Preventing Peanut Allergies with Peanuts

A recent clinical trial found that feeding peanut products to infants who are at high risk of developing peanut allergies was safe and actually led to an 81 percent reduction in developing peanut allergies. Published in The New England Journals of Medicine, the study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and was conducted by the NIAID-funded Immune Tolerance Network.

The study, called Learning Early About Peanut Allergy (LEAP), had researchers comparing two strategies to prevent peanut allergies—consumption or avoidance of dietary peanuts—in infants who were at high risk of developing peanut allergies because they already had egg allergies and/or severe eczema. More than 600 high-risk infants between 4 and 11 months of age were assigned randomly either to avoid peanuts entirely or to regularly consume at least 6 grams of peanut protein per week. Both regimens were continued until the children reached age 5. Participants were monitored throughout this period with recurring visits with health care professionals.

Researchers then conducted a supervised, oral peanut food challenge with the 5-year-olds. They found an overall 81 percent reduction of peanut allergies in children who began early, continuous consumption of peanuts compared to those who avoided peanuts.

Over the years, the food industry has been searching for ways to reduce peanut allergic reactions. “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent,” says NIAID director Anthony S. Fauci, MD. “The results have the potential to transform how we approach food allergy prevention.”

Prior to this latest study, parents were told to avoid allergenic foods for their young children. “While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage a serious public health problem,” says Daniel Rotrosen, MD, director of NIAID’s Division of Allergy, Immunology and Transplantation.

However, pediatric specialists are concerned that parents are getting the wrong message regarding the safety of letting their children eat peanuts to prevent them from developing peanut allergies. The American College of Surgeons released an advisory that warns parents and caregivers about the risks of giving nuts to babies and infants, acknowledging that while The New England Journal of Medicine study did address these worries, much of the mainstream news coverage of the research has not.

“It is important that parents realize that exposure to peanut antigen in babies at-risk for allergy should take place in a physician’s office where the babies can be carefully monitored,” according to the advisory. “An appropriate trial should include the eating of smooth peanut butter while monitored and NOT the eating of peanuts!”

A follow-up study called LEAP-On will ask all LEAP study participants to avoid consuming peanuts for one year. These results will determine whether continuous peanut consumption is required to maintain children’s tolerance to peanuts.