Food allergies are a big concern for anyone who has kids, and at Atlanta Allergy & Asthma, we talk to parents about this issue every day. No one wants their children to have to go through life with a food allergy, but is there a way to prevent them? In the case of peanut allergies, there has been encouraging news this year. Two new studies provided further evidence that exposing children to peanuts early in life may stop them from developing an allergy later.
These studies built on work conducted last year by Dr. Gideon Lack at King’s College in London and published in the New England Journal of Medicine (called LEAP-Learning Early About Peanut). In that study, Lack and his team proved that exposing children to peanuts during infancy (from 4-11 months old) sharply reduced their chances of developing a peanut allergy when they got older. Lack’s findings challenged the long-held belief that peanuts should be kept away from young children.
Although the medical community found Dr.Lack’s results intriguing, they felt he left some important questions unanswered. Lack sought to address these questions in another round of two separate studies. In the first, he tested whether children who had consumed peanuts from an early age would have an enduring resistance to peanut allergies; one that would not wane even after exposure to the allergen was limited for a period of one year. The second study tested whether or not this early exposure technique could be applied to other common allergenic foods.
At the March meeting of the American Academy of Allergy, Asthma and Immunology, follow up to the LEAP study was presented. In this new study, called LEAP-On, researchers looked at children who had consumed peanuts for more than four years and questioned whether they were protected long term from developing peanut allergy even when they stopped eating it on a regular basis. In the study, five-year-olds who were fed peanuts in infancy and did not develop allergies as they got older were told to refrain from eating peanuts for one year. At the end of the study, they were exposed to peanuts again to see if they caused an allergic reaction. Dr. Lack found that the effect was enduring, and that most of these children had not developed allergies even after staying away from peanuts for a year.
In the second study, three-month-olds who were fed only breast milk were exposed to some common allergenic foods to see if they developed allergies to them at age three. Unfortunately, this study did not show a statistically significant difference between the allergen-exposed children and the control group. This may have been a coincidence, or it may have been the result of parents who didn’t strictly adhere to the constraints of the experiment.
Guidelines for the addition of food to an infant’s diet have changed. The latest recommendation of the American Academy of Pediatrics is to breast feed for 4-6 months and then introduce solids. Most children should have had most foods by age one (as long as there is no choking hazard.) However, pediatricians and allergists have not been proactively starting children on a regular diet of peanut to prevent the development of allergy. This study and the earlier one by the same group of scientists suggests that the early introduction of peanut is the appropriate recommendation.
The guidelines on how to introduce peanuts in high risk children, those with eczema and/or already diagnosed with other food allergies, have not yet been formalized. These recommendations should be forthcoming from the NIAID Working Group. Experts in the field of food allergy find the data so compelling that they are suggesting any infant between four to eight months old and believed to be at risk for peanut allergy should undergo a skin prick test for peanut. If the tests are negative, the child should be started on a diet that includes two grams of peanut three times a week for three years. This would be the equivalent of six teaspoons of peanut butter a week that could be mixed into cereal. If children have minimal reactions on skin testing, they should undergo an oral food challenge in the allergist office. If they do not have a reaction, they too should start on the peanut prevention program. The study does not address siblings of children with food allergy or children with no obvious risk factors. Many allergists would consider a sibling of a food-allergic-child at increased risk and this allergist may follow the protocol for these children as well. “I believe that we as physicians should be actively advising parents to change the long-held tradition of withholding certain foods like peanut,” says Kathleen Sheerin, MD, allergist with Atlanta Allergy & Asthma and the parent of a child with food allergies. “The magic window seems to be between four to eleven months. If you wait, you may miss your opportunity.”
Additional study is required. Questions regarding how much, how long, how often need to be answered. The LEAP–On study is encouraging, suggesting sustained tolerance after four years of regular peanut ingestion. The new recommendations may frighten some parents and pediatricians alike. Board Certified allergists are the experts equipped to help parents with decisions regarding food introduction, testing, and food challenges for high risk children. Further study will need to address the early addition of other allergenic foods such as tree nuts, shellfish, fish and eggs.
So while the future looks promising for early introduction of peanut in preventing allergies later in life, more research is needed. In fact, the Atlanta Allergy & Asthma’s Research Department is currently enrolling peanut allergic patients, age 4-55, for a new potentially beneficial therapy for patients with a history of severe allergic reaction from peanut. Our practice, and the specially trained allergists, is committed to help with the development of new therapies to help our allergic patients. As always, we’re here to help you and your family manage allergies of all kinds, so call us or schedule an appointment online to speak to one of our experts.