Infant Exposure Might Limit Later Peanut Allergies

Year in Review |
December 30, 2015

Infant Exposure Might Limit Later Peanut Allergies

  1. David J. Amrol, MD

The American Academy of Pediatrics now recommends that infants be given peanuts before age 1.

  1. David J. Amrol, MD

In westernized countries, prevalence of allergic diseases has been increasing rapidly. Originally, allergen avoidance early in life was thought to protect against allergic diseases and, in 2000, the American Academy of Pediatrics (AAP) recommended that children at high risk for food allergies should avoid peanut consumption until age 3. However, the incidence of peanut allergy more than doubled between 2000 and 2008, increasing to nearly 2%; in 2008, the AAP recommendations were withdrawn.

The gut is the largest immune organ in the body, and experts now hypothesize that early introduction of highly allergenic foods might be the key to producing tolerance. Thus, researchers in the U.K. performed a randomized, controlled trial in 640 high-risk infants (those with severe eczema or egg allergy) and showed that early peanut introduction (age range, 4–11 months) lowered risk for developing peanut allergy by 80% compared with peanut introduction after age 5 years (NEJM JW Gen Med Mar 15 2015 and N Engl J Med 2015; 372:803, 875). The AAP now recommends early peanut introduction in high-risk children (NEJM JW Pediatr Adolesc Med Oct 2015 and Pediatrics 2015; 136:600).

Almost daily in my allergy clinic, I encounter parents who want to start their infants on peanuts to prevent peanut allergy but are afraid to do so. The difficulty for primary care is that, in the U.K. trial, all children underwent skin-prick testing, and only those with negative tests were immediately started on peanuts. Children with wheals ≤4 mm received in-office challenges, and those with larger wheals were excluded from the study. Also, we don't know if these results can be extrapolated to other foods or to lower-risk children. My advice for parents and clinicians is to recommend that all children start eating all foods, including peanuts, during the first year of life. If a child has severe eczema or another known food allergy, consider either ingesting the first dose in the primary care office or consulting with an allergist for skin-prick testing prior to ingestion.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Amrol, MD at time of publication Equity Abbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health Leadership positions in professional societies Allergy Society of South Carolina (Past President)

Reader Comments (2)

ZITA MAGLOIRE Physician, Family Medicine/General Practice, Private Practice, Georgia

Very interesting study. The abstract mentions peanuts, but actually infants were given peanut protein, as giving peanuts to infants is of course a huge choking risk!

Santiago Prado Physician, Pediatrics/Adolescent Medicine, private

Coincides with my own experience concerning several other alergens
S.P.P.-

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