Follow-up to Adolescence after Early Peanut Introduction for Allergy Prevention.
Level 2 - randomized trial
Long-term follow-up of an individual randomized controlled trial
PubMed 38804779 · doi:10.1056/EVIDoa2300311
What was done
Long-term follow-up study evaluating participants from an original randomized trial of peanut consumption versus avoidance from infancy to age 5 years. Between ages 6 and 12 years (72 to 144 months), peanut intake was ad libitum. The primary endpoint was the rate of peanut allergy at age 144 months. A total of 508 of the original 640 participants (79.4%) enrolled, and 497 had complete primary endpoint data. Serum Ara h2-specific IgE and peanut-specific IgG4 levels were also evaluated.
What was found
At age 144 months, peanut allergy prevalence was significantly lower in the original peanut consumption group than in the avoidance group (4.4% [11 of 251] vs. 15.4% [38 of 246]; P < 0.001). Ara h2-specific IgE was 0.03 ± 3.42 kU/l in the consumption group versus 0.06 ± 11.21 kU/l in the avoidance group. Peanut-specific IgG4 was 535.5 ± 4.98 µg/l in the consumption group versus 209.3 ± 3.84 µg/l in the avoidance group. Adverse events were uncommon and mostly related to oral food challenges.
Why it matters
Early peanut introduction in infancy provides lasting protection against peanut allergy into adolescence, demonstrating durable tolerance that persists despite subsequent ad libitum or intermittent peanut consumption.
Limits
Approximately 20.6% of the original randomized cohort was not enrolled at follow-up, and 11 enrolled participants lacked complete primary outcome data. Post-intervention peanut consumption was unstandardized (ad libitum), with participants in both arms reporting prolonged avoidance periods between ages 6 and 12.