Prevalence and Determinants of Food Allergy in the Era of Early Allergen Introduction: The EarlyNuts Population-Based Study

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-11-01 DOI:10.1016/j.jaip.2024.07.001

Victoria X. Soriano PhD , Katrina J. Allen MBBS, PhD , Shyamali C. Dharmage MBBS, PhD , Desalegn Markos Shifti PhD , Kirsten P. Perrett MBBS, PhD , Rushani Wijesuriya PhD , Jennifer J. Koplin PhD , Rachel L. Peters PhD

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Abstract

Background

Infant feeding guidelines in Australia changed in 2016 to recommend introducing common allergy-causing foods by age 1 year to prevent food allergy. Although most Australian infants now eat peanut and egg by age 6 months, some still develop food allergy despite the early introduction of allergens.

Objectives

To describe the prevalence of food allergy in a cohort recruited after introducing the nationwide allergy prevention recommendations; identify characteristics of infants who developed allergy despite early introduction of allergens; and estimate the causal effect of modifiable exposures on food allergy prevalence and whether this differed between infants who were introduced to allergens before or after age 6 months.

Methods

We recruited a population-based sample of 12-month-old infants in Melbourne, Australia. Infants had skin prick tests to four foods and parents completed questionnaires. Infants with evidence of sensitization were offered oral food challenges. Prevalence estimates were adjusted using inverse probability weighting.

Results

In a cohort of infants (n = 1,420) in which nearly all infants had been introduced to common allergens such as egg, milk, and peanut by age 1 year, the prevalence of food allergy remained high at 11.3% (95% CI, 9.6-13.4). Infants who developed food allergy despite introduction of the allergen by age 6 months were more likely to have Asian-born parents. Early-onset moderate or severe eczema was associated with an increased odds of food allergy irrespective of whether allergens were introduced before or after age 6 months. Among infants who were introduced to peanut at age 6 months or earlier, antibiotic use by age 6 months was associated with an increased odds of peanut allergy (adjusted odds ratio = 6.03; 95% CI, 1.15-31.60).

Conclusions

In a cohort in which early allergen introduction was common, the prevalence of food allergy remained high. Infants who developed food allergy despite introduction of the respective allergen by age 6 months were more likely to have had Asian parents and early-onset eczema. New interventions are needed for infants with a phenotype of food allergy that is not amenable to early allergen introduction.

查看原文本刊更多论文

早期引入过敏原时代食物过敏症的发病率和决定因素：早期坚果人群研究。

背景：澳大利亚的婴儿喂养指南于 2016 年做出改变，建议在婴儿 1 岁前引入常见的致敏食物，以预防食物过敏。虽然现在大多数澳大利亚婴儿在6个月大之前就能吃花生和鸡蛋，但尽管很早就引入了过敏原，仍有一些婴儿患上了食物过敏症：我们的目的是描述在引入全国性过敏预防建议后所招募的人群中食物过敏的发生率；确定尽管较早引入过敏原但仍发生过敏的婴儿的特征；估计可改变的暴露对食物过敏发生率的因果效应，以及在 6 个月之前或之后引入过敏原的婴儿之间是否存在差异：方法：我们在澳大利亚墨尔本市对 12 个月大的婴儿进行了人口抽样调查。婴儿对 4 种食物进行了皮肤点刺试验，家长填写了调查问卷。有过敏证据的婴儿将接受口服食物挑战。采用反概率加权法对患病率估计值进行了调整：在一组婴儿（人数=1420）中，几乎所有婴儿在一岁前都接触过鸡蛋、牛奶和花生等常见过敏原，但食物过敏的患病率仍然高达 11.3% (95% CI 9.6-13.4%)。在 6 个月大之前引入过敏原但仍出现食物过敏的婴儿，其父母更有可能是亚裔。无论过敏原是在 6 个月之前还是之后引入，早发中度/重度湿疹都与食物过敏几率增加有关。在6个月以下接触花生的婴儿中，6个月前使用抗生素与花生过敏几率增加有关（aOR 6.03 (95%CI 1.15-31.60)）：在一个普遍早期引入过敏原的人群中，食物过敏的发病率仍然很高。尽管在 6 个月前引入了相应的过敏原，但仍出现食物过敏的婴儿更有可能父母为亚洲人，并患有早发湿疹。对于那些食物过敏表型不适合早期引入过敏原的婴儿，需要采取新的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.