DOES PEANUT EXPOSURE INCREASE ALLERGY RISK?
Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813. doi: 10.1056/NEJMoa1414850.
Among children at high risk for peanut allergy, early introduction of peanuts significantly reduced the risk for allergy, according to a randomized controlled trial of 640 infants with severe eczema, egg allergy, or both.
Participants ages 4 to 11 months who were high risk—based on severe atopy or allergy to eggs—were tested for sensitivity to peanut extract at baseline and then assigned to either avoid or consume peanuts.
At 60 months of age, skin allergy testing was repeated; the resulting prevalence of peanut allergy was as follows
A greater percentage of the consumption group showed an increase in levels of peanut-specific IgG4 antibody; the avoidance group, elevated titers of peanut specific IgE antibody.
COMMENTARY
The prevalence of peanut allergy in the United States has increased from 0.4% in 1997 to more than 2% in 2010.1 In 2000, the American Academy of Pediatrics recommended peanut avoidance until age 3 in children at high risk for atopic disease; then in 2008, based on emerging evidence that early introduction of allergenic foods, including peanuts, may decrease the development of allergy, the recommendations were retracted.2,3 The present study, using a randomized trial design, confirms the paradigm-changing hypothesis that early introduction of allergenic foods decreases the subsequent development of food allergies. The authors of the accompanying editorial state that these data are incontrovertible and that children at high risk for peanut allergy should, under supervision of an allergist, be tested and if skin-prick–negative for peanut allergy, be started on a peanut protein–containing diet.1—NS
1. Gruchalla RS, Sampson HA. Preventing peanut allergy through early consumption ready for prime time? N Engl J Med. 2015;372:875-876.
2. Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122:984-991.
3. Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010;126:77-82.
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