D1.197 - Casual consumption of small amounts of peanut in children with IgE-mediated allergy is associated with outgrowing IgE-mediated peanut allergy: results of a retrospective observational study

Young children with IgE-mediated peanut allergy are more likely to outgrow their allergy if they reach maintenance oral immunotherapy to peanut. However, many families find the daily oral immunotherapy dosing too time consuming and cannot initiate this treatment. Some young children with IgE-mediated peanut allergy can tolerate small amounts of peanut in their diet, with higher thresholds for allergic reactions. We evaluated if children with IgE-mediated peanut allergy were more likely to outgrow their allergy if they tolerated and casually consumed tiny amounts of peanut. 

We retrospectively reviewed medical records from the Pediatric Allergy Clinic at the Children's Hospital of Winnipeg between July 2015 and June 2019 for children with IgE-mediated peanut allergy, some of whom had undergone oral challenges to peanut to determine their threshold of tolerance as part of their clinical care. Electronic medical records were used to evaluate the children's IgE-mediated peanut allergy diagnosis, oral challenges, tolerance of small amounts of peanut versus strict avoidance, history of eczema, asthma and rhinitis, family history of food and other allergies, and exposure to potential cofactors such as second-hand smoke. 

Medical records of children with IgE-mediated peanut allergy (N=268) ages 0-17 years (median 1.2 years, interquartile range 0.8-2.2) were reviewed going back to their time of diagnosis. Children (N=60) casually consumed a small amount of peanut (10-500mg) regularly or sporadically and 29 of these consumed a small amount at least once per week; 208 children strictly avoided peanut. After adjusting for the presence of eczema and asthma, children were more likely to outgrow their IgE-mediated allergy if they consumed a small amount of peanut with any frequency (odds ratio [OR] 9.3, 95% confidence interval [CI] 4.7-18. 9, p<0.001), and a small amount of peanut at least weekly (OR 32.8, 95% CI 12.9-96.1, p<0.001).

In this retrospective observational study, children were more likely to outgrow IgE-mediated peanut allergy if they casually consumed small amounts of peanut.