The natural history of egg and peanut allergy to age 6 years
Published: May 18, 2022
IgE-mediated food allergy remains a significant public health concern in many countries. Although we know that some food allergy naturally resolves in childhood, little is known about when, and in whom, food tolerance is likely to occur. This is because prospectively collected data on the natural history of food allergy from population-representative studies are lacking.
In the current issue of The Journal of Allergy and Clinical Immunology (JACI), Peters et al report on the natural history of peanut and egg allergy in Australia. The HealthNuts cohort consists of 5276 children recruited at age 1-year who have been followed prospectively. At age 6 years, the whole cohort was invited to participate in clinical allergy assessments and complete questionnaires. Children with challenge-confirmed food allergy at age 1 year (peanut n=156 or raw egg n=471) and children who developed new food sensitizations or food reactions after age 1 year were assessed for food allergy at the 6-year follow-up, informed by clinical history, skin prick tests and oral food challenges.
Although nearly one third of peanut allergy resolved by age 6 (29%, 95% CI 22-38%), the prevalence of peanut allergy at age 6 remained similar to age 1 prevalence, (age 6, 3.1% (95% CI 2.6-3.7% and age 1, 3.1% (95% CI 2.7%-3.6%). This was largely driven by new-onset peanut allergy, which occurred in 0.7% (95% CI 0.5-1.1%) of those who were peanut tolerant at age 1. The majority of egg allergy (89%, 95% CI 85-92%) naturally resolved by age 6 years. Late-onset egg allergy was rare, and the prevalence of egg allergy at 6 years was 1.2% (95% CI 0.9-1.6%).
Infants with larger SPT wheal sizes, early-onset-severe eczema or multiple food sensitizations and/or allergies were less likely to outgrow their egg or peanut allergy by age 6 years. Disease modifying interventions in early life, such as immunotherapy, may be best targeted to these infants as they are less likely to naturally develop tolerance.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
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