We are writing regarding the Learning Early About Peanut (LEAP) study preventing peanut allergy through early consumption in “at-risk” infants recently published in the New England Journal of Medicine. Early peanut consumption was effective at preventing allergy not only in infants who showed no indication of peanut sensitization at baseline (primary prevention) but also in infants who showed mild peanut sensitization assessed by allergy skin prick testing (secondary prevention). The results were very impressive. By age 5 the prevalence of peanut allergy was decreased by 70%-86%. The results were far more striking than initially imagined! Timing seems to be important. There is a narrow window of opportunity to intervene early. Early introduction of peanut, between the ages of 4-11 months, appears to be associated with tolerance compared to introducing peanut at a later age which results in sensitization and allergy. Results of this study indicate that early consumption of peanut can result in a decreased incidence of peanut allergy. While not yet proven, similar results are anticipated with other foods as well.
There are potential risks involved with this procedure. Infants should be skin tested with peanut to be absolutely sure that they are not sensitized before being fed peanut. Parents should consult with an allergist prior to feeding peanuts to at-risk infants. Some patients had respiratory or cardiovascular symptoms requiring intramuscular epinephrine when peanut was introduced into the diet. The evaluation of these patients, specific testing, and treatment, such as oral introduction of peanut, should be performed by a Board Certified Allergist experienced in the treatment of food allergy. At-risk infants should be skin tested with peanut and pass a peanut challenge in a supervised setting to determine whether it is safe to introduce peanut into the diet.
The following at-risk infants are recommended for referral:
• Any infant with eczema, particularly moderate to severe eczema.
• Any infant with a history of food allergy to egg, cow’s milk, tree nuts or seeds.
• Any infant whose parents or siblings have a history of food allergy, especially peanuts.
We believe this study offers the beginning of a significant change in our understanding of food allergies and their development. The Board Certified Allergists at Colorado Allergy and Asthma Centers feel confident that the “allergic march” can be altered in a large percentage of patients at risk for the development of food allergy. We have developed protocols for testing, challenging, and treating infants who are at risk for developing food allergy. Please refer to our website for additional information or call one of our providers for more information or call any of our offices to schedule a referral.
The Physicians at Colorado Allergy and Asthma Centers
Main phone numbers: (720) 858-7600 or (800) 735-1434
CAAC website: www.coloradoallergy.com
Reference: Du Toit G, Roberts G, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy N Eng J Med 2015; 372:803-813
AAP NEWS – Study: Feeding peanut to high-risk infants may reduce allergy rate – Dr. Sicherer
New England Journal of Medicine – Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy
Journal Watch – Early Peanut Introduction Reduces Risk for Peanut Allergy
New England Journal of Medicine – Preventing Peanut Allergy through Early Consumption —
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