Peanut Sensitization is Associated with Greater Respiratory Morbidity in Preschool Children with Comorbid Asthma

Peanut sensitization occurs early in childhood and persists in the majority of affected children. Asthma is a frequent comorbidity, affecting nearly half of peanut-sensitized young children. Given the rising prevalence of peanut sensitization and the ability of peanut proteins to provoke a potent Type-2 immune response, this study evaluated whether peanut sensitization is associated with greater respiratory morbidity in children with comorbid asthma. Baseline and follow-up data from four NHLBI multi-center clinical trials involving preschool participants ages 12-71 months with asthma were merged for the analysis. Children were assigned to one of three groups based on allergen sensitization results. Primary outcomes were the occurrence of any asthma exacerbation treated with systemic corticosteroids during the study observation period and the annualized rate of asthma exacerbations. The sample consisted of 1,372 preschool children with asthma (no sensitization to aeroallergens or peanut, n=739; sensitization to aeroallergens only, n=388; sensitization to aeroallergens and peanut, n=245). During follow-up, children with sensitization to aeroallergens and peanut had a greater occurrence of any asthma exacerbation treated with systemic corticosteroids (34.0% vs. 38.9% vs. 51.9%, p<0.001) and a higher annualized exacerbation rate (0.54±0.95 vs. 0.61±.94 vs. 0.80±1.07, p=0.002). In exploratory analyses, children with sensitization to aeroallergens and peanut also had more days with asthma symptoms and poorer quality of life. Peanut sensitization is associated with poorer asthma outcomes in preschool children with comorbid asthma. Comorbid asthma may be a risk factor for impaired health-related quality of life in peanut sensitized children.