January 18, 2019

Peanut Allergy: Eat Peanuts Early Like Israelis?

Deadly peanut allergies are on the rise, not just in the United States but around the world.

Israeli children have lower rates of peanut allergy when compared to Jewish children of similar ancestry in the United Kingdom.  Israelis consider the popular peanut-flavored Bamba their favorite snack.   Bamba contains 50% peanuts.  Unlike many Western countries that ban nuts in school, in Israel, children can pack peanuts.  Whereas doctors in Western countries tell parents to avoid peanut-based foods, in Israeli babies are fed Bamba! 

This week a landmark study tested the hypothesis that the low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption beginning in infancy.  Researchers recruited 640 children considered high risk (who had an egg allergy or eczema) aged four to 11 months.  530 children did not have a peanut allergy in the initial skin test, while 98 had a positive test at onset of study. These children were then divided.   In one group, the parents were asked to feed their babies peanut butter or Bamba, three times a week until the age of five. The second group was told to keep their children’s diets peanut-free until age five.  The children were tested for allergies again when they turned five.

Researchers found that exposing infants to peanuts within their first year helped prevent peanut allergy by as much as 81 percent.

The new “Learning About Peanut Early” (LEAP) study makes recommendation for the management of infants considered to be at high risk for peanut allergy.  The finding that consumption, not avoidance, reduces the risk of developing peanut allergy by the age of 5 led the LEAP investigators to call for new guidelines to be drafted.

Dr. James Baker, chief executive officer of Food Allergy Research & Education said  “We hope that parents understand this isn't something you do without consulting a physician and making absolutely sure the child is not allergic first.”

According to Dr. Daniel Rotrosen of the National Institute of Allergy and Infectious Diseases, “new guidelines are urgently needed to reflect these findings…even with a landmark study like this, and obvious improvement, it's difficult to move to implementation.”  Infants who are at risk should receive skin-prick testing for peanut, per LEAP. Those with a negative test can have normal peanut consumption. Infants with a positive test will undergo an oral food challenge and, depending on the results, proceed to normal peanut consumption with careful supervision or avoidance. Infants in the LEAP cohort had only mild to moderate allergic reactions, but no hospitalizations or epinephrine were required.

Also this week, at the American Academy of Allergy, Asthma and Immunology, researchers presented a small skin patch which when applied to patients with peanut allergies appears to safely and effectively protect against life-threatening reactions, with no serious side effects to the treatment.  The patch exposes patients to a small dose of peanut protein.  The study evaluated some 200 patients with peanut allergies for a year.  Half of those who used the largest patch saw their peanut tolerance increase 10-fold.

The debate among parents and the medical community is raging.  Should policy be changed on the basis of one study?  The study was small, although important.

The results need to be replicated in the United States.  Stay tuned!