LEAP study update - Twitter summary from #CSACI15 meeting

Twitter summary made possible by:
@dranneellis
@allergydoc4kidz
@igecpd
@erika_ladouceur
@drloriconnors
@drdougmackmd

Dr George du Toit @GoAllergy presenting a #LEAP study update. Dr George du Toit providing some updates from the #LEAP study and an overview of the LEAP-ON study. The LEAP ON study is now done...but the data is not yet available.

LEAP update - in Israel infants eat 24 g of peanut per month. #LEAP study inspired by Israel study that showed those infants with the highest amount of peanuts lowest allergy risk. The amount of peanut chosen in LEAP based on the upper quartile of what children in Israel were eating in childhood. Bamba was used as one of the early and main sources of peanut but peanut butter was also being eaten in #LEAP.

No differences between growth, weight or BMI in the consumption vs avoidance group in #LEAP study. Growth/weight the same in the PN consumption and avoidance groups over the 5 years.

One participant in #LEAP had peanut induced FPIES (food protein induced enterocolitis).

Blood IgE testing generates lots of noise, use skin testing instead

Skin prick test diameters to peanut steadily increased in the peanut avoidance group of #LEAP.

Up to 25 % of skin test neg participants in #LEAP had not insignificant specific IgE to peanut - thus @GoAllergy says don't do it. IgE should not be used to decide allergenic food introduction. @GoAllergy IgE testing generates lots of noise.

Blood IgG and IgG4 to peanut were also measured with levels increased at beginning of eating peanut then falling. Very early rise in PN IgG after introduction of peanut, gradually starts to drift downwards after a couple of years.

LEAP-On study

LEAP-On study to clarify whether early regular exposure has resulted in true long-term tolerance, or transient non-responsiveness.

The vast majority of children excluded from #LEAP as being probably PN allergic...turned out to be PN allergic at age 5.

The window for sensitization to peanut is narrow - intervene early - feed early. The older the infant, or the more severe their eczema, the greater the risk for PN sensitization. The more severe the eczema, the more likely the sensitization. The longer the duration of eczema, the more likely the peanut sensitization.

CHILD study showed delayed intro of PN to 18 mos = 4x risk +SPT and 2x risk dx'd PN allergy.

Round table discussion on incorporating early peanut introduction into practice. Opportunities and barriers to LEAP implementation.

Round table re: LEAP Level 1 evidence to introduce peanut early 4-11 months.

Re: LEAP barriers to implementation - do we really need to screen all babies ? This is not consistent with our guidelines. The position of CSACI is to not skin test prior to ingestion - the. AAAAIs recommendation is the same.

Dr Greenhawt: #LEAP study extrapolated to US population with eczema could mean early peanut introduction could prevent 50,000 cases. We should not recommend screening for all foods including peanut. Allergists need to do more oral challenges.

Dr Greenhawt points out that we have vaccination timeframes/clinics in pediatrics...should we have food introduction clinics?

Approximate number of board certified Allergists in US: 5440 Canada: 260 UK (via @BSACI_Allergy) : fewer than 20.

Panel: There's been a paradigm shift about food introduction in high risk children with peanut...the question is implementation.

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