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Reduced peanut sensitization with maternal peanut consumption and early peanut introduction while breastfeeding

Published online by Cambridge University Press:  09 December 2020

Meghan B. Azad Open the ORCID record for Meghan B. Azad [Opens in a new window] ,
Christoffer Dharma ,
Elinor Simons ,
Maxwell Tran ,
Myrtha E. Reyna ,
Ruixue Dai ,
Allan B. Becker ,
Jean Marshall ,
Piushkumar J. Mandhane  and
Stuart E. Turvey
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Meghan B. Azad*
Affiliation:
Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
Christoffer Dharma
Affiliation:
Department of Medicine, McMaster University, Hamilton, ON, Canada
Elinor Simons
Affiliation:
Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
Maxwell Tran
Affiliation:
Department of Medicine, McMaster University, Hamilton, ON, Canada
Myrtha E. Reyna
Affiliation:
Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Ruixue Dai
Affiliation:
Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Allan B. Becker
Affiliation:
Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
Jean Marshall
Affiliation:
Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
Piushkumar J. Mandhane
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
Stuart E. Turvey
Affiliation:
Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
Theo J. Moraes
Affiliation:
Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Diana L. Lefebvre
Affiliation:
Department of Medicine, McMaster University, Hamilton, ON, Canada
Padmaja Subbarao
Affiliation:
Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Malcolm R. Sears
Affiliation:
Department of Medicine, McMaster University, Hamilton, ON, Canada
*
Address for correspondence: Meghan B. Azad PhD, 501G 715 McDermot Ave, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, CanadaR3E 3P4. +1-204-975-7754. Email: Meghan.Azad@umanitoba.ca
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Abstract

New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother–child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14–0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01–0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this “triple exposure” hypothesis.

Keywords

Breastfeedinglactationfood allergydevelopmental origins of health and diseaseCHILD Cohort Study
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 12 , Issue 5 , October 2021 , pp. 811 - 818
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Copyright
© The Author(s), 2020. Published by Cambridge University Press in association with International Society for Developmental Origins of Health and Disease

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