British Journal of Nutrition

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British Journal of Nutrition (2010), 103:1278-1286 Cambridge University Press
Copyright © The Authors 2010
doi:10.1017/S000711450999376X

Systematic Review

Peanut sensitisation and allergy: influence of early life exposure to peanuts


Rachel L. Thompsona1, Lisa M. Milesa1 c1, Joanne Lunna1, Graham Devereuxa2, Rebecca J. Dearmana3, Jessica Strida4 and Judith L. Buttrissa1

a1 British Nutrition Foundation, High Holborn House, 52–54 High Holborn, London WC1V 6RQ, UK
a2 Department of Environmental and Occupational Medicine, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
a3 Faculty of Life Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK
a4 Peter Gorer Department of Immunobiology, King's College London School of Medicine at Guy's Hospital, London SE1 9RT, UK
Article author query
thompson rl [PubMed]  [Google Scholar]
miles lm [PubMed]  [Google Scholar]
lunn j [PubMed]  [Google Scholar]
devereux g [PubMed]  [Google Scholar]
dearman rj [PubMed]  [Google Scholar]
strid j [PubMed]  [Google Scholar]
buttriss jl [PubMed]  [Google Scholar]

Abstract

The aim of the present systematic review was to evaluate the influence of early life exposure (maternal and childhood) to peanuts and the subsequent development of sensitisation or allergy to peanuts during childhood. Studies were identified using electronic databases and bibliography searches. Studies that assessed the impact of non-avoidance compared with avoidance or reduced quantities of peanuts or peanut products on either sensitisation or allergy to peanuts, or both outcomes, were eligible. Six human studies were identified: two randomised controlled trials, two case–control studies and two cross-sectional studies. In addition, published animal and mechanistic studies, relevant to the question of whether early life exposure to peanuts affects the subsequent development of peanut sensitisation, were reviewed narratively. Overall, the evidence reviewed was heterogeneous, and was limited in quality, for example, through lack of adjustment for potentially confounding factors. The nature of the evidence has therefore hindered the development of definitive conclusions. The systematic review of human studies and narrative expert-led reviews of animal studies do not provide clear evidence to suggest that either maternal exposure, or early or delayed introduction of peanuts in the diets of children, has an impact upon subsequent development of sensitisation or allergy to peanuts. Results from some animal studies (and limited evidence from human subjects) suggest that the dose of peanuts is an important mediator of peanut sensitisation and tolerance; low doses tend to lead to sensitisation and higher doses tend to lead to tolerance.

(Received February 02 2009)

(Revised July 15 2009)

(Accepted September 28 2009)

(Online publication January 26 2010)

Key Words:Peanut allergy; Diet; Prenatal exposure; Childhood exposure

Correspondence:

c1 Corresponding author: Ms Lisa M. Miles, fax +44 20 7404 6747, email l.miles@nutrition.org.uk

Footnotes

Abbreviations: COT, Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment; RCT, randomised controlled trial