I remember when I had my first child, Will, in 2009 and being so anxious. You know how it is with your first-born. You want to make sure you do everything by the book. At that time the recommendations were uncertain about when you could expose your child to peanuts and peanut products. As a doctor and dermatologist, I had issues with the recommendations to avoid peanut products until your child was two years old. You see, dermatologists are trained to learn about the immune system and all of its intricacies because management of many skin diseases and conditions involves understanding of the immune system. Knowing what I know about the immune system, I didn’t agree with the recommendations to avoid certain foods. I believed that early exposure and lots of repetition of foods made more sense. However, there was no data to support that gut feeling of mine at the time.
Since both my husband and I are doctors and feel comfortable diagnosing food allergy symptoms, we made the decision to expose both of our eczema-prone children to most everything that we ate, even before the age of one. This included peanuts. And – “knock-on-wood” – our kids are ok and have no food allergies and less eczema than they used to. They are now 5 and 7.
Two new landmark studies just came out about the exposure of peanuts and peanut products with infants. This is so exciting to me! My friends that weren’t doctors couldn’t believe that we would expose our children to peanuts early on, but now there is more data to support that logic. Also, after seeing more and more family members and friends manage their children’s nut allergies, I am excited to share and further explain these results. Let me be clear- I am not offering a doctor’s recommendation- I am simply sharing my personal experience and the important data that has come out of two trials to keep us moving forward toward a goal to reduce food and peanut allergies. So let’s go through the new findings on peanut allergies – what do they mean?
Food allergies affect up to 8% of children up to 3 years old, and peanut allergies, specifically, affect up to 3% children in Western countries like the United States and the United Kingdom. Peanut allergy rates have almost doubled within the last 10 years. Why? Back in 2000, the American Academy of Pediatrics recommended that parents of children who were at high risk of allergies should eliminate peanut and other foods known to cause allergies from their children’s diets. They also recommended that mothers avoid these foods during pregnancy and lactation. Clinical practice guidelines in the U.K. recommended the same at that time. As a result, both the U.S. and the U.K. have seen food allergy rates such as peanut allergy rates shoot up over the past 10 to 15 years. Once you are peanut allergic, it is almost impossible to outgrow this food allergy. Having a peanut allergy can also cause psychosocial stress to the child and the whole family. In 2008 s peanut allergy rates increased, the clinical practice guidelines of early peanut avoidance in the U.S. were lifted, but there are still many uncertainties on what to do as parents and what doctors should recommend.
“Learning Early About Peanut” (LEAP), part of the <a href=”https://www.immunetolerance project team management.org”>Immune Tolerance Network, has recently published two landmark trials, which strive to answer the question of whether early exposure to peanuts can reduce the risk of developing a peanut allergy. LEAP discussed these trials at the American Academy of Allergy and Immunology annual meeting and published their findings in the New England Journal of Medicine in February 2015. They found that early exposure to peanut products actually reduces a child’s chance of developing a peanut allergy. In this 2015 study, over 600 high-risk children ages 4 to 11 months old were randomly chosen to consume or avoid peanuts until 5 years old. Children are considered high-risk if they have a personal or family history of allergies, including eczema. Children consumed a product containing peanuts at least three times a week. The results showed that 17% of the children who avoided peanut products developed a peanut allergy by age 5, while only 3% of children exposed to peanut products developed a peanut allergy. This study was the first impactful study to show that early peanut exposure actually reduces a high-risk child’s chance of developing a peanut allergy.
The second study showed that the benefits of regularly consuming peanut-containing foods early in life to prevent the development of peanut allergy persist even after stopping peanut consumption for one year. On March 4th LEAP-On published a follow up study in the New England Journal of Medicine. The new study asked that all children that participated in the original trial – both those that ate peanut products and those that did not – not eat any peanut products for a year after the trial ended. The study found that only 4.8% of children who ate peanut products during the LEAP trial were allergic to peanuts following a year of no peanut products. On the other hand, 18.6% of children who had not eaten peanut products in either trial showed a peanut allergy. In other words, exposure to peanut products early on (before 5 years old) helped to prevent peanut allergies, and preventing peanut allergies did not need continuous exposure to peanuts to keep kids free from peanut allergies.
This is really exciting stuff! With more studies and data, guidelines regarding food allergies, and specifically peanut allergy, will continue to be modified. So, pay attention to updates! Currently, the data supports early exposure of peanut to high-risk children in order to reduce the risk of developing a peanut allergy. As we gather more information we can continue to keep our children healthy and strong.
By Dr. Amy