Caution Urged Following Landmark Peanut Allergy Study
Consuming peanuts during infancy could help prevent peanut allergy, according to a new study published in The New England Journal of Medicine, but some allergists are urging caution on changing food allergy therapies based on the research.
Following the release of the Learning Early About Peanut (LEAP) study at the American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting onFeb. 23, some food allergy experts said the data was important enough to warrant new national food allergy guidelines.
Not so fast, says Matthew Greenhawt, MD, assistant professor at University of Michigan Health System’s Division of Allergy and Clinical Immunology, and director of research at the University of Michigan Food Allergy Center.
Dr. Greenhawt says he has concerns about changing guidelines so abruptly based on just one highly compelling study. LEAP was conducted in England and included 640 infants between 4 to 11 months, some of whom had severe eczema or egg allergy, putting them at high risk for peanut allergy. The study suggested that early introduction of peanut could dramatically decrease the risk of developing peanut allergy by 70-80 percent.
Dr. Greenhawt says he wants to see the research replicated in at least one additional cohort, preferably in the United States, before new guidelines are implemented.
In addition, Dr. Greenhawt says more research is needed on possible benefits among more highly peanut-sensitized children than were studied, given that early introduction had a dramatic reduction in risk in the peanut-sensitized group compared to the non-sensitized group.
Among those suggesting that new guidelines should be forthcoming is Hugh Sampson, MD, past president of AAAAI and current director of the Jaffe Food Allergy Institute.
However, in a New England Journal of Medicine editorial accompanying the LEAP study, Sampson also says many questions surrounding the study results remain, including: 1) whether to introduce peanuts to all infants before 11 months of age; 2) how much peanut an infant should ingest, how often, and for how long; 3) whether tolerance will persist if peanut consumption is discontinued for a prolonged period; and 3) whether the findings can be applied to other food allergens such as milk, eggs and tree nuts.
Meantime, parents of children at risk for peanut allergy SHOULD NOT introduce peanut into their child’s diet without first consulting a board-certified allergist who can closely supervise and monitor the results, says Stanley Fineman, MD, allergist and immunologist at Atlanta Allergy & Asthma and past president of the American College of Allergy, Asthma & Immunology (ACAAI).
Adds Dr. Fineman: “The results of this study are very exciting because of the implications for children at risk for peanut allergy. Some of these children may be candidates for a cautious oral food challenge. For those children, peanut allergy tests and treatment should be performed by a board-certified allergist.”
For many years, public health guidelines recommended parents avoid giving infants foods containing common allergens – such as peanut, milk and eggs – in order to reduce risk of developing an allergy. In 2008, the American Academy of Pediatrics backed off from the recommendation, saying the evidence was not clear.
The LEAP study suggests that sustained consumption of peanut early in life – in pureed form, not whole due to the risk of choking – could help develop immunity from peanut allergy.
“There appears to be a narrow window of opportunity to prevent peanut allergy,” says professor Gideon Lack, who led the study at Kings College London.
The study was funded by the National Institutes of Allergy and Infectious Diseases (NIAID) and supported by Food Allergy Research and Education (FARE).