Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy

作者：George Du Toit, Graham Roberts, Peter H. Sayre, Henry T. Bahnson, Suzana Radulović, Alexandra F. Santos, Helen Annaruth Brough, Deborah Phippard, Monica Basting, Mary Jo Feeney, Victor Turcanu, Michelle L. Sever, Margarita Gomez Lorenzo, Marshall Plaut, Gideon Lack · 发表于：New England Journal of Medicine · 年份：2015 · DOI：10.1056/nejmoa1414850 · 被引用次数：2253 · 研究领域：Food Allergy and Anaphylaxis Research、Eosinophilic Esophagitis、Asthma and respiratory diseases

BACKGROUND: The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS: We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS: Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consum...