Scientific Study

Background: Little is known about the development and resolution of early peanut allergy (PA). We examined the natural history and biomarkers of PA longitudinally in three cohorts. Methods: PA development was examined in the EAT, LEAP and PAS cohorts. Early PA was defined by skin prick test (SPT) >4mm by 12-months or oral food challenge (OFC) at study entry. PA was confirmed by OFC at study endpoint (36-months for EAT, 60-months for LEAP/PAS). Four groups were defined: early PA development with persistence (EP); early PA development with resolution (ER); late PA development (LA); never peanut allergic (NA). Clinical characteristics and biomarkers were compared between the groups. Results: 56.3% of peanut allergic children developed PA by 12-months; 32.1% had early PA resolution by study endpoint. The rate of early PA resolution was 54.2% in EAT, 41.4% in LEAP and 18.6% in PAS cohorts. Median SPTs for EP, ER and LA were: 6mm, 2mm, 0mm at baseline and 10mm, 0mm, 9mm at study endpoint. Median peanut-sIgE levels for EP, ER and LA were 5.9kUA/L, 0.4kUA/L, 0.3kUA/L (p<0.001) at baseline; 4.7kUA/l, 1.3kUA/L, 0.9kUA/L (p<0.001) at 12-months; and 20.1kUA/L, 0.2kUA/L, 5.1kUA/L (p<0.001) at study endpoint. LA had slower component expansion (number of components Ara h 1-sIgE, Ara h 2-sIgE, Ara h 3-sIgE >0.1kUA/L) compared to EP. ER showed component expansion from baseline to 12-months but component retraction by study endpoint. Absence of eczema and egg allergy, low peanut-sIgE or SPT were predictive of PA resolution. Conclusion: A significant proportion of PA resolves in early childhood. Different phenotypes of PA display different biomarkers trajectories.

https://doi.org/10.1016/j.jaci.2024.10.042