Prevention of peanut allergy in the Netherlands: Avoid avoidance

In the past decade, randomized trials have shown the effect of early introduction of peanut and egg in prevention of IgE mediated food allergies in comparison with a delayed introduction. Implementation of this new knowledge is restricted by a few knowledge gaps, in particular whether infants with a higher risk should be screened for peanut and egg allergies before home introduction. The PeanutNL cohort study was initiated as a healthcare evaluation study, following the Dutch “Advice on Early introduction of Peanut and Egg” in 2017 by the Dutch Society of Pediatrics. The PeanutNL cohort is the result of a prospective cohort study that included infants with a higher risk of peanut allergy which were referred to pediatric allergology centers in the Netherlands. They were evaluated with skin prick tests (SPT) and peanut open food challenges (OFC). Furthermore, infants with reactions at home to peanut were also included and analyzed via the same protocol.

The six participating centers included 892 infants between the ages of 4 to 12 months of which 706 had never eaten peanut before and were referred for screening and primary introduction of peanut. A second subgroup of 186 infants below the age of 12 months was referred due to reactions to peanut after a primary introduction of peanut at home.

Main findings include an increased prevalence of peanut allergy when peanut is introduced beyond the age of 8 months in infants with moderate and severe eczema; a high portion of infants with reactions to peanut and sensitization to peanut that were shown to have negative challenges, and that introduced peanut at home; A high median reaction threshold to peanut and a relative low amount of anaphylaxis during challenges; a low prevalence of 0.3% of peanut induced FPIES during early introduction; and that severity of eczema and an introduction beyond 9 months were associated with egg allergy in infants that introduced peanut at an early age.