INTRODUCTION
eczema
INFECTIOUS DISEASES, PEANUT ALLERGY, ALLERGY, EGG ALLERGY, REGRESSION, PEANUT ALLERGY, ECZEMA
Despite strong findings favoring early peanut introduction, there are gaps in our knowledge base, especially with respect to whether to target high risk or normal populations and age of intervention. It is therefore not surprising that specialist organizations provide different guidelines regarding peanut introduction. Most recently, the European Academy of Allergy and Clinical Immunology (EAACI) guidelines gave a conditional recommendation for the introduction of peanut to the whole infant population as the strength of the evidence was considered to be moderate.Until recently, UK and US guidelines recommended avoidance of peanut in infancy to prevent the development of peanut allergy.An observational study comparing Israeli and UK children found that the early introduction and regular consumption of peanut in infancy was strongly protective against developing peanut allergy.The Learning Early About Peanut allergy (LEAP) study recruited infants at high risk of developing peanut allergy aged 4–10 months and showed an 81% relative reduction in peanut allergy prevalence between the peanut consumption and avoidance groups.Despite the LEAP study demonstrating that earlier age of introduction of peanut reduced peanut allergy in high‐risk participants and subsequent changes to the American infant feeding guidelines,When adherence to an intervention is lacking, patients and investigators have been shown to prefer bias‐corrected estimates of an intervention's effectiveness across risk subgroups using valid per‐protocol (PP) effect estimates.Based on evidence from the LEAP study, and supported by results of the EAT study, the National Institute of Allergy and Infectious Diseases (NIAID) and a number of other specialist national societies issued guidelines recommending the early introduction of peanut for peanut allergy prevention. The evidence cited to support the NIAID recommendations in different eczema subgroups is based on those LEAP infants recruited with egg allergy (who had varying levels of eczema) and also from the EAT study participants, most of whom had no or mild to moderate eczema at enrollment.The pooled analysis of data from the LEAP and EAT cohorts presented here provides a unique opportunity to look at the effect of the early introduction of peanut across a variety of risk strata (presence of eczema and its severity, enrolment sensitization status to peanut and ethnicity), while implementing regression adjustment methodologies to estimate the causal effect of oral tolerance induction when adhered to.