Introduction of Peanuts in Younger Siblings of Children With Peanut Allergy: A Prospective, Double-blinded Assessment of Risk, of Diagnostic Tests, and an Analysis of Patient Preferences
Bibliographic record
Abstract
The purpose of the Finding the Risk of Anaphylaxis and Testing Rational In youngEr Siblings (FRATRIES) study was to determine the risk of anaphylaxis, the predictive values of peanut allergy tests, and parents’ preferences in the context of peanut introduction in the younger siblings of peanut-allergic children.The study cohort included 154 peanut-naïve children (median age of 23 months) who each had an older sibling with a diagnosis of peanut allergy. Participants were recruited in Canada through advertising in allergy clinics and through local food allergy web-based communities. Reference cohorts included parents of (1) peanut-naïve children from nonallergy pediatric clinics and (2) peanut-allergic children.This was a prospective cohort study. Peanut-naïve younger siblings underwent double-blind skin prick testing (SPT) followed by parent-led peanut introduction. At least 2 g of peanut protein was ingested to consider the introduction complete. Subjects were observed in a clinic for 2 hours. A phone call 24 hours later inquired about delayed reactions. Parents were then advised to introduce peanut in the younger child’s diet at least once a week. A phone follow-up occurred 1 year later. Questionnaires were dispensed prior to and up to a year after peanut introduction to investigate parental preferences with regard to peanut introduction in this subgroup.Eight participants (5.2%) had an unequivocal IgE-mediated reaction upon peanut introduction, including 5 with anaphylaxis. Peanut-allergic participants were significantly older than the rest of the cohort (median age of 4.0 vs 1.9 years, P = .04). The negative predictive values of SPT with peanut extract, peanut butter, and peanut-specific IgE were 99%, 100%, and 100%, respectively. The absolute positive predictive values of peanut extract SPT, peanut butter SPT, and specific IgE were 88%, 72%, and 62%, respectively. Peanut introduction at home without supervision was associated with high levels of parental anxiety in parents with a previously peanut-allergic child (median of 8.4 on a 10-point Likert scale), compared with introduction under supervision without testing (median of 3.8, P < .001) and home introduction after negative testing (median of 4.3, P < .001). If a provider recommended home peanut introduction without prior testing, 82% of parents would keep avoiding the food.Siblings of children with peanut allergy have an increased risk of anaphylaxis upon peanut introduction, with a potentially higher risk for older children who delayed introduction. Parents with a previously peanut-allergic child have significant anxiety regarding introducing peanut without prior skin testing or without supervision.This study supports previous studies showing that younger siblings of peanut-allergic children have a higher rate of peanut allergy. Recent NIAID guidelines for the prevention of peanut allergy recommend early introduction of peanut for high-risk children but do not make specific recommendations for siblings without other risk factors. In our practice, we do specifically recommend early and consistent peanut introduction in younger siblings of peanut-allergic patients, usually with prior testing. As highlighted in this study, parental anxiety regarding a possible reaction in the younger sibling, as well as the peanut-allergic child, is likely to impact home peanut introduction unless it is done with some level of medical supervision.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".