RevPaulPediatr.2015;33(4):493---494
www.rpped.com.br
REVISTA
PAULISTA
DE
PEDIATRIA
LETTER
TO
THE
EDITOR
Early
introduction
of
food
to
prevent
food
allergy.
The
LEAP
study
(Learning
Early
about
Peanut)
Introduc
¸ão
precoce
do
alimento
para
prevenc
¸ão
de
alergia
alimentar.
O
estudo
LEAP
(Learning
Early
about
Peanut)
DearEditor,
Peanutallergyisanincreasingglobalhealthproblem,which affects1---3% ofchildren in Westerncountries.The preva-lencemayhavetripledinthelast15years,whichconstitutes approximately100,000newcasesannuallyintheUSA and Canada.1---3
The most recent evidence, challenging the current guidelines,highlightsthe benefitsof early introductionof peanuts,ratherthanavoidance,duringtheinfants’ comple-mentaryfoodperiod.The basisis thestudy ‘‘Randomized Trial of Peanut Consumptionin Infants at Risk for Peanut Allergy(LearningEarlyAboutPeanut---LEAPTrial),’’which demonstratedanabsolutedecreaseof11---25%intheriskof developing peanutallergyin high-risk childrenifthe food wereintroducedbetween4and11monthsofage.4 Inthe
LEAPtrial,640Britishinfantsathighrisk forallergy,aged 4---11months,wererandomlyassignedtoconsumeproducts thatcontainedpeanutat least threetimesaweek (6gof peanutprotein,theequivalentto24peanutsor6teaspoons ofpeanutbutter aweek)or tocompletelyavoidproducts containingpeanutsin thefirstfiveyearsof life.This pop-ulationincluded 542 infantswithnegativeskinprick tests atbaselineand98infantswithpositivetests,withpapule diameterof1---4mmtopeanutextract.Atotalof76children whoseskintestsshowedpapuleslargerthan4mmin diame-ter,whichimpliedahighprobabilityofrespondingtopeanut challenge, were excluded. In an intent-to-treat analysis, 17.2% ofthe group thatavoided peanutdeveloped a pos-itivepeanutchallengetestattheageof5yearscompared to3.2% in thegroup thatconsumed the food.This corre-spondedtoa14%reductionintheabsoluteriskofreaction, i.e.,thenecessarynumber(NNT)of7.1treatedindividuals
DOIoforiginalarticle:
http://dx.doi.org/10.1016/j.rpped.2015.07.002
foronetobenefitfromthetreatment,andan80%reduction intherelativerisk.
The LEAP trial included only infants withminimal risk ornegativeskintestsand,therefore,itdidnotfocusona strategyforthosewithouttheriskfactorstodeveloppeanut allergy. This study is level 1 evidence for thepractice of earlyintroductionofpeanut,whichissafeandeffectivein selectedinfantsatriskofdevelopingallergy.Thisisthefirst prospective,randomizedstudyonfoodallergyintervention andincluded thosewithpositiveskin tests,butnoclinical reaction,with80%reductionintheriskofdevelopingpeanut allergy.
Infantswithearly-onsetallergicdiseases,suchasatopic dermatitisor foodallergy in the first4---6 months of life, shouldbeevaluatedbyanallergisttoimplementLEAPtrial suggestions.5---7Theevaluationofthesepatientsshould
con-sist of skin tests and/or peanut ingestion in the doctor’s presencetoestablish whichonesareclinicallyreactive to thefood,beforestartingitsintroductionathome.
Therehave been nostudies withthislevelof accuracy in low-risk populations investigating the benefit of early introductionofpeanuts.Anotherchallengeistoestablishin populationsinwhichotherfoodsareoftenallergy-causing, for instance, cow’s milk, whether early intervention may reducethe prevalence ofallergy tomilkproteins or even otherfoods.Theguidelinesthatdealwiththetimeof intro-ductionoffoodsintotheinfant’sdietwillbereviewedbased onthisnewevidence.8,9
Funding
Thisstudydidnotreceivefunding.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
References
1.NwaruBI,HicksteinL,PanesarSS,MuraroA,WerfelT,CardonaV, etal.TheepidemiologyoffoodallergyinEurope:asystematic reviewandmeta-analysis.Allergy.2014;69:62---75.
2.Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol.2011;127:668---76.
2359-3482/©2015SociedadedePediatriadeS˜aoPaulo.PublishedbyElsevierEditoraLtda.ThisisanopenaccessarticleundertheCC
494 LETTERTOTHEEDITOR
3.VenterC,HasanArshadS,GrundyJ,PereiraB,BernieClaytonC, VoigtK,etal.Timetrendsintheprevalenceofpeanutallergy: threecohortsofchildrenfromthesamegeographicallocationin theUK.Allergy.2010;65:103---8.
4.DuToitG,RobertsG,SayrePH,BahnsonHT,RadulovicS,Santos AF,etal.Randomizedtrialofpeanutconsumptionininfantsat riskforpeanutallergy.NEnglJMed.2015;372:803---13.
5.MuraroA,HalkenS,ArshadSH,BeyerK,DuboisAE,DuToitG, et al. EAACI food allergy and anaphylaxis guidelines. Primary preventionoffoodallergy.Allergy.2014;69:590---601.
6.deSilvaD,GeromiM,HalkenS,HostA,PanesarSS,MuraroA, etal.Primarypreventionoffoodallergyinchildrenandadults: systematicreview.Allergy.2014;69:581---9.
7.Fleischer DM, SpergelJM, Assa’ad AH, Pongracic JA. Primary preventionofallergicdiseasesthroughnutritionalinterventions. JAllergyClinImmunolPract.2013;1:29---36.
8.Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Kolet-zko B, et al. Complementary feeding: a commentary by the ESPGHANcommitteeonnutrition.JPediatrGastroenterolNutr. 2008;46:99---110.
9.AustralasianSocietyofClinicalImmunologyandAllergy(ASCIA). ASCIA Infant Feeding Advice; 2010. Available from: http:// www.allergy.org.au/images/stories/aer/infobulletins/2010pdf/ ASCIAInfantFeedingAdvice2010.pdf[accessed29.05.15].
NelsonRosárioFilho
UniversidadeFederaldoParaná(UFPR),Curitiba,PR, Brazil
