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Peanut Allergy 2009

  • 1. Narissara Suratannon,MD. What's New in Peanut Allergy?
  • 2.
  • 3.
  • 4.
  • 5. Parent-reported adverse food reactions in Hong Kong Chinese pre-schoolers:epidemiology, clinical spectrum and risk factors Leung et al.Ped AI 2009: 20: 339–346.
  • 6. Chieng et al. Clinical and Experimental Allergy 2007: 37 : 1055–61
  • 7. Legumes Bean Pea Lentil Peanut Lupine
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 15.
  • 16.
  • 17.
  • 18. Maillard reaction JACI 2000;106:763-8 (MRPs)
  • 19. JACI 2000;106:763-8 JACI 2001;107:1077-81
  • 21. Clin Exp Aller.2000: 30 ; 1540 - 46
  • 22. Clin Exp Aller.2000: 30 ; 1540 - 46
  • 23. Roberts et al.JACI 2005;115:1291-6 Wheal size >= 8 mm or >= 15 kUA/L of specific IgE was correlate with positive oral challenge test of peanut allergy Outcome No compare group Compare What size of skin prick test and which levels of specific IgE that will be correlate with oral challenge test Intervention Pt. under 16 yr. who was suspected FA (n=121) and from ALSPAC study who SPT +ve (n=40) Patient
  • 24. PPV = 94.4%, S pecificity = 98.5% , NPV = 57.3% , sensitivity = 25.4%. Roberts et al.JACI 2005;115:1291-6
  • 25.
  • 26.
  • 27.
  • 28. Natural History of Peanut Allergy
  • 29.
  • 30. JACI 2008;121:731-6 Skin prick test >= 6 mm and specific IgE to peanut >= 3 kUA/L before 2 years of age are predictors of persistent peanut allergy Outcome Remitters (n=49) Compare Find out what are predictors of remission (clinical, lab tests) Intervention Children under 2 years who had peanut allergy ; non-remitters (n= 218) Patient
  • 32.
  • 33. Factors associated Developing of Peanut Allergy
  • 34.
  • 35. NEJM 2003:348;977-85 Maternal peanut consumption , positive cord-blood specific IgE to peanut :not increased risk of PA but .. Outcome Eczematous children without peanut allergy (n=70) , healthy controls (n=140) Compare Find factors associated with the development of peanut allergy Intervention Children with had peanut allergy aged under 38 months (n=49,36) from ALPSAC study Patient (questionaire, OC)
  • 37.
  • 38. FAQ : prevalence of peanut allergy 10,786 children aged 4-19 years in 24 schools (13 in UK, 11 in Israel) 8,600 children 1960 not-returned 226 was excluded Israel = 4657 UK = 3943 FFQ : mothers & infants consumption questionnaire Mothers of Jewish infants aged 8-14 months (n=176) Israel = 99 UK = 77 Du Toit et al.JACI 2008;122:984-91 81.8%
  • 39.
  • 42. The largest and most significant difference between UK and Isarel was in age of introduction of peanut (P<0.001) Du loit et al.JACI 2008;122:984-91
  • 43. Could different methods of preparing peanut be responsible for different rates? Du loit et al.JACI 2008;122:984-91 Summery : there was a strong inverse association between peanut consumption in infancy and prevalence of PA in childhood
  • 44. Fox et al.JACI 2009;123:417-23 Levels of peanut exposure by different routes between groups Outcome Eczematous children with egg allergy but not sensitize to peanut (n=160) , healthy controls (n=150) Compare Peanut exposure during first year of life during pregnancy, lactation and household peanut consumption Intervention (questionnaire before SPT) Eczematous children with peanut allergy aged under 48 months (n= 133) Patient
  • 45.
  • 46. Fox et al.JACI 2009;123:417-23
  • 47. Fox et al.JACI 2009;123:417-23
  • 48.
  • 49.
  • 50.
  • 51.
  • 52. Clark et al.Allergy 2009.Feb 17; ePub ahead of Print
  • 53. 6 weeks after final dose Clark et al.Allergy 2009.Feb 17; ePub ahead of Print
  • 54.
  • 55.
  • 56. Thank You for Your Attention