Longitudinal Dynamics of The Gut Microbiome and Metabolome in Peanut Allergy Development

Investigate the relationship between gut microbiome and metabolome dynamics in relation to development of peanut allergy (PA).This study included 122 children from the multicenter National Institute of Allergy and Infectious Diseases Consortium for Food Allergy Research Observational Study that provided stool samples at defined points in both infancy and midchildhood. Patients met inclusion criteria if they provided stool samples at baseline and at mid-childhood, and if they had no known peanut allergy, but with risk factors for PA, such as likely egg allergy, milk allergy, and/or severe atopic dermatitis with a positive egg and/or milk skin prick test at enrollment.This was a longitudinal, integrative study of patients in a multicenter cohort with allergy risk factors but NPA that were followed through midchildhood at 6-to-12-month intervals. The gut microbiome and metabolome were analyzed and profiled using 16S rRNA sequencing, measurements of short chain fatty acid measurements, and global metabolome profiling of fecal samples collected at points in infancy and mid-childhood.Of the 122 children who met criteria, 35 (29%) developed PA by mid-childhood (mean age of 9 years). Less diversity in the infant gut microbiome was associated with PA development. Changes in relative abundance of Clostridium sensu stricto 1 sp and Bifidobacterium sp over time were associated with development of PA. Clostridium sensu stricto 1 sp was found to have lower concentrations in infancy, then higher at mid-childhood in children who developed PA when compared with those who did not. The relative abundance of Bifidobacterium sp demonstrated the opposite dynamic. Decreased levels of butyrate and isovalerate over time were noted in patients who developed PA. Metabolites noted in patients who developed PA were clustered within the histidine metabolism pathway.There are distinct patterns in the temporal dynamics of the gut microbiome and metabolome in early childhood in children who develop PA. These patterns can be useful to consider when caring for patients at risk for PA.Peanut is one of the most common food allergens in children, and rarely outgrown. Although there are treatments available to decrease the likelihood of severe reactions to peanut in PA patients, there is no cure at this time. While this study highlighted a small population of PA patients, it provided insight about risk factors in the gut microbiota and metabolites that may play a role in development of this allergy over time, making way for emerging strategies to possibly prevent peanut allergy in patients otherwise at risk.