澳大利亚默多克儿童研究所Jennifer J. Koplin团队研究了早期引入花生与澳大利亚婴儿花生过敏率之间的相关性。该研究于2022年7月5日发表在《美国医学会杂志》上。

随机临床试验表明，早期引入花生可以在特定高危人群中预防花生过敏。这导致2016年婴儿喂养指南发生变化，建议所有婴儿尽早食用花生，以降低花生过敏的风险。

为了评估引入这些新指南后婴儿花生过敏人群患病率的变化，并评估早期引入花生与花生过敏之间的相关性，研究组使用相同的抽样框架和方法，从相隔10年的12个月大的婴儿中抽取两个基于人群的横断面样本，以比较随时间的变化。婴儿从澳大利亚墨尔本周围的免疫中心招募。

无论是否有花生接触史或过敏史，参加12个月免疫接种访视的婴儿都有资格参加（合格年龄段为11-15个月）。通过调查问卷收集有关人口统计、食物过敏风险因素、花生介绍和反应的数据。所有婴儿都接受了花生皮肤点刺试验，结果呈阳性的婴儿接受了口服食物挑战。流行率的估计是标准化的，以说明人口统计学随时间的变化。

该研究共包括7209名婴儿（2018-2019年为1933名，2007-2011年为5276名）。在早期组和近期组的参与者中，51.8%和50.8%为男性；中位年龄分别为12.5个月和12.4个月。东亚血统的婴儿随着时间的推移而增加（2018-2019年占16.5%，2007-2011年占10.5%），这是一个食物过敏危险因素。

在对婴儿祖先和其他人口统计学变化进行标准化后，2018-2019年花生过敏率为2.6%，而2007-2011年为3.1%，组间差异不显著。2018-2019年，早期引入花生与澳大利亚血统婴儿的花生过敏风险较低显著相关（12月龄与6月龄或更小的婴儿相比：校正后的优势比为0.08；12月龄与7至10月龄的婴儿相比：校正后的优势比为0.09），但在东亚血统的婴儿中不显著。

研究结果表明，在这项横断面分析中，在澳大利亚引入建议早期食用花生的指南与人口中花生过敏率在统计学上显著降低或升高无关。

附：英文原文

Title: Association Between Earlier Introduction of Peanut and Prevalence of Peanut Allergy in Infants in Australia

Author: Victoria X. Soriano, Rachel L. Peters, Margarita Moreno-Betancur, Anne-Louise Ponsonby, Grace Gell, Alexsandria Odoi, Kirsten P. Perrett, Mimi L. K. Tang, Lyle C. Gurrin, Katrina J. Allen, Shyamali C. Dharmage, Jennifer J. Koplin

Issue&Volume: 2022/07/05

Abstract:

Importance  Randomized clinical trials showed that earlier peanut introduction can prevent peanut allergy in select high-risk populations. This led to changes in infant feeding guidelines in 2016 to recommend early peanut introduction for all infants to reduce the risk of peanut allergy.

Objective  To measure the change in population prevalence of peanut allergy in infants after the introduction of these new guidelines and evaluate the association between early peanut introduction and peanut allergy.

Design  Two population-based cross-sectional samples of infants aged 12 months were recruited 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Infants were recruited from immunization centers around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate (eligible age range, 11-15 months), regardless of history of peanut exposure or allergy history.

Exposures  Questionnaires collected data on demographics, food allergy risk factors, peanut introduction, and reactions.

Main Outcome and Measures  All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time.

Results  This study included 7209 infants (1933 in 2018-2019 and 5276 in 2007-2011). Of the participants in the older vs more recent cohort, 51.8% vs 50.8% were male; median (IQR) ages were 12.5 (12.2-13.0) months vs 12.4 (12.2-12.9) months. There was an increase in infants of East Asian ancestry over time (16.5% in 2018-2019 vs 10.5% in 2007-2011), which is a food allergy risk factor. After standardizing for infant ancestry and other demographics changes, peanut allergy prevalence was 2.6% (95% CI, 1.8%-3.4%) in 2018-2019, compared with 3.1% in 2007-2011 (difference, 0.5% [95% CI, 1.4% to 0.4%]; P=.26). Earlier age of peanut introduction was significantly associated with a lower risk of peanut allergy among infants of Australian ancestry in 2018-2019 (age 12 months compared with age 6 months or younger: adjusted odds ratio, 0.08 [05% CI, 0.02-0.36]; age 12 months compared with 7 to less than 10 months: adjusted odds ratio, 0.09 [95% CI, 0.02-0.53]), but not significant among infants of East Asian ancestry (P for interaction=.002).

Conclusions and Relevance  In cross-sectional analyses, introduction of a guideline recommending early peanut introduction in Australia was not associated with a statistically significant lower or higher prevalence of peanut allergy across the population.

DOI: 10.1001/jama.2022.9224

Source: https://jamanetwork.com/journals/jama/article-abstract/2793827