However, the positive findings published in the New England Journal of Medicine Feb. 23 likely will not change existing restrictions on eating peanut products at many schools any time soon, and by extension likely will not change the shopping habits of parents of older children, added Jillian Hochfelder, a practicing doctor at ENT and Associates in New York.
“So many kids still have peanut allergies,” and the practice of introducing peanuts to young children to reduce their risk of allergy will not impact those older children who already have the reaction, she explained. As a result, even if the early introduction of peanuts successfully reverses the upward trend of the allergy developing in the U.S., it likely will still be 10 years before these children fill elementary schools and the establishments are comfortable with the nut’s presence again, if at all, she added.
However, she noted, parents of infants and toddlers likely will be looking for introductory foods with peanut, such as puffed cereals that dissolve quickly in children’s mouths, now that this study shows the “striking” benefits of introducing the food to children at a young age.
Risk reduction between 70%-80%
The landmark study, led by George Du Toit, a consultant in pediatric allergy at Guy’s and St. Thomas’ NHS Foundation Trust, and Gideon Lack, a professor at King’s College London, found introducing peanuts to children younger than 11 months of age lowered their risk of developing a peanut allergy 70% to 80%.
The study randomly assigned more than 600 children to regularly consume or avoid peanuts starting before 11 months of age until 5 years of age when they were re-tested for an allergic reaction. Of those who avoided peanuts, 17.2% developed an allergy compared to only 3.2% of those who ate peanuts.
A more granular analysis reveals that of the 98 children who originally tested positive for mild peanut allergy, only 10.6% who regularly ate peanut still had a reaction at age 5 compared to 35.3% of the group that avoided the nut, the researchers found. They added of the 530 children who originally tested negative for the allergy, 13.7% of those who avoided peanut developed the allergy, compared to 1.9% of those who ate peanuts, according to the study.
These results show “the early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune response to peanuts,” the study concluded.
The potential to reduce the risk of developing peanut allergy, which most people do not outgrow, is pivotal for public health given the prevalence of the allergy in the U.S. has quadrupled in the past 13 years from 0.4% in 1997 to 1.4% in 2008 to more than 2% in 2010, Rebecca Gruchalla, from the University of Texas Southwestern Medical Center, and Hugh Sampson from the Icahn School of Medicine at Mount Sinai, note in an accompanying editorial in NEJM.
“Peanut allergy has become the leading cause of anaphylaxis and death related to food allergy in the United States,” they add.
Policy and guidelines
The results also validate the American Academy of Pediatrics’ decision in 2008 to retract its previous recommendation that children not eat peanuts until age 3 years. This decision was made in light of observational studies suggesting similar outcomes as this study.
The academy did not establish new guidelines at the time, however, and likely will not be fast to do so now, either, Hochfelder said. Grunchalla and Sampson agreed, explaining in their editorial that there are still too many unknown questions to answer before guidance can be drafted, such as how much and how often children should eat peanut to avoid developing the allergy and whether tolerance will persist if consumption is discontinued for a period of time.
Hochfelder explained, however, this study empowers individual physicians to recommend earlier consumption of peanut products.
Parents can now introduce peanut to children who do not already have known peanut allergy whenever they introduce other foods, which usually begins between 4 and 6 months of age, Hochfelder said. She personally introduced her daughter to peanut at 9 months.
Parents of children with known peanut allergies should not introduce peanuts to their young children without the supervision and guidance of their physician, Hochfelder added.
Likewise, children 4 months to 8 months old believed to be at risk for peanut allergy should undergo a skin prick test for the allergy prior to eating peanuts, Grunchalla and Sampson said.
In addition, food manufacturers must continue to comply with labeling requirements to identify when peanuts and other main allergens are in food or share production machinery with peanut products.