Dr. Gideon Lack discusses prevention of peanut allergy
Gideon Lack, MBBCH, MA, FRCPHC, professor of pediatric allergy at the Kings College of London, discusses the importance of peanut allergy prevention.
Dr. David Fleischer discusses early introduction
David Fleischer, MD, associate professor of pediatrics and director of the food challenge unit at the Children’s hospital of Colorado, discusses the importance of the LEAP study and subsequent guidelines, which says introducing peanut to an infant “early and often” can reduce the risk of developing peanut allergy.
How the study was conducted
The Learning Early about Peanut Allergy (LEAP) study identified 640 infants between the ages of 4-11 months with either severe eczema, egg allergy or both. These infants, considered high-risk for peanut allergy, were randomly assigned to two groups – one that consumed peanuts and one that avoided consumption. Infants assigned to the group which consumed peanuts were given at least 1 ¼ teaspoon of either smooth peanut butter or Bamba, a peanut-containing snack consumed regularly by children in Israel.
Within the group consuming peanuts, the infants were further segmented into those with a mild reaction to a peanut skin-prick test and those with none. An oral food challenge was used to determine true peanut allergy in 617 of the subjects. The study showed that early consumption benefited both groups in reducing the prevalence of peanut allergy.
Recommendations regarding introduction have changed
In 2008, citing that insufficient evidence existed to call for food avoidance, the American Academy of Pediatrics reversed a prior recommendation that peanuts should be avoided in pregnant women, during breast feeding and in early feeding of children before 3 years of age for those at high-risk of developing peanut allergy. During the eight years the recommendation was in place, there was no reduction in the prevalence of peanut allergies.
LEAP adds to research surrounding early peanut protein introduction
This study builds on another conducted by some of the same researchers in 2008, which found that risk of development of peanut allergy was 10 times higher among Jewish children in the UK as it was in those living in Israel. Over 10,000 participants (5171 in the UK and 5615 in Israel) completed a clinically validated questionnaire to determine the prevalence of peanut allergy. Timing of peanut introduction was a primary difference among the two populations. In Israel, peanut protein is typically introduced around 7 months and in the UK, after the first year.
LEAP changed the recommendations on early infant feeding.
As the result of the ground-breaking LEAP study results, new guidelines have been released to promote early introduction of peanut foods to prevent peanut allergy. These new guidelines followed a consensus statement where allergy organizations from across the globe and the American Academy of Pediatrics joined together to agree that peanut foods should be fed to infants early. The researchers who conducted the LEAP trial continue to monitor the subjects in the study to monitor the long-term impact of early peanut consumption on the development of food allergies.
Read more about LEAP here.
*(LEAP) DuToit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803-13.