guidelines are based on new research that shows introducing
peanuts into an infant’s diet can prevent the development of
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In February 2015, the NIH published results from a
clinical trial which compared consumption and avoidance
of peanuts in over 600 infants. The “LEAP study” findings
suggested that introducing peanut products into the diets of
infants who were at high risk (defined as having eczema
and/or egg allergy) was safe, and regular consumption from
infancy until the age of five led to an 81 percent reduction
in the development of a peanut allergy.
“The study clearly showed that introduction of peanut early
in life significantly lowered the risk of developing peanut
allergy by age 5,” Dr. Daniel Rotrosen, director of NIAID’s
Division of Allergy, Immunology and Transplantation, stated
in the NIH report.
are three separate guidelines according to an infant’s risk
for developing a peanut allergy.
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The risk of developing a peanut allergy is linked to having
eczema and/or an egg allergy, so these are the two criteria
researchers used for infants in the landmark LEAP study which
is the backbone for the guidelines. “It’s possible that there
are other risk groups but all we know now is that infants
with eczema and/or egg allergy seem to benefit the most from
early introduction,” Togias says.
The guidelines are as follows:
Guideline 1: Infants at high risk of developing a
peanut allergy because they already have severe eczema, egg
allergy or both, should have peanut-containing foods
introduced into their diets as early as 4–6 months of age.
Guideline 2: Infants with mild or moderate eczema
should have peanut-containing foods introduced into their
diets around 6 months of age.
Guideline 3: Infants without eczema or any food
allergy should have peanut-containing foods freely introduced
(whenever) into their diets.
In all cases, infants should start eating other solid foods
before they get introduced to peanut-containing foods, the
report states. Families should also introduce peanuts
according to their own cultural needs or food customs, Togias
says, so the form of peanut can vary.
new guidelines replace the previous recommendation from the
American Academy of Pediatrics (AAP), which said families
should not expose high-risk infants to peanuts until
the age of three.
Actually, the concept of promoting early ingestion is nearly
a complete reversal of the
AAP guidelines published in 2000. However, Togias says
AAP was one of the members of the coordinating committee
of the new guidelines, and they are in full support of
adopting them for use among pediatricians.
allergies are a growing health problem, and there is no
treatment or cure.
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Currently, 2% of chlidren in the US have a peanut allergy. A
develops a peanut allergy when they get exposed to
peanuts and their body makes antibodies which attach to
immune cells. The next time that person eats peanuts, it
triggers an immune response that can result in a severe or
life-threatening allergic reaction (anaphylaxis).
Scientists are still investigating why some people develop
severe allergies and others don’t, but the new findings on
prevention are a big step forward. “The most common theory is
that at a very young age, the immune system is still
developing its ability to recognize what’s bad and what’s
not, so early introduction helps the immune system get
acquainted,” Togias says.
“Preventing the development of peanut allergy will improve
and save lives and lower healthcare costs,” NIH director Dr.
Anthony Fauci states in the report.
People who live with a peanut allergy and their caregivers
must be constantly vigilant and avoid any foods or
environments where they could be exposed to peanuts.
Additionally, many of those same people have had to cope with
last year’s price increase of the
EpiPen, a lifesaving injection to treat anaphylaxis.
The guidelines are targeted at healthcare providers, like
pediatricians or family practice physicians, who can work
with parents to introduce peanut-containing foods to infants.
Researchers hope this new practice will ultimately prevent
the development of a peanut allergy in susceptible children
and lower the prevalence of peanut allergies in the US.
“Even if we can cut the current rate of 2% in half, then we
have a huge number of children who get protection from a
lifelong, unfortunate allergy,” Togias says.