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Early‐life predictors and risk factors of peanut allergy, and its association with asthma in later‐life: Population‐based birth cohort study
Author(s) -
Kotsapas Constantinos,
Nicolaou Nicolaos,
Haider Sadia,
Kerry Gina,
Turner Paul J.,
Murray Clare S.,
Simpson Angela,
Custovic Adnan
Publication year - 2022
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.14103
Subject(s) - medicine , asthma , wheeze , peanut allergy , allergy , atopy , filaggrin , sensitization , cohort , population , cohort study , pediatrics , immunology , food allergy , atopic dermatitis , environmental health
Background Understanding risk factors for peanut allergy (PA) is essential to develop effective preventive measures. Objective The objective was to ascertain associates and predictors of PA, and the relationship between PA and asthma severity. Methods In a population‐based birth cohort, we investigated the association between objectively confirmed PA with early‐life environmental exposures, filaggrin ( FLG )‐loss‐of‐function mutations and other atopic disease. We then examined the association of PA with longitudinal trajectories of sensitization, wheeze and allergic comorbidities, which were previously derived using machine learning. Finally, we ascertained the relationship between PA and asthma severity. Results PA was confirmed in 30/959 participants with evaluable data. In the multivariate analysis, eczema in infancy (OR = 4.4, 95% CI 1.5–13.2, p = 0.007), egg sensitization at age 3 years (OR = 9.7, 95% CI 3.3–29.9, p < 0.001) and early‐life cat ownership (OR = 3.0, 95% CI 1.1–8.4, p = 0.04) were independent associates of PA. In the stratified analysis among 700 participants with genetic information, in children with early‐life eczema there was no difference in FLG mutations between children with and without PA (3/18 [16.7%] vs. 42/220 [19.1%], p = 1.00). In contrast, among children without eczema, those with PA were almost eight times more likely to have FLG mutations (2/6 [33.3%] vs. 27/456 [5.9%], p = 0.049). We observed associations between PA and multiple allergic sensitization profiles derived using machine learning, with ~60‐fold increase in risk among individuals assigned to multiple early sensitization. PA was significantly associated with persistent wheeze (but not other wheeze phenotypes), and with trajectories of atopic disease characterized by co‐morbid persistent eczema and wheeze (but not with transient phenotypes). Children with PA were more likely to have asthma, but among asthmatics we found no evidence of an association between PA and asthma severity. Conclusions Peanut allergy is associated with multiple IgE sensitization and early‐onset persistent eczema and wheeze. FLG loss‐of‐function mutations were associated with peanut allergy in children without eczema.