Early Peanut Introduction: Translation to Clinical Practice (EPI)

The recent finding that early introduction of peanut can prevent ~70-90% of peanut allergy is a major step towards prevention of food allergy. However, because that finding was from a clinical trial in a very select population, there are several major questions that must be answered in order to implement these findings into clinical practice without causing more harm than good. These questions include who, if anyone, should be screened prior to early introduction for peanut allergy, how this screening should be done, and what quantity of peanut ingestion is needed to prevent peanut allergy. The goal of this project is to answer these critical questions so that the potential of these recent findings can be realized. To that end, 400 infants at high-risk of peanut allergy will be enrolled. These infants will be given a peanut skin prick test, peanut food challenge and have blood drawn for measurement of peanut IgE, and then will be followed for assessment of peanut consumption and development of peanut allergy until 3 years of age.

Study Overview

• Status: Completed
• Conditions: Peanut Allergy
• Intervention / Treatment: Other: Peanut in diet

Detailed Description

400 infants aged 4-11 months from three high risk groups will be enrolled in a prospective observational study. All subjects will have a baseline research clinic visit, where they will be given a peanut skin prick test, peanut food challenge and have blood drawn for measurement of peanut immunoglobulin E (IgE). Based on the baseline oral food challenge, the participants will be advised to begin introducing peanut following the current practice guidelines. Participants will then be followed until 30 months of age with two clinic visits and regular monitoring of peanut consumption.

• Study Type: Observational
• Enrollment (Actual): 333

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins Hospital
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 months to 11 months (Child)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Infants age 4 monhts to 11 months

Description

Inclusion Criteria:

• Infants age 4-11 months

• Have at least one of the following criteria:

  1. physician diagnosis of milk, egg or other non-peanut food allergy,
  2. at least moderate eczema as defined by a SCORAD score of at least 25 on present or previous evaluation, OR a rash that required the application of topical creams or ointments containing corticosteroids or calcineurin inhibitors and occurred on at least 7 days on two separate occasions, or is described by the parent or guardian as "a bad rash in joints or creases" or "a bad itchy, dry, oozing or crusted rash".
  3. a first degree relative (parents or siblings) with either a physician diagnosis of IgE mediated peanut allergy OR reported history of symptoms consistent with IgE mediated peanut allergy (onset of symptoms within 2 hours of exposure, AND symptoms of urticaria, angioedema, wheezing, vomiting, or abdominal pain with exposure, AND no subsequent exposure to peanut without symptoms).

Exclusion Criteria:

• History of feeding problems
• History of eosinophilic gastro-intestinal disease
• Significant medical history (aside from eczema, food allergy or history of wheeze)
• History of peanut reactions or tolerance prior to baseline screening

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of infants with peanut allergy at baseline	Percentage of infants who fail the peanut challenge at the baseline visit	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compare results of peanut skin prick test to peanut challenge outcomes among the high risk infants	Results of peanut skin prick tests compared to peanut challenge among the high risk infants	baseline
Compare results of anti-peanut IgE testing to peanut challenge outcomes among the high risk infants	Results of anti-peanut IgE testing compared to peanut challenge among the high risk infants	baseline
Compare results of anti-Ara h2 IgE testing to peanut challenge outcomes among the high risk infants	Results of anti-Ara h2 IgE testing compared to peanut challenge among the high risk infants	baseline
Percent of infants who develop peanut allergy by age 30 months	Percent of infants at risk who develop peanut allergy during the study window (30 months)	30 months
Percent of infants with a skin prick test of 3 mm or more at baseline who develop peanut allergy	Percent of infants with a positive skin prick test who develop peanut allergy during the study window (30 months)	30 months
Peanut levels in bedroom dust as measured by home dust collection	Peanut levels will be tested by Elisa in bed dust collected by patients using a DUSTREAM(R) vacuum adaptor.	18 months

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: National Institute of Allergy and Infectious Diseases (NIAID); Massachusetts General Hospital
• Investigators: Principal Investigator: Corinne Keet, MD, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2016
• Primary Completion (Actual): October 31, 2022
• Study Completion (Actual): March 24, 2023

Study Registration Dates

• First Submitted: January 10, 2017
• First Submitted That Met QC Criteria: January 10, 2017
• First Posted (Estimate): January 12, 2017

Study Record Updates

• Last Update Posted (Actual): April 11, 2023
• Last Update Submitted That Met QC Criteria: April 10, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: atopic dermatitis; eczema; peanut allergy; food allergens; infant food allergy testing; skin prick testing; peanut IgE; early peanut introduction; food allergy prevention
• Additional Relevant MeSH Terms: Immune System Diseases; Food Hypersensitivity; Hypersensitivity, Immediate; Nut and Peanut Hypersensitivity; Hypersensitivity; Peanut Hypersensitivity
• Other Study ID Numbers: IRB00095833; 1U01AI125290 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO