact on the development of allergic disease in the LEAP Study Cohort. [Published online ahead of print October 30, 2017]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2017.09.034.

Commentary:

This article reinforces a few points in our understanding of clinical features in the atopic patient. In the last few years it has become evident that early oral exposure to peanut reduces the incidence of peanut allergy, which has led to a rather profound change in our feeding recommendations. But while early peanut exposure may be good, we still don't have a good idea about reducing other food allergies. It is important, however, to understand that allergy tests (either prick or RAST) can only provide a guide towards the presence of clinically significant allergy. Caregiver observation to associate symptoms with food challenge is critical in deciding if foods are really contributing to GI, pulmonary, or skin symptoms.

Dr. Joseph Fowler, MD

Clinical Professor of Dermatology, University of Louisville, KY

Assistant Clinical Professor, Division of Occupational Medicine, University of Kentucky, KY

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