Peanut allergy can result in severe, and at times fatal, allergic reactions. Unfortunately, peanut allergy has become more and more common over the years. A new study, however, gives hope that early interventions may decrease the risk of developing peanut allergy.
A recent study published in the New England Journal of Medicine suggests that early exposure to peanuts helps to prevent peanut sensitization in high risk children. The study was performed in response to the significant increase in the incidence of peanut allergy worldwide, especially in westernized countries, such as the United States. The most recent recommendations by the American Academy of Pediatrics (AAP) came in 2000, in response to outcomes from infant feeding trials conducted in Europe and the United States. At that time, the AAP recommended refraining from introduction of peanuts to children until age 3. Despite this recommendation, the incidence of peanut allergy continues to rise, and in 2008, the AAP retracted its recommendation due to insufficient evidence. Since that time, multiple observational studies have found that early introduction of peanut protein, as well as cow’s milk and egg, result in decreased incidence of these food allergies.
In a new study by Du Toit et al., Learning Early about Peanut Allergy (LEAP), investigators studied over 500 infants at high risk of peanut allergy (severe eczema, egg allergy, or both). Half of the children were randomly selected to consume peanuts and the other half, to avoid peanuts. At age 5, the children underwent peanut challenge to determine if they were allergic. Results indicated that the prevalence of peanut allergy in the peanut-avoidance group was significantly higher at 17.2%, compared to 3.2% in the group that consumed peanuts.
The trial went on to compare two groups: one group of infants with skin prick test (SPT) that was initially negative to peanut, and another with mildly positive results (wheal of 1-4mm). Infants with a wheal of >4mm were excluded from the study (about 10%). In infants with an initially negative SPT, prevalence of peanut allergy was 13.7% in the avoidance group and 1.9% in the consumption group. For infants with mildly positive SPT, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group.
Although many questions still remain, early testing of infants at high risk for peanut allergy in the first 4-8 months of life, along with early introduction of peanut protein or in-office peanut challenge may have the potential to prevent peanut allergy in the future.
Allergy Partners’ board certified allergists are experts in the diagnosis and treatment of food allergies. If you have questions regarding food allergies, contact your local Allergy Partners physician.