Background: Early peanut (PN) introduction may prevent peanut allergy in at-risk children. Little data exists regarding early introduction for infants with large skin prick tests (SPT) or high peanut IgE levels, who are not often offered oral food challenges (OFC). Objective: To retrospectively assess tolerance of a low dose (1 gram) of peanut in infants at risk for peanut allergy, including highest-risk infants (HRI) with SPT wheal >7mm. Methods: We reviewed PN OFCs performed over a two-year period at our pediatric allergy center. Low-dose PN OFC was offered to all infants considered at risk for PN allergy, regardless of peanut SPT or IgE results. Dosing was escalated after OFC at home. Results: Of infants with SPT wheal <=4 mm (n=30), 29 (97%) were low-dose-tolerant. Of those with SPT >4 mm (n=40), 25 (63%) were low-dose-tolerant, and Ara h2 IgE was significantly lower compared to non-tolerant individuals (median 0.62 versus 6.49 kU/L, p<0.05). Among HRI with SPT >7mm (n=22), 12 (55%) were tolerant, with median SPT 9mm (range 8-11mm), PN-IgE 1.1 kU/L (0.3-10.7 kU/L) and Ara h2 1.6 kU/L (0-9.57 kU/L). Age, sex, race, eczema, and egg sensitization did not affect tolerance regardless of SPT size. After 3-6 months, most infants tolerant at OFC were gradually able to consume larger doses of PN. Conclusion: Many infants with PN-SPT >4mm are tolerant of low-dose peanut, and Ara h 2 IgE may be predictive for clinical tolerance among these infants. Low-dose PN-OFC with gradual updosing may help prevent PN allergy in a greater number of at-risk infants.

中文翻译：

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花生口服食品挑战后低剂量耐受性的高风险婴儿

背景：早期引入花生（PN）可以预防高危儿童的花生过敏。对于皮肤刺试验（SPT）较大或花生IgE水平高的婴儿，较不经常进行口服食物挑战（OFC）的婴儿早期引入的数据很少。目的：回顾性评估低剂量（1克）花生对有花生过敏风险的婴儿的耐受性，包括SPT≥7mm的高危婴儿（HRI）。方法：我们回顾了在儿童过敏中心进行的为期两年的PN OFC。无论花生SPT或IgE结果如何，均向所有有PN过敏风险的婴儿提供低剂量PN OFC。在家中进行OFC后剂量增加。结果：SPT≤4毫米（n = 30）的婴儿中，有29例（97％）对低剂量耐受。在SPT> 4 mm（n = 40）的患者中，有25（63％）是低剂量耐受的，与非耐受性个体相比，Ara h2 IgE显着降低（中位数为0.62 vs 6.49 kU / L，p <0.05）。在SPT> 7mm（n = 22）的HRI中，有12位（55％）可以耐受，中位SPT为9mm（范围8-11mm），PN-IgE 1.1 kU / L（0.3-10.7 kU / L）和Ara h2 1.6 kU / L（0-9.57 kU / L）。无论SPT大小如何，年龄，性别，种族，湿疹和卵敏化均不会影响耐受性。3-6个月后，大多数对OFC耐受的婴儿逐渐能够摄入更大剂量的PN。结论：许多PN-SPT> 4mm的婴儿对低剂量花生耐受，并且Ara h 2 IgE可以预测这些婴儿的临床耐受性。逐渐增加剂量的低剂量PN-OFC可能有助于预防更多高危婴儿的PN过敏。在SPT> 7mm（n = 22）的HRI中，有12位（55％）可以耐受，中位SPT为9mm（范围8-11mm），PN-IgE 1.1 kU / L（0.3-10.7 kU / L）和Ara h2 1.6 kU / L（0-9.57 kU / L）。无论SPT大小如何，年龄，性别，种族，湿疹和卵敏化都不会影响耐受性。3-6个月后，大多数对OFC耐受的婴儿逐渐能够摄入较大剂量的PN。结论：许多PN-SPT> 4mm的婴儿对低剂量花生耐受，并且Ara h 2 IgE可以预测这些婴儿的临床耐受性。逐渐增加剂量的低剂量PN-OFC可能有助于预防更多高危婴儿的PN过敏。在SPT> 7mm（n = 22）的HRI中，有12位（55％）可以耐受，中位SPT为9mm（范围8-11mm），PN-IgE 1.1 kU / L（0.3-10.7 kU / L）和Ara h2 1.6 kU / L（0-9.57 kU / L）。无论SPT大小如何，年龄，性别，种族，湿疹和卵敏化都不会影响耐受性。3-6个月后，大多数对OFC耐受的婴儿逐渐能够摄入较大剂量的PN。结论：许多PN-SPT> 4mm的婴儿对低剂量花生耐受，并且Ara h 2 IgE可以预测这些婴儿的临床耐受性。逐渐增加剂量的低剂量PN-OFC可能有助于预防更多高危婴儿的PN过敏。不论SPT大小如何，卵敏化都不会影响耐受性。3-6个月后，大多数对OFC耐受的婴儿逐渐能够摄入较大剂量的PN。结论：许多PN-SPT> 4mm的婴儿对低剂量花生耐受，并且Ara h 2 IgE可以预测这些婴儿的临床耐受性。逐渐增加剂量的低剂量PN-OFC可能有助于预防更多高危婴儿的PN过敏。不论SPT大小如何，卵敏化都不会影响耐受性。3-6个月后，大多数对OFC耐受的婴儿逐渐能够摄入更大剂量的PN。结论：许多PN-SPT> 4mm的婴儿对低剂量花生耐受，并且Ara h 2 IgE可以预测这些婴儿的临床耐受性。逐渐增加剂量的低剂量PN-OFC可能有助于预防更多高危婴儿的PN过敏。