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Environmental peanut exposure increases the risk of peanut sensitization in high-risk children
Kings Coll London, Guys Hosp, Sch Life Course Sci, Paediat Allergy Grp,Dept Women & Childrens Heath, London, England;Guys & St Thomass NHS Fdn Trust, Childrens Allergy Serv, London, England;Kings Coll London, Guys Hosp, Sch Immunol & Microbial Sci, Paediat Allergy Grp, London, England.
Karolinska Inst, Inst Environm Med, Stockholm, Sweden;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden;Soder Sjukhuset, Sachs Childrens Hosp, Stockholm, Sweden.
Kings Coll London, Guys Hosp, Sch Life Course Sci, Paediat Allergy Grp,Dept Women & Childrens Heath, London, England;Kings Coll London, Guys Hosp, Sch Immunol & Microbial Sci, Paediat Allergy Grp, London, England.
Karolinska Inst, Inst Environm Med, Stockholm, Sweden;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
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2018 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 5, p. 586-593Article in journal (Refereed) Published
Abstract [en]

Background: High household peanut consumption is associated with the development of peanut allergy, especially when peanut allergic cases are compared against atopic controls; thus, environmental peanut exposure (EPE) may be a risk factor for peanut sensitization and allergy. In this study, we explored the relationship between EPE and school-age peanut sensitization in a population-based cohort.

Methods: Maternal bed dust was collected postnatally, and EPE was quantified using a polyclonal peanut ELISA. Peanut sensitization was assessed by specific IgE to peanut extract and sIgE to peanut protein component allergens Ara h 1, 2 or 3 >= 0.35kU/L (primary peanut sensitization). Initial nested case-control analysis was performed comparing peanut-sensitized cases against high-risk controls (matched for parental atopy) (n = 411) using a conditional regression analysis. This was followed by whole cohort analysis (n = 1878) comparing EPE against peanut sIgE sensitization at ages 4 and 8 years using generalized estimating equations and against primary peanut sensitization at age 8 years using a logistic regression model. Finally, a subgroup analysis was performed comparing the impact of EPE in peanut-sensitized vs egg-sensitized, peanut-tolerant individuals using logistic regression analysis. Levels of EPE were compared between groups using the Mann-Whitney U test.

Results: In the nested case-control analysis, a higher level of EPE around birth was associated with peanut-specific IgE sensitization at age 4 years (OR=1.41, 95% CI:1.05-1.90) and primary peanut sensitization at age 8 years (OR=2.11, 95% CI:1.38-3.22) compared against high-risk controls. When the whole BAMSE cohort was assessed, EPE was no longer associated with peanut sensitization; however, on subgroup analysis, EPE was associated with primary peanut sensitization when compared against egg-sensitized peanut-tolerant controls with an adjusted odds ratio of 1.44 per unit EPE (95% CI:1.06-1.94). There was no significant interaction between EPE and FLG loss-of-function mutations, egg sensitization at age 4 years, infantile eczema or parental atopy on peanut sensitization.

Conclusions: Higher levels of environmental exposure to peanut in the first few months of life appear to increase the probability of developing school-age peanut sensitization in atopic children (based on egg sensitization and parental atopy).

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 48, no 5, p. 586-593
Keywords [en]
BAMSE, egg sensitization, environmental peanut exposure, FLG mutation, infantile eczema peanut sensitization
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-359666DOI: 10.1111/cea.13111ISI: 000435946700012PubMedID: 29405462OAI: oai:DiVA.org:uu-359666DiVA, id: diva2:1245554
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-09-05Bibliographically approved

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