Expecting Mothers' Study of Consumption or Avoidance of Peanut and Egg (ESCAPE)

准妈妈食用或避免花生和鸡蛋的研究（ESCAPE）

• 批准号: 10733927
• 负责人: Kirsi Jarvinen-Seppo
• 金额: $ 76.45万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733927
• 关键词: Academy; Address; Adult; Age Months; Allergens; Allergic; Allergic Reaction; Allergic rhinitis; Allergy to eggs; Allergy to peanuts; American; Anaphylaxis; Antibodies; Antigen-Antibody Complex; Antigens; Asthma; Atopic Dermatitis; Basophils; Biological; Biological Markers; Black race; Blood; Breast Feeding; Cattle; Cellular Phone; Child; Childhood; Clinical; Consumption; Data; Development; Diet; Disease; Dose; Enrollment; Environment; Environmental Exposure; Environmental Risk Factor; Enzyme-Linked Immunosorbent Assay; Exclusion; Exposure to; Feeds; Fetus; First Degree Relative; Food; Food Hypersensitivity; General Population; Heredity; Home; Homing; House Dust; Household; Human Milk; Hypersensitivity; IgE; IgG4; Immune response; Immune system; Immunoglobulin A; Immunoglobulin G; Infant; Ingestion; Knowledge; Lactation; Life; Life Style; Mediating; Milk; Modernization; Mothers; Oral; Outcome; Participant; Pediatrics; Perinatal; Peripheral Blood Mononuclear Cell; Population; Pregnancy; Pregnant Women; Prevalence; Prevention; Prevention strategy; Primary Prevention; Randomized; Randomized, Controlled Trials; Risk; Risk Assessment; Risk Factors; Role; Sampling; School-Age Population; Skin; Solid; Surveys; T cell response; T memory cell; T-Lymphocyte; Testing; airborne allergen; arm; cohort; crosslink; dietary; dietary guidelines; dietary restriction; egg; feeding; high risk; high risk infant; high risk population; in utero; infancy; microbial; mother nutrition; novel; offspring; primary outcome; recruit; response; secondary outcome; social media; trial design

PROJECT SUMMARY/ABSTRACT Whereas peanut (PN) allergy is the most common cause of fatal and near-fatal food-allergic reactions in older children and adults, egg and cow’s milk are the most common food triggers of anaphylaxis in infancy. Egg allergy is the most common childhood IgE-mediated food allergy with prevalence rates ranging from 1.3-1.6% in general population up to 20% in high-risk infants. Egg sensitization is a significant risk factor for PN allergy and early aeroallergen sensitization, which can lead to the “atopic march”. Black children are over-represented among children with egg allergy and asthma is more prevalent in children with allergy to egg than any other food. Only 50% develop tolerance to egg by school-age; PN allergy is rarely outgrown. There is a critical “window of opportunity” for the introduction of allergenic solids around 4-6 months in decreasing the risk of food allergy as shown in randomized controlled trials with egg and PN. However, 36% of infants were already sensitized to egg at enrollment and about 9% to PN, excluding them from early introduction; 20% infants were clinically allergic, even anaphylactic, on their first introduction of egg. To be more effective, primary prevention strategies must begin much earlier before sensitization is established, possibly even during pregnancy or breastfeeding. Prior studies are conflicting in the effect of maternal diet including or excluding egg or PN on development of food allergy in infancy. Per the American Academy of Pediatrics, “Current evidence does not support a role for maternal dietary restrictions during pregnancy or lactation”, but randomized controlled trials are lacking. Thus, there is an urgent need to provide mothers with concrete advice on feeding practices based on good quality evidence. The overall objective of this application is to define the role for egg and PN exposure during pregnancy and via human milk in food sensitization and to identify the biomarkers of sensitization or tolerance. We will conduct a nationally-enrolled, randomized controlled, four-arm parallel trial. Mothers pregnant with infants at high risk (with first degree relative with an atopic disease) who intend to breastfeed >3 months will be enrolled utilizing social media and referrals and randomized to either consumption or avoidance of egg and PN containing foods throughout pregnancy and lactation to assess the risk of sensitization to egg and PN at 4 months before introduction of solid foods. In Aim 1, we will determine the effect of maternal dietary egg and PN avoidance during pregnancy and lactation on the risk of egg and PN sensitization in high-risk infants. In Aim 2, we will assess the level of infant oral and environmental exposure to egg and PN. In Aim 3, we will identify the immune responses elicited by maternal diet including or excluding egg and PN during pregnancy and lactation. Knowledge gained from these studies will uncover mechanisms of early-life sensitization necessary to establish maternal dietary guidelines in prevention of food allergy and the atopic march. 1

项目摘要/摘要 而花生（PN）过敏是老年人致命和近乎致命食品反应的最常见原因 儿童和成人，鸡蛋和牛奶是婴儿期过敏反应的最常见食物触发器。鸡蛋过敏 是最常见的童年时期IgE介导的食物过敏，患病率范围从1.3-1.6％ 高危婴儿的人口高达20％。卵灵敏度是PN过敏和早期的重要危险因素 Aeroallergen敏感性，可能导致“特征游行”。黑人儿童在 患有卵过敏和哮喘的儿童对卵过敏的儿童比其他任何食物都更普遍。仅有的 50％的开发耐受能力划分鸡蛋； PN过敏很少长大。有一个关键的“窗口 在4-6个月左右引入过敏固体的机会”，以降低食物过敏的风险 在用鸡蛋和PN进行的随机对照试验中显示。但是，36％的婴儿已经对鸡蛋敏感 在入学率和大约9％的PN，将它们排除在早期介绍之外； 20％的婴儿在临床上过敏， 甚至是过敏反应，在第一次引入鸡蛋时。为了更有效，主要的预防策略必须 在建立敏感性之前，即使在怀孕或母乳喂养期间也可能开始。 先前的研究在母校饮食的影响方面存在冲突 婴儿期的食物过敏。根据美国儿科学院的说法，“当前的证据不支持 孕妇饮食限制在怀孕或哺乳期间的饮食限制”，但缺乏随机对照试验。 这是迫切需要为母亲提供基于良好的喂养实践的具体建议 质量证据。该应用的总体目的是定义鸡蛋和PN暴露的作用 怀孕和通过人类牛奶在食物敏感性中，并确定敏感性或耐受性的生物标志物。 我们将进行全国注射，随机对照，四臂并行试验。母亲怀有 高风险的婴儿（具有特应性疾病的一级亲戚）打算母乳喂养> 3个月 使用社交媒体和推荐招收，并随机分配给鸡蛋和PN的消费或避免 在整个怀孕和哺乳过程中含有食物，以评估4 引入固体食品之前的几个月。在AIM 1中，我们将确定孕妇饮食鸡蛋和PN的影响 在怀孕期间避免了高危婴儿卵和PN传感的风险。在AIM 2中， 我们将评估婴儿口服和环境暴露于卵和PN的水平。在AIM 3中，我们将确定 在怀孕和哺乳期间，由Mater饮食引起的免疫反应包括或排除PN。 从这些研究中获得的知识将发现建立早期敏感性的机制 孕产妇饮食指南预防食物过敏和特应经营游行。 1