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Are early exposures linked with childhood peanut allergy?

J Fam Pract. 2003 July;52(7):512-525
By
Kelly Hayday, MD
Scott Shannon, MD
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  • BACKGROUND: The increase in peanut allergies over recent decades, as well as the potential seriousness of such allergies, prompted the authors to investigate possible sensitizing agents to avoid. A history of atopy and family history of peanut allergy have been suggested as predisposing factors. These findings had not been replicated previously.
  • POPULATION STUDIED: Children of pregnant women enrolled with the Avon (England) Longitudinal Study of Parents and Children made up the cohort of 13,971 preschoolers in this study. Using responses to prospectively collected questionnaires, investigators identified 49 children up to age 38 months with a clear history of adverse reactions to peanuts.
  • STUDY DESIGN AND VALIDITY: Data reported in this study came from 2 sources. A portion draws on questionnaires collected from a large prospective cohort study. This portion includes data on exposure to soy products within the first 2 years of life, a history of rash over joints and skin creases, and a history of oozing, crusted rash. The remaining interview data were collected retrospectively through a nested case-control design within the cohort.
  • OUTCOMES MEASURED: The outcome studied was development of peanut allergy as documented through response to questionnaires and confirmed by positive double-blind, placebo-controlled oral peanut challenge.
  • RESULTS: Independent factors associated with peanut allergy included consumption of soy milk or formula (adjusted odds ratio [AOR]=3.15; 95% confidence interval [CI], 1.27–7.80); rash over joints or skin creases (AOR=3.88; 95% CI, 1.36–11.04); oozing, crusted rash (AOR=24.62, 95% CI, 5.47–110.87); and use of creams containing peanut oil during the first 6 months of life (AOR=8.34, 95% CI, 1.05–66.1).
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PRACTICE RECOMMENDATIONS

Peanut allergies are associated with intake of soy products in the first 2 years of life, a history of rashes over joints and skin creases (especially oozing, crusted ones), and use of skin creams containing peanut oil. Instructing parents to avoid peanut oil–containing creams and limiting soy milk or formula in the first 2 years of life may reduce sensitization.

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