Avoiding Peanuts in Childhood

Over the years, experts have gone back and forth about introducing peanut products at an early age to children. The notion is that doing so can prevent kids from developing food allergies.

Previous studies were observational and lacked controlled trials to deliver definitive clinical guidance.

However, the Learning About Peanut Allergy Study (LEAP) detailed in the New England Journal of Medicine may change all that.

In the study, researchers looked at 640 infants who were allergic to eggs, had eczema, or both. The infants were at least four months old and put into two groups. They would either eat peanut products or avoid them until 5 years of age.

Peanut Butter

Of those tested, 530 infants with a negative response to an initial skin prick test were assigned to the peanut exposure group. This group was fed 6 grams of peanut protein in three or more meals a week, until they were 5 years old. The researchers used Bamba, a snack food made from peanut butter and puffed maize.

The rest did not eat peanut products.

At 5 years old, 13.7 percent of those who avoided peanuts developed a peanut allergy whereas only 1.9 percent who ate peanuts developed an allergy.

Of the 98 children who had a positive result during the skin prick test, 35.3 percent of the avoidance group and 10.6 percent of the consumption group were allergic to peanuts at 5 years of age.

Another analysis revealed similar results.

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The authors said fewer of the children who continued to eat peanut products in their first 11 months developed allergies compared to those who didn’t consume peanut products when both groups were evaluated at 5 years of age.

“Early consumption was effective not only in high-risk infants who showed no indication of peanut sensitivity at study entry … but also in infants who had slight peanut sensitivity,” wrote Drs. Rebecca S. Gruchalla and Hugh A. Sampson in an article accompanying the study.

Gruchalla is the director of the Division of Allergy and Immunology at the University of Texas Southwestern Medical Center at Dallas. Sampson is the director of the Jaffee Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York.

There are still more questions about peanut allergies, but the authors said the study “makes it clear that we can do something now to reverse the increasing prevalence of peanut allergy.”

“(The research) raises questions about the usefulness of deliberate avoidance of peanuts as a strategy to prevent allergy.
Learning About Peanut Allergy Study

Additional studies are needed to determine whether the children who ate peanuts would be protected from the allergy if they stopped consuming peanuts for a while, the authors said.

“Conversely, peanut avoidance was associated with a greater frequency of clinical peanut allergy than was peanut consumption, which raises questions about the usefulness of deliberate avoidance of peanuts as a strategy to prevent allergy,” the study stated.

Dr. Mary Ann Lila, the director of North Carolina State University's Plants for Human Health Institute in Kannapolis, N.C., said the LEAP study could lead to a breakthrough for many families that have had to cope with fear of their children ingesting peanuts.

“This evidence will clearly lead to a series of follow-up studies, but all the better, especially since it is logical that the same strategy may successfully influence development of soy, milk, egg, and other food allergies which can be most devastating in infants,” Lila said.

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Cassie Bjork, a registered, licensed dietitian from HealthySimpleLife.com recommends introducing peanuts around 6 months of age. It should be done after the child has tolerated a few nonallergenic foods such as sweet potatoes, carrots, pears, and apples.

She recommends giving children foods that commonly cause allergens one at a time. That way, parents can pinpoint any food that causes sensitivity. If there are peanut allergies in the family, she encourages parents to have their children tested before giving them peanut products.

“The reasoning why it can be beneficial to introduce common allergens like peanuts earlier rather than later is because if it’s done later on, the child’s system might treat them as foreign substances and attack them, resulting in an allergic reaction that may not have taken place if introduced sooner,” Bjork said.

In related news, data from the EpiPen4Schools survey assessed anaphylaxis and the use of epinephrine auto-injectors. They looked at these in U.S. schools during an academic year.

The data show that 757 students experienced an anaphylactic event.

Anaphylaxis causes about 1,500 deaths each year in the United States. The Centers for Disease Control and Prevention reported that 25 percent of anaphylaxis events in schools happened to children who were not previously diagnosed with a food allergy.

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