A decade after a landmark study showed that feeding young babies peanut products could prevent the development of life-threatening allergies, new research finds that the change has made a big difference in the real world.
About 60,000 children have avoided developing peanut allergies after a guideline first published in 2015 changed medical practice by recommending introducing the allergen to babies starting at 4 months.
“That’s something remarkable, right?” said Dr. David Hill, an allergist and researcher at Children’s Hospital of Philadelphia and author of a study published Monday in the medical journal Pediatrics. Hill and her colleagues analyzed electronic medical records from dozens of pediatric practices to track food allergy diagnoses in young children before, during and after the guidelines were issued.
“In fact, I can come to you today and tell you that there are fewer children with food allergies today than there would be if we had not implemented this public health effort,” he added.
Researchers found that peanut allergies in children ages 0 to 3 decreased by more than 27% after guidelines for high-risk children were first published in 2015 and by more than 40% after the recommendations were expanded in 2017.
The effort has yet to slow the overall rise in food allergies in the U.S. in recent years. About 8% of children are affected, including more than 2% with peanut allergies.
Peanut allergy occurs when the body’s immune system mistakenly identifies peanut proteins as harmful and releases chemicals that trigger allergic symptoms, such as hives, respiratory symptoms, and sometimes life-threatening anaphylaxis.
For decades, doctors had recommended delaying feeding children peanuts and other foods that could trigger allergies until age 3. But in 2015, Gideon Lack of King’s College London published the groundbreaking paper Learning Early About Peanut Allergy, or LEAP.
Lack and his colleagues showed that introducing peanut products in childhood reduced the future risk of developing food allergies by more than 80%. Further analysis showed that protection persisted in approximately 70% of children into adolescence.
The study immediately generated new guidelines calling for the early introduction of peanuts, but implementation has been slow.
Only about 29% of pediatricians and 65% of allergists reported following the expanded guidance published in 2017, according to surveys.
Confusion and uncertainty about the best way to introduce peanuts early in life caused this delay, according to a commentary that accompanied the study. At first, both medical experts and parents questioned whether the practice could be adopted outside of strictly controlled clinical settings.
Data for the analysis came from a subset of participating practice sites and may not represent the entire U.S. pediatric population, noted the commentary, led by Dr. Ruchi Gupta, an expert in childhood allergies at Northwestern University.
However, the new research offers “promising evidence that early introduction of allergens is not only being adopted but may be having a measurable impact,” the authors concluded.
Advocates for the 33 million people in the United States with food allergies welcomed signs that the early introduction of peanut products is gaining popularity.
“This research reinforces what we already know and underscores a significant opportunity to reduce the incidence and prevalence of peanut allergy nationwide,” said Sung Poblete, executive director of the nonprofit group Food Allergy Research & Education, or FARE.
The new study emphasizes current guidance, updated in 2021, which calls for the introduction of peanuts and other major food allergens within four to six months, without prior screening or testing, Hill said. Parents should consult their pediatricians if they have any questions.
“It doesn’t have to be a lot of food, but small flavors of peanut butter, milk-based yogurt, soy-based yogurts and tree butters,” she said. “These are really good ways to allow the immune system to be exposed to these allergenic foods safely.”
Tiffany Leon, 36, a registered dietitian in Maryland and director of FARE, introduced peanuts and other allergens to her own children, James, 4, and Cameron, 2, early.
At first, Leon’s own mother was surprised by the advice to feed babies such foods before age 3, she said. But León explained how science had changed.
“As a dietitian, I practice evidence-based recommendations,” she said. “So when someone told me, ‘This is how it’s done now, these are the new guidelines,’ I thought, Okay, well, this is what we’re going to do.”
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