Joining the push to expose more kids to peanuts to prevent allergies

September 14, 2015

SEATTLE ó It may look like just another lunch, but when 11-month-old Reese Couty bites into a peanut-butter sandwich at her Renton home, itís nothing less than revolutionary.

The wispy-haired toddler is at high risk for food allergies, after having severe eczema as a newborn and a scary reaction the first time her mom fed her scrambled eggs.

"She was puffed up like a big old balloon fish, hives everywhere, on her face," recalled Meghan Couty, 29. "We had paramedics, the whole 9 yards."

With that kind of history, parents of babies like Reese were told for years to avoid feeding their kids peanuts until age 3, for fear of inducing the potentially deadly allergy and a lifetime of worry.

But a landmark study published this year turned that conventional notion on its head, suggesting that many peanut allergies may be prevented by exposing children to the food in infancy.

The results of the Learning Early About Peanut Allergy (LEAP) study, conducted in London, are so compelling theyíve already made their way to medical clinics and home kitchens across the country.

Local allergists say theyíre now seeing dozens of high-risk babies a month, testing to see whether they have a severe peanut allergy and, if they donít, starting them right away on a diet that includes peanut products. The hope is that the early intervention will halt peanut allergy in the future for the individual child ó and the larger population.

"This is a revolutionary change," said Dr. Kevin Dooms, an allergist with Allergy & Asthma Associates in Bellevue, Wash., and with Swedish Medical Center in Seattle. "This would have been heretical a year or two ago."

The change comes amid an alarming rise in peanut allergies, particularly among children in the U.S., where the condition has quadrupled in the past 13 years.

The LEAP trial was led by Dr. Gideon Lack, a professor of pediatric allergy at Kingís College, London. He had begun questioning avoidance of peanuts early in life after finding that the rate of peanut allergy in Israeli children was about one-tenth the rate among kids in Britain. The difference, he concluded in a 2008 study, was likely because Israeli babies ate high amounts of peanut protein in the first year of life, while British parents avoided giving such foods.

In the LEAP trial, Lack and colleagues studied 530 infants, ages 4 months to 11 months, at high risk of developing a peanut allergy. Those included infants with severe eczema or egg allergy, or both. The babies were given skin-prick tests for peanut allergy, and those who were already allergic were left out of the study.

The researchers randomly assigned the babies either to be regularly given food containing peanuts or to avoid those foods.

By the time the kids turned 5, overall results showed just 3.2 percent of the group given peanut products had the allergy, compared with 17.2 percent in the group that avoided them.

Among children who showed evidence of mild peanut sensitivity to begin with, 10.6 percent who ate peanuts developed peanut allergy, compared with 35.3 percent of those who avoided it.

The trial "clearly indicates that the early introduction of peanut dramatically decreases the risk of development of peanut allergy," said an editorial published with the results in February in The New England Journal of Medicine.

"The LEAP study makes it clear that we can do something now to reverse the increasing prevalence of peanut allergy," conclude the authors, Dr. Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center and Dr. Hugh A. Sampson of the Icahn School of Medicine at Mount Sinai in New York.

The study was primarily funded by the National Institutes of Health (NIH) and Food Allergy Research and Education (FARE), a national advocacy group.

Recently the American Academy of Pediatrics (AAP) issued interim guidelines, in consensus with national and international allergy groups, which suggest using LEAP-style treatment for high-risk infants.

"I think the allergy community, physicians and other providers, are embracing it wholeheartedly," said Dr. Stephen Tilles of the Northwest Allergy & Asthma Center in Seattle, who is seeing about 10 babies each week for peanut evaluation.

"This is one of the most stunning results Iíve ever seen that pertain to my specialty."

For Tilles and Dooms, the new guidance has helped cement growing efforts to overturn what experts now say was misguided advice to avoid peanuts.

In 2000, largely in response to results from feeding trials in the U.S. and Europe, the AAP recommended that parents not give their children peanuts until age 3. In 2008, the group retracted the guidance, saying there was not enough evidence to support it.

But that didnít reverse the damage, especially in the general public. Fear of introducing peanuts too early had become ingrained, even among parents whose children had no sign of allergies.

"Whatís surprising is how few people got the memo," Dooms said. "That fear has been internalized and that fear was based on no evidence."

Only after the results of the LEAP study were issued did AAP and other groups issue the interim guidance, with plans for formal recommendations next year.

Still, thatís not to say parents of high-risk kids should start feeding peanuts on their own.

"Medical decisions should be made under the advice of a physician," said Dr. James R. Baker Jr., FAREís chief executive. "Parents should consult with their doctors and see if the guidance for early introduction is appropriate for them."

The prime window for peanut introduction appears to be in the first year, with testing beginning between 4 months and 6 months, when babies start eating solid foods.

Dooms has tested about a half-dozen high-risk children so far, exposing them to peanut protein carefully in a clinic, then monitoring the kids for reaction. One child did have a severe ó though not life-threatening ó reaction, evidence of a true peanut allergy.

But other patients came through the challenge in good shape. In those cases, Dooms advised the parents to begin giving their children peanut products regularly. In the LEAP study, children received at least 6 grams of peanut protein a week, the equivalent of 24 peanuts, spread over at least three meals.

Babies canít eat whole peanuts because of the risk of choking. Recommended foods include smooth peanut butter, peanut soup or finely ground peanuts mixed into other foods, such as yogurt.

One preferred food in the study was Bamba, a puffed peanut-butter snack made in Israel. Since the LEAP trial was publicized, more mainstream grocery stores have started carrying the treat, noted Tilles.

With additional research, Tilles said, he expects the new practice to catch fire with doctors and parents, potentially curbing ó or reversing ó the recent dramatic rise in peanut allergies.

"Hopefully, in the next 10 to 15 years, the prevalence of peanut allergy in kids will be where it was when I was in training 20 years ago," he said.

For parents like Meghan Couty, the idea that she may have prevented her daughter from developing a peanut allergy is profound.

"Iím really happy we did it," she said. "Being able to have peanut butter to give her now has really been nice. We are avoiding all these foods until later in life, and I think we should be giving them earlier."



Associated Press