PEANUT ALLERGY Early exposure cuts kids’ risk

By Jonel Aleccia

The Seattle Times

SEATTLE

It may look like just another lunch, but when 11-month-old Reese Couty bites into a peanut-butter sandwich at her home, it’s nothing less than revolutionary.

The 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.

“She 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.”

With 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 of worry.

But a 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.

The results of the Learning Early About Peanut Allergy (LEAP) study, conducted in London, are so compelling they’ve already made their way to medical clinics and home kitchens across the country.

Local allergists say they’re now seeing dozens of high-risk babies a month, testing to see whether they have a severe peanut allergy and, if they don’t, 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 – and the larger population.

The 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.

The LEAP trial was led by Dr. Gideon Lack, a professor of pediatric allergy at King’s 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.

In the 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.

The researchers randomly assigned the babies either to be regularly given food containing peanuts or to avoid those foods.

By the 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.

Among 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.

The 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.

“The 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 New York.

The study was primarily funded by the National Institutes of Health (NIH) and Food Allergy Research and Education (FARE), a national advocacy group.

Recently the American Academy of Pediatrics (AAP) issued interim guidelines, in consensus with national and international allergy groups, which suggest using LEAP-style treatment for high-risk infants.

“I 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.

For Tilles, the new guidance has helped cement growing efforts to overturn what experts now say was misguided advice to avoid peanuts.

In 2000, 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.

But that didn’t 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.

Only 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.

Still, that’s not to say parents of high-risk kids should start feeding peanuts on their own.

“Medical decisions should be made under the advice of a physician,” said Dr. James R. Baker Jr., FARE’s chief executive. “Parents should consult with their doctors and see if the guidance for early introduction is appropriate for them.”