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）

基本信息

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
项目类别：
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

项目摘要

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

项目概要/摘要花生（PN）过敏是老年人致命和近乎致命的食物过敏反应的最常见原因对于儿童和成人，鸡蛋和牛奶是婴儿期过敏反应的最常见食物诱因。是最常见的儿童 IgE 介导的食物过敏，患病率一般为 1.3-1.6% 高达 20% 的高危婴儿中，鸡蛋过敏是 PN 过敏和早期过敏的重要危险因素。空气过敏原致敏，可能导致“特应性游行”，黑人儿童中比例过高。儿童对鸡蛋过敏和哮喘仅对鸡蛋过敏的儿童比对任何其他食物过敏的儿童更常见。 50% 的人在学龄前就对鸡蛋产生了耐受性；PN 过敏很少会随着年龄的增长而消失。大约 4-6 个月引入致敏固体可降低食物过敏风险的机会” 鸡蛋和 PN 的随机对照试验显示，36% 的婴儿已经对鸡蛋过敏。在入组时，约 9% 的婴儿患有 PN，排除早期引入的婴儿；20% 的婴儿有临床过敏，即使是过敏，在第一次引入鸡蛋时，为了更有效，一级预防策略也必须如此。在过敏发生之前就开始，甚至可能在怀孕或哺乳期间。先前的研究对于母亲饮食中包含或不包含鸡蛋或 PN 对胎儿发育的影响存在矛盾。根据美国儿科学会的说法，“目前的证据不支持婴儿期食物过敏”。母亲在怀孕或哺乳期间的饮食限制”，但缺乏随机对照试验。因此，迫切需要根据良好的喂养习惯向母亲提供具体的喂养建议。该应用的总体目标是确定鸡蛋和 PN 暴露期间的作用。怀孕和通过母乳进行食物致敏，并确定致敏或耐受的生物标志物。我们将进行一项全国招募、随机对照、四臂平行试验。打算母乳喂养 > 3 个月的高风险婴儿（具有第一相对程度的特应性疾病）将被利用社交媒体和推荐进行登记，并随机选择食用或避免食用鸡蛋和 PN 整个怀孕和哺乳期含有的食物，以评估 4 岁时对鸡蛋和 PN 过敏的风险在目标 1 中，我们将确定母亲膳食鸡蛋和 PN 的影响。在目标 2 中，怀孕和哺乳期间避免鸡蛋和 PN 过敏的风险。我们将评估婴儿经口和环境接触鸡蛋和 PN 的水平。在目标 3 中，我们将确定怀孕和哺乳期间母亲饮食（包括或不包括鸡蛋和 PN）引起的免疫反应。从这些研究中获得的知识将揭示早期生命敏感化的机制，这是建立预防食物过敏和特应性过敏的母亲饮食指南。 1