Peanut introduction before the age of 6 months and the risk of peanut allergy
Level of evidence: A
Peanut introduction before 6 months of age decreases the risk of peanut allergy.
A systematic review of early food introduction found early introduction of peanuts to decrease the risk of peanut allergy by RR 0.31 (95% CI 0.19-0.51) «Scarpone R, Kimkool P, Ierodiakonou D, ym. Timing of Allergenic Food Introduction and Risk of Immunoglobulin E-Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatr 2023;177(5):48»1. By excluding one trial with peanut avoidance until 5 years of age, RR was still 0.43 (0.24-0.76). With a risk of peanut allergy of 1-2%, translates into an absolute reduction of 7-14 per 1000 infants. The early introduction increased the study withdrawal, RR 1.91 (95% CI 1.19-3.05). Relative risks for study withdrawal were lower in one placebo-controlled trial, suggesting good tolerability, but difficulties in the implementation/acceptability of the intervention.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| SR=systematic review; MA=meta-analysis | |||||
| «Scarpone R, Kimkool P, Ierodiakonou D, ym. Timing of Allergenic Food Introduction and Risk of Immunoglobulin E-Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatr 2023;177(5):48»1 | SR and MA | Infants 3-10 months old. Both low and high-risk populations. | Early peanut introduction vs placebo or no intervention until at least 6 months. | Peanut allergy: double-blind, placebo-controlled food challenge; open food challenge; medical diagnosis at 18-60 months. | Low |
| Reference | Comments |
|---|---|
| «Scarpone R, Kimkool P, Ierodiakonou D, ym. Timing of Allergenic Food Introduction and Risk of Immunoglobulin E-Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatr 2023;177(5):48»1 | The smallest trial was the only placebo-controlled trial, although this may not be so important as the outcome is not subjective. Two trials had comparison arm with peanut introduction at 6 months, one trial at 8 months and one trial at 5 years. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events I | Absolute number of events C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «Scarpone R, Kimkool P, Ierodiakonou D, ym. Timing of Allergenic Food Introduction and Risk of Immunoglobulin E-Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatr 2023;177(5):48»1 | 4 | 18-60 months | 27/1891 | 94/1905 | 0.31 (0.19-0.51) |
| Level of evidence: high | |||||
References
- Scarpone R, Kimkool P, Ierodiakonou D, ym. Timing of Allergenic Food Introduction and Risk of Immunoglobulin E-Mediated Food Allergy: A Systematic Review and Meta-analysis. JAMA Pediatr 2023;177(5):489-497 «PMID: 36972063»PubMed