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.
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.
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."
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
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.
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.
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.
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."
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.
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.
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.
researchers randomly assigned the babies either to be
regularly given food containing peanuts or to avoid those
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.
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.
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.
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
study was primarily funded by the National Institutes of
Health (NIH) and Food Allergy Research and Education (FARE), a
national advocacy group.
the American Academy of Pediatrics (AAP) issued interim
guidelines, in consensus with national and international
allergy groups, which suggest using LEAP-style treatment for
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.
is one of the most stunning results Iíve ever seen that
pertain to my specialty."
Tilles and Dooms, the new guidance has helped cement growing
efforts to overturn what experts now say was misguided advice
to avoid peanuts.
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.
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.
surprising is how few people got the memo," Dooms said.
"That fear has been internalized and that fear was based
on no evidence."
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.
thatís not to say parents of high-risk kids should start
feeding peanuts on their own.
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
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.
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.
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
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.
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.
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
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.
parents like Meghan Couty, the idea that she may have
prevented her daughter from developing a peanut allergy is
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."