Behind The Headlines: A Pediatrician Talks about LEAP-On

A study about the benefits of introducing peanut to children at high-risk for peanut allergy rocked the food allergy world in March and continues to make headlines. The LEAP-On study, led by Gideon Lack, M.D., of King’s College London, was a follow up to 2015’s LEAP study. LEAP-On showed that the benefits of regularly consuming peanut-containing foods early in life to prevent the development of peanut allergy continue even after stopping peanut consumption for one year.

Watch a video of the lead researchers discussing the study here:

National Peanut Board has been carefully following the research around early introduction of peanut containing foods and their impact on the development of peanut allergy in high-risk infants. Here, pediatrician Dr. JJ Levenstein provides insight into LEAP-On and how the research continues to support early introduction to help prevent peanut allergies.

NPB: What was the rationale for conducting the LEAP On trial after LEAP?

Dr. JJ: In confirming that early introduction of peanut protein to high risk babies resulted in a drastically reduced risk of peanut allergies [via the LEAP Study], Drs. DuToit and Lack wanted to test the hypothesis that tolerance to peanuts could be sustained even without continuation of eating peanut protein. Their hypothesis was correct – and LEAP On demonstrated a sustainable tolerance to peanut protein in high risk children a year after avoiding peanuts.

NPB: To your knowledge, were there any unexpected things/outcomes that happened during the LEAP On trial?

Dr. JJ: I was surprised that over 30% of the children in the treatment arm of the study couldn’t go without peanuts for a year. The abstinence rate in the treatment group was still 69.3%, but lower than I expected.

NPB: Now that the results of both LEAP and LEAP-On are in hand, how do they inform recommendations regarding the introduction and consumption of peanut foods in early-feeding of high risk infants and children?

Dr. JJ: Parents of high risk children should feel more confident, and perhaps even elated, that they can reduce their child’s potential risk of allergy to peanut through early introduction. Key to their success is their partnership with their healthcare provider and/or pediatric allergist as a certain level of anxiety should be expected. Pediatricians and allergists need to be armed with recommendations for how to introduce peanut protein so that families have affordable and varied choices. [It is also essential that peanut containing foods be introduced in safe ways (ex. peanut butter thinned with breast milk or formula, not whole peanuts).]

The LEAP and LEAP-On studies will help shape our expectations about whether other allergens, if introduced early, can prevent future allergy. There’s a lot more good science coming to change the landscape of food allergies in children.

NPB: Any changes in your thoughts for those not at high-risk?

Dr. JJ: I think it is reasonable to continue to follow the AAP’s current recommendations about offering all complementary foods, both low and “high risk,” to otherwise healthy children in the first year of life.

NPB: There’s a lot of talk about preciseness of “dosing” for introduction and consumption of peanut proteins as the result of the LEAP and LEAP On studies. What are your thoughts on ad lib feeding once a child has not had a reaction?

Dr. JJ: I would recommend incorporating peanut protein at least 3 times weekly – that’s what the LEAP study showed us. I also think it’s important to recognize that the concept of ad lib means to make sure there is a balance of many good foods in a baby’s diet.

NPB: For parents who want to introduce peanut foods early, what are your basic recommendations?

Dr. JJ: Try a small amount while at home with your child. Observe your child for a few hours so that if there is any hint of a reaction, you are very tuned in. Never give a new food at daycare or when on the road – it’s hard to completely focus your attention under those circumstances. Once your baby has shown he or she is a fan of peanut protein, incorporate it into your baby’s diet at least 3 times a week. You can use smooth peanut butter swirled into hot cereal, thinned out peanut butter as a dipping sauce, peanut flour or ground peanuts incorporated into baked goods, or peanut-based weaning snacks (once baby is interested) can be utilized as well. Parents with young infants and toddlers always need to be reminded of choking hazards with chunky peanut butter, too thick preparations, or eating whole peanuts. We have plenty of safe and delicious options, and a growing repertoire of child friendly recipes out there on the web.

Check out the National Peanut Board instructional video on making your own peanut containing infant and toddler foods.