27 April 2016
Peanut allergy is a growing public health problem. In 1999, peanut allergy was estimated to affect 0.4% of children in the United States and 0.7% of adults. By 2010 (just 11 years later), peanut allergy prevalence had increased to approximately 2% among children.
Peanut allergy is the leading cause of death related to food-induced anaphylaxis in the United States
Although overall mortality from food-induced anaphylaxis is low, the fear of life-threatening anaphylactic reactions contributes significantly to the medical and psychosocial burden of disease. From my own experience as an allergy specialist, I’ve witnessed this stress firsthand, from kids constantly worried that they may eat the wrong thing and go into shock, to parents feeling that they have to always be on the lookout for “dangerous” foods.
Groundbreaking study paves the way for new thinking about peanut allergy
In February 2015, the New England Journal of Medicine published the results of the “Learning Early about Peanut Allergy” (LEAP) trial. This trial was based on a prior observation that the prevalence of peanut allergy was 10-fold higher among Jewish children in the United Kingdom compared to Israeli children of similar ancestry. In Israel, peanut-containing foods are usually introduced in the diet (as a boiled peanut product) when infants are approximately 7 months of age, and consumed in substantial amounts, whereas in the United Kingdom children do not typically consume any peanut containing foods during their first year of life. This corresponds to the practice in the U.S., where peanuts are generally not consumed until age 3.
The LEAP trial randomized 640 children, 37 between 4 and 11 months of age, with severe eczema, egg allergy or both to consume or avoid peanut-containing foods until 5 years of age.
The LEAP study (Learning Early about Peanut Allergy) results: 13.7% of children in the peanut-avoidance group developed allergy while only 1.9% in the consumption group did so.
Subsequently, a follow-up study, “LEAP–On,” reported at the March 2016 meeting of the American Academy of Allergy, Asthma & Immunology that those children fed peanuts early in life did not develop allergic reactions to peanuts compared to those who avoided peanuts. In fact, even if these non-allergic children stopped eating peanuts after 5 years, their tolerance (i.e. lack of allergy) persisted for the next year.
Conclusion: Exposing children to peanuts early in life may actually prevent peanut allergy
These studies suggest that when parents expose their children to peanuts at an early age (4-6 months) rather than avoiding them, this may prevent peanut allergy. As the results of these two studies become more widely accepted, this method of early exposure may be something pediatricians recommend in the future to prevent peanut (and perhaps other food) allergies. In fact, the American Academy of Allergy, Asthma & Immunology is suggesting the creation of new guidelines for health professionals regarding this new information.
The thinking concerning children’s peanut allergies is definitely changing, so stay tuned!