Striking new evidence shows that
feeding peanuts to high-risk children in their first year of life can reduce the likelihood of peanut allergy years later by up to 80 percent.
Dr. Hugh Sampson, past president of the American Academy of Allergy, Asthma and Immunology recently wrote in an editorial: "We believe the results from this trial are so compelling, and the problem of the increasing peanut allergy so alarming, that new guidelines should be forthcoming very soon".
Over the past years, Dr. Sampson has published many articles on food allergy. But here he is referring to the LEAP (Learning Early About Peanut Allergy) study. It was published in the New England Journal of Medicine last month, and led by George Du Toit, M.B., B.Ch. (see links below.)
This study included 640 children between the ages of 4-11 months who were high-risk for development of peanut allergy. High-risk was defined, in this study, as having a history of severe eczema, egg allergy or both. The children were divided into one group that would be regularly fed peanut snacks, and another that would be restricted from peanuts. They were monitored for five years.
The investigators began the study by dividng the children into two groups based on the results of a peanut allergy skin-test. Only the children that tested negative for peanut were divided into those that would either be given or restricted panuts for the study. Those who skin-tested or orally tested positive were immediately removed from the study. However, researchers kept children who showed a slight peanut allergy. These included those who skin-tested positive to peanut, but didn't react to an oral allergy test.
The results of the study were described as astonishing. At 5 years of age, only 3 percent of the children getting peanuts were found to be allergic to them, but 17 percent of the peanut avoidance group became peanut-allergic. Furthermore, the skin-test positive children were far less peanut-allergic at age 5 if they had been exposed to peanut snacks**
(10.6 percent if fed peanuts versus 35 percent if restricted). The overall percentage of peanut allergy in the country was 2 percent (the study included only high-risk children).**** Up until 2008, allergists advised parents of high-risk children to restrict their young from peanuts and tree nuts until school age. Based on developments over the last decade, and highlighted by this study, the opposite is true.**** What does this mean?**
National guidelines for prevention of peanut allergy will change in oncoming months. They will likely recommend early peanut testing of high-risk infants and consultation with allergists.
Unanswered Questions Include:
- How long does peanut tolerance last once achieved?
- Do children need to continue to eat peanut products three times weekly in order to maintain tolerance (as done in the study)? How much peanut snack needs to be consumed?
- What happens if there is an interruption in peanut consumption during the first several months or years?
- What if the infants don't want to eat peanut butter snacks? Feeding them peanuts won't be an option because of the risk of choking.
- Wouldn't early introduction of peanuts place other peanut allergic members of the family at risk for accidental exposure?
- What can we do about young children already allergic to peanut?
- Would this work for other food allergies?
Bottom Line:** The Leap study is truly a game changer, but only for high-risk children under one year of age.** In this group the results showed a 70 to 80 percent reduction in the development of peanut allergy. Health experts in the U.S. will further review these findings and make appropriate recommendations to allergists, pediatricians and other primary care doctors, so stay tuned
It is important to understand that conclusions in this study are to be reviewed and utilized by physicians to manage patients. Parents should not expose their infants to peanut if they are at increased risk, before discussing it with their doctor.
New England Journal of Medicine
About LEAP: Food Allergy Research and Education