Randomized trial of peanut consumption in infants at risk for peanut allergy
Open accessAbstract
BACKGROUND: The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS: We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS: Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy. CONCLUSIONS: The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is increasing evidence on the tolerance hypothesis in the etiology of food allergy, in which a clinical trial has shown that early consumption of peanuts can reduce the development of peanut allergy.
“Interestingly, there is increasing evidence on this tolerance hypothesis in the etiology of food allergy in which a clinical trial has shown that early consumption of peanuts can reduce the development of peanut allergy (138, 139).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [138]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Boyce, J. A., Assa’ad, A., Burks, A. W., Jones, S. M., Sampson, H. A., Wood, R. A., Plaut, M., Cooper, S. F., Fenton, M. J., Arshad, S. H., et al. (2010) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.10.008 · Cited by 2,353 · see citing works
Self-citationFatalities due to anaphylactic reactions to foods
Böck, S., Muñoz‐Furlong, A., & Sampson, H. A. (2001) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2001.112031 · Cited by 1,570 · see citing works
Boyce, J. A., Assa’ad, A., Burks, A. W., Jones, S. M., Sampson, H. A., Wood, R. A., Plaut, M., Cooper, S. F., Fenton, M. J., Arshad, S. H., et al. (2010) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.10.007 · Cited by 1,263 · see citing works
Self-citationGreer, F. R., Sicherer, S. H., & Burks, A. W. (2007) · PEDIATRICS · doi:10.1542/peds.2007-3022 · Cited by 1,110 · see citing works
US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up
Sicherer, S. H., Muñoz‐Furlong, A., Godbold, J., & Sampson, H. A. (2010) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.03.029 · Cited by 930 · see citing works
Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy
Toit, G. D., Katz, Y., Sasieni, P. D., Mesher, D., Maleki, S. J., Fisher, H. R., Fox, A. T., Turcanu, V., Amir, T., Zadik-Mnuhin, G., et al. (2008) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2008.08.039 · Cited by 829 · see citing works
Self-citationOral Immunotherapy for Treatment of Egg Allergy in Children
Burks, A. W., Jones, S. M., Wood, R. A., Fleischer, D. M., Sicherer, S. H., Lindblad, R., Stablein, D. M., Henning, A. K., Vickery, B. P., Liu, A. H., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1200435 · Cited by 699 · see citing works
Self-citationHypoallergenic Infant Formulas
(2000) · PEDIATRICS · doi:10.1542/peds.106.2.346 · Cited by 687 · see citing works
A global survey of changing patterns of food allergy burden in children
Prescott, S. L., Pawankar, R., Allen, K. J., Campbell, D. E., Sinn, J. K. H., Fiocchi, A. G., Ebisawa, M., Sampson, H. A., Beyer, K., & Lee, B. W. (2013) · World Allergy Organization Journal · doi:10.1186/1939-4551-6-21 · Cited by 606 · see citing works
Cummings, A. J., Knibb, R. C., King, R. M., & Lucas, J. S. (2010) · Allergy · doi:10.1111/j.1398-9995.2010.02342.x · Cited by 580 · see citing works
Varshney, P., Jones, S. M., Scurlock, A. M., et al. (2011) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2010.12.1111 · Cited by 562 · see citing works
Grass Pollen Immunotherapy Induces Mucosal and Peripheral IL-10 Responses and Blocking IgG Activity
Nouri‐Aria, K. T., Wachholz, P. A., Francis, J. N., Jacobson, M. R., Walker, S. M., Wilcock, L. K., Staple, S. Q., Aalberse, R. C., Till, S. J., & Durham, S. R. (2004) · The Journal of Immunology · doi:10.4049/jimmunol.172.5.3252 · Cited by 561 · see citing works
The epidemiology of food allergy in Europe: a systematic review and meta‐analysis
Nwaru, B. I., Hickstein, L., Panesar, S. S., Muraro, A. M., Werfel, T., Cardona, V., Dubois, A. E. J., Halken, S., Hoffmann‐Sommergruber, K., Poulsen, L. K., et al. (2013) · Allergy · doi:10.1111/all.12305 · Cited by 513 · see citing works
Self-citationSustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy
Vickery, B. P., Scurlock, A. M., Kulis, M. D., Steele, P. H., Kamilaris, J. S., Berglund, J. P., Burk, C. M., Hiegel, A. M., Carlisle, S. K., Christie, L., et al. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.11.007 · Cited by 435 · see citing works
Early regular egg exposure in infants with eczema: A randomized controlled trial
Palmer, D. J., Metcalfe, J. R., Makrides, M., Gold, M., Quinn, P., West, C. E., Loh, R., & Prescott, S. L. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.05.002 · Cited by 326 · see citing works
Toit, G. D., Roberts, G. C., Sayre, P. H., Plaut, M., Bahnson, H. T., Mitchell, H., Radulović, S., Chan, S., Fox, A. T., Turcanu, V., et al. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2012.09.015 · Cited by 284 · see citing works
Self-citationSantos, A. F., James, L. K., Bahnson, H. T., et al. (2015) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.01.012 · Cited by 276 · see citing works
Self-citationClinical characteristics of peanut allergy
Hourihane, J. O., Kilburn, S. A., DEAN, P., & Warner, J. O. (1997) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.1997.tb01190.x · Cited by 266 · see citing works
Venter, C., Arshad, S. H., Grundy, J. D., Pereira, B., Clayton, C. B., Voigt, K., Higgins, B., & Dean, T. (2009) · Allergy · doi:10.1111/j.1398-9995.2009.02176.x · Cited by 253 · see citing works
Peanut oral immunotherapy modifies IgE and IgG4 responses to major peanut allergens
Vickery, B. P., Lin, J., Kulis, M. D., et al. (2012) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2012.10.048 · Cited by 217 · see citing works
American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas.
(2000) · PubMed · Cited by 217 · see citing works
State of the art on food allergen immunotherapy: Oral, sublingual, and epicutaneous
Jones, S. M., Burks, A. W., & Dupont, C. M. (2014) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.12.1040 · Cited by 198 · see citing works
Primary prevention of food allergy in children and adults: systematic review
de Silva, D., Geromi, M., Halken, S., et al. (2014) · Allergy · doi:10.1111/all.12334 · Cited by 189 · see citing works
Brough, H. A., Santos, A. F., Makinson, K., Penagos, M., Stephens, A. C., Douiri, A., Fox, A. T., Toit, G. D., Turcanu, V., & Lack, G. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.02.034 · Cited by 149 · see citing works
Self-citationA novel model of sensitization and oral tolerance to peanut protein
Strid, J., Thomson, M., Hourihane, J. O., Kimber, I., & Ströbel, S. (2004) · Immunology · doi:10.1111/j.1365-2567.2004.01989.x · Cited by 124 · see citing works
Allergen-specific oral immunotherapy for peanut allergy
Nurmatov, U. B., Venderbosch, I., Devereux, G. S., Simons, F. E. R., & Sheikh, A. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009014.pub2 · Cited by 107 · see citing works
Distribution of peanut protein in the home environment
Brough, H. A., Makinson, K., Penagos, M., Maleki, S. J., Cheng, H., Douiri, A., Stephens, A. C., Turcanu, V., & Lack, G. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.02.035 · Cited by 97 · see citing works
Self-citationDiagnosis of Food Allergy: Epicutaneous Skin Tests, In Vitro Tests, and Oral Food Challenge
Lieberman, P., & Sicherer, S. H. (2010) · Current Allergy and Asthma Reports · doi:10.1007/s11882-010-0149-4 · Cited by 90 · see citing works
Food allergy in South African children with atopic dermatitis
Gray, C. L., Levin, M. E., Zar, H. J., et al. (2014) · Pediatric Allergy and Immunology · doi:10.1111/pai.12270 · Cited by 75 · see citing works
Savilahti, E. M., Kuitunen, M., Savilahti, E., et al. (2014) · International Archives of Allergy and Immunology · doi:10.1159/000361023 · Cited by 35 · see citing works
Fox, D., & Lack, G. (1998) · The Lancet · doi:10.1016/s0140-6736(05)60863-x · Cited by 19 · see citing works
Self-citationAssessing Peanut Consumption in a Population of Mothers and Their Children in the UK
Sofianou‐Katsoulis, A., Mesher, D., Sasieni, P. D., Toit, G. D., Fox, A. T., & Lack, G. (2011) · World Allergy Organization Journal · doi:10.1097/wox.0b013e318205ab27 · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Weidinger, S., Beck, L. A., Bieber, T., Kabashima, K., & Irvine, A. D. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0001-z · Cited by 1,549 · see citing works
Epidemiology of Asthma in Children and Adults
Dharmage, S. C., Perret, J. L., & Custovic, A. (2019) · Frontiers in Pediatrics · doi:10.3389/fped.2019.00246 · Cited by 1,200 · see citing works
Wollenberg, A., Barbarot, S., Bieber, T., Christen‐Zaech, S., Deleuran, M., Fink‐Wagner, A., Gieler, U., Girolomoni, G., Lau, S., Muraro, A., et al. (2018) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.14891 · Cited by 1,181 · see citing works
After asthma: redefining airways diseases
Pavord, I. D., Beasley, R., Agusti, A., Anderson, G. P., Bel, E., Brusselle, G., Cullinan, P., Custovic, A., Ducharme, F. M., Fahy, J. V., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)30879-6 · Cited by 1,073 · see citing works
EAACI Molecular Allergology User's Guide
Matricardi, P. M., Kleine‐Tebbe, J., Hoffmann, H. J., Valenta, R., Hilger, C., Hofmaier, S., Aalberse, R. C., Agache, I., Asero, R., Ballmer‐Weber, B., et al. (2016) · Pediatric Allergy and Immunology · doi:10.1111/pai.12563 · Cited by 932 · see citing works
Self-citationThe gut-skin axis in health and disease: A paradigm with therapeutic implications
O'Neill, C. A., Monteleone, G., McLaughlin, J. T., & Paus, R. (2016) · BioEssays · doi:10.1002/bies.201600008 · Cited by 449 · see citing works
Posa, D., Perna, S., Resch, Y., Lupinek, C., Panetta, V., Hofmaier, S., Rohrbach, A., Hatzler, L., Grabenhenrich, L., Tsilochristou, O., et al. (2017) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2016.08.014 · Cited by 281 · see citing works
Han, H., Roan, F., & Ziegler, S. F. (2017) · Immunological Reviews · doi:10.1111/imr.12546 · Cited by 285 · see citing works
Brough, H. A., Nadeau, K. C., Sindher, S. B., Alkotob, S. S., Chan, S., Bahnson, H. T., Leung, D. Y. M., & Lack, G. (2020) · Allergy · doi:10.1111/all.14304 · Cited by 275 · see citing works
Self-citationRETRACTED: Skin barrier impairment at birth predicts food allergy at 2 years of age
Kelleher, M. M., Dunn-Galvin, A., Gray, C., Murray, D. M., Kiely, M., Kenny, L., McLean, W. H. I., Irvine, A. D., & Hourihane, J. O. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.12.1312 · Cited by 169 · see citing works
RetractedBonifacio, E., Beyerlein, A., Hippich, M., Winkler, C., Vehik, K., Weedon, M. N., Laimighofer, M., Hattersley, A. T., Krumsiek, J., Frohnert, B. I., et al. (2018) · PLOS Medicine · doi:10.1371/journal.pmed.1002548 · Cited by 148 · see citing works
Senda, T., Dogra, P., Granot, T., Furuhashi, K., Snyder, M. E., Carpenter, D. J., Szabo, P. A., Thapa, P., Miron, M., & Farber, D. L. (2019) · Mucosal Immunology · doi:10.1038/s41385-018-0110-8 · Cited by 114 · see citing works
Pluymen, L. P. M., Wijga, A. H., Gehring, U., Koppelman, G. H., Smit, H. A., & van Rossem, L. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1639-8 · Cited by 68 · see citing works
Edwards, M. R., Saglani, S., Schwarze, J., Skevaki, C., Smith, J. A., Ainsworth, B., Almond, M., Andreakos, E., Belvisi, M. G., Chung, K. F., et al. (2017) · European Respiratory Journal · doi:10.1183/13993003.02448-2016 · Cited by 55 · see citing works
Microbiome influences on allergy in mice and humans
Marsland, B. J., & Salami, O. (2015) · Current Opinion in Immunology · doi:10.1016/j.coi.2015.07.005 · Cited by 49 · see citing works
Early immunologic changes during the onset of atopic dermatitis
Brunner, P. M. (2019) · Annals of Allergy, Asthma & Immunology · doi:10.1016/j.anai.2019.03.033 · Cited by 42 · see citing works
Preventing peanut allergy through early consumption–ready for prime time?
Gruchalla, R. S., & Sampson, H. A. (2015) · New England Journal of Medicine · doi:10.1056/nejme1500186 · Cited by 23 · see citing works
- Authors
- Du Toit, G., Roberts, G., Sayre, P. H., Bahnson, H. T., Radulovic, S., Santos, A. F., Brough, H. A., Phippard, D., Basting, M., Feeney, M., Turcanu, V., Sever, M. L., Gomez Lorenzo, M., Plaut, M., & Lack, G.
- Affiliations
- National Institute for Health and Care Research (GB)
- Rho (United States) (US)
- National Health Service (GB)
- Immune Tolerance Network (US)
- National Institute of Allergy and Infectious Diseases (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-02-26
- Volume
- 372
- Issue
- 9
- Pages
- 803-813
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4416404
- OpenAlex
- W2133827756
- Cited by
- 2,237
- References
- 32
- Citations by year
- 2026: 134 · 2025: 161 · 2024: 186 · 2023: 223 · 2022: 191 · 2021: 197 · 2020: 237 · 2019: 166 · 2018: 188 · 2017: 214 · 2016: 211 · 2015: 119 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 215.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Food Allergy Research and Education
- King's College Hospital NHS Foundation Trust
- Action Medical Research
- National Institute for Health and Care Research (HHSN272200800029C, NO1-AI-15416)
- Asthma and Lung UK
- King's College London
- National Institutes of Health (n01ai15416-28-0-11, HHSN272200800029C, Z99 AI999999, NO1-AI-15416, AI-15416)
- Medical Research Council (MR/M008517/1)
- National Institute of Allergy and Infectious Diseases (AI-15416, NO1-AI-15416, HHSN272200800029C, N01-AI-015416, UM1AI109565)
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Keywords
- peanut allergy, peanut allergy prevention, early peanut introduction, peanut avoidance, severe eczema, egg allergy, peanut-specific IgE
- MeSH terms
- Diet, Eczema, Female, Humans, Immunoglobulin E, Immunoglobulin G, Infant, Male, Arachis, Risk, Skin Tests, Prevalence, Chi-Square Distribution, Egg Hypersensitivity, Peanut Hypersensitivity, Intention to Treat Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
