The LEAP Peanut Allergy Study: What to Know

Editor

The groundbreaking LEAP (Learning Early About Peanut Allergy) study has experts agreeing about one thing: The way we think about allergy treatment is changing. Results from the study, published in the New England Journal of Medicine_,_suggest that early infant-introduction to peanuts can greatly reduce the chances that a child will develop allergies later on. But more testing is needed on this matter.Dr. James Thompson, who writes about allergies and asthma for HealthCentral, shares what there is to know so far. Much about this study is still left to be tested.

What are the main findings of the study?** Dr. Thompson**: Investigators found that by feeding peanut snacks to young infants at high risk for food allergy, they could reduce the development of peanut allergy by 70 to 80 percent.

Why is that important?** Dr. Thompson**: The incidence of peanut allergy has more than doubled in the last few decades and is the leading cause of death or near death from severe food allergy in the U.S.

When scientists speak of “high-risk” children, what do they mean?** Dr. Thompson**: Generally speaking, children who are at high risk for peanut or other food allergies are those who have a family history of allergic disorders. These include food allergy, allergic rhinitis, asthma or eczema. If the child already has any allergy to foods or one of the above disorders he/she is considered high-risk.

In this study, children were considered high-risk if they had a personal history of egg allergy, severe eczema or both.

How can a person know if their child is high-risk?** Dr. Thompson**: If there is a personal or family history (parents or siblings) of allergic disorders or food allergy, a child would be considered high-risk for developing other food allergies, including peanuts.

Does this mean there’s a cure for allergies?** Dr. Thompson**: No, this does not mean there is a cure for food allergy. This study reflects one basic theme:  Very young children who are at increased risk of  food allergy may have a good chance of preventing or delaying its development. The study does not address children who are already allergic to peanuts.

Should you start feeding your allergic child peanuts?** Dr. Thompson**: No one should start feeding their allergic child peanuts. If your child is peanut-allergic and eats peanut, a severe allergic reaction may occur. This study included only children who were not allergic to peanuts. Although a small subset of children were skin test positive to peanuts (leaning towards peanut allergy), they were proven not to be allergic to it.

What about other allergies?** Dr. Thompson:** Other food allergies were not studied in this report. More clinical investigations need to be done to see if the same strategy will work for foods such as egg, milk or shellfish.

Parents may be frustrated, thinking they may have missed an opportunity--especially since old guidelines recommended restricting peanut at an early age. What do you advise?** Dr. Thompson**: It’s important to explain to parents that research over the last 20 years has changed how we approach food allergies. The increased number of people with food and environmental allergies has led to a higher interest and increased funding for clinical trials that address these problems. I advise parents to continue to learn more about food allergy by reading about it and discussing it with their doctors. I also warn them not to make decisions about treatment or diet changes until discussing it with their doctor.

Should all infants be fed peanuts?** Dr. Thompson**: No. Only high-risk infants were under investigation in this study. We don’t know the impact of feeding all young children peanut snacks. We know that intentional restriction of peanuts early on (before any signs of food allergy) is probably not a good thing.

If a person’s child is less than 11 months old. What should they do?** Dr. Thompson**: Guidelines for changes food allergy prevention and treatment have not yet been published. Talk to your doctor  about seeing an allergist for consultation. The first steps should include evaluation and testing.

When will official guidelines for prevention become available?** Dr. Thompson**: There is no set date I’m aware of, but the expectation is they should be available later on this year or by next year.

What’s next?** Dr. Thompson**: Future studies will focus on the same children in this study or similar studies, and follow them for several more years.  We need to see what happens to peanut sensitivity over time, whether regular consumption continues or stops.  Further studies need to address older children who are at high-risk, and children who are already peanut allergic. We also need to see if other food allergies can be prevented using the same strategy.

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