Posted on: July 29, 2015
Does early introduction of peanut products reduce the incidence of peanut allergy?
By Dr. Craig Osleeb
Peanut allergy is a major problem. It is currently one of the 6 most common causes of food allergy in childhood. The prevalence of peanut allergy has risen over the past decade and currently affects approximately 1.4% of the USA population. While many children will outgrow their food allergy to milk, egg, wheat and soy, 82% of those allergic to peanut will remain so for life. This is a great concern to parents, patient’s and the healthcare community at large. In February of this year the New England Journal of Medicine published a prospective placebo blinded study (Learning Early about Peanut Allergy, LEAP, study) that has far reaching implications for the prevention of peanut allergy.
Risk factors for the development of peanut allergy include atopic dermatitis, symptoms include dry scaly patches on the skin – typically face, forehead and scalp, and egg allergy. Indeed 37% of children what atopic dermatitis will develop a food allergy. As such, researchers selected 640 infants between 4–11 months of age with atopic dermatitis and/or egg allergy. These infants were then entered into a Study to answer the question: Does early introduction of peanut products reduce the incidence of peanut allergy? All infants were initially skin tested for peanut allergy. Those who had positive skin tests in the high predictive range were eliminated from the study. Infants with either negative skin test or low positive predictive skin test underwent a physician supervised challenge to peanut product. Those who passed the challenge were then randomized into 2 groups. One group would receive peanut products 3 times a week and the other would avoid all peanut products. The groups were then compared over 5 years. The results were dramatic. Early introduction of peanuts resulted in a 70–86 percent reduction of the overall incidence of peanut allergy!
“Infants less than 11 months of age with atopic dermatitis and/or egg allergy
should be refered for appropriate evaluation.”
This paramount study to reduce the risk of peanut allergy represents a major triumph for preventative medicine. Preventing the development of a lifelong allergy has significant implications with respect to morbidity and healthcare cost. Subsequent studies will likely follow and help confirm these results. It is important to caution against introduction of peanut products and high risk infants without appropriate evaluation. Indeed some of them may already be peanut allergic. Parents and physicians alike are encouraged to refer infants less than 11 months of age with atopic dermatitis and/or egg allergy for appropriate evaluation.
Editor’s Note: Craig Osleeb, MD, is a Pediatrician who specializes in Allergy & Immunology at Northern Westchester Hospital.