In the United States, United Kingdom and other western countries, food related allergies have emerged as a major medical and public health concern. Peanut allergy prevalence has doubled over the past ten years, emerging as the leading cause of anaphylaxis cases and even death.(1)
“The recurring theme at the American Academy of Allergy Asthma & Immunology (AAAAI) meeting [in February] seemed to be that by being so clean and careful in the U.S. we have created a generation of more allergic children” stated an Allergy and Immunology specialist participating in SERMO’s online thread on the study.
“Some people with severe peanut allergies can go into anaphylaxis from inhaled allergen exposure.” stated an Allergy & Immunology specialist. Airplanes, schools and other public spaces are now enacting more stringent guidelines to address major public health concerns.(2)
SERMO released a poll to gain insight on whether physicians believe that peanut exposure guidelines should be changed following ground-breaking research presented at the AAAAI annual meeting and subsequently published in the New England Journal of Medicine.
60% (1178) of the physicians who participated in the SERMO poll believe that introducing peanut products to infants in their first year of life is an important preventative measure. Only 5% (115) disagree while the remaining 36% (716) believe that additional research is needed. Among specialists that treat children and mothers with peanut allergy, an even higher percentage believe that early consumption is the way to go.
The Learning Early About Peanut (LEAP) study is the first randomized trial to prevent food allergy in a large cohort of high-risk infants. (2) Dr. Gideon Lack, professor of paediatric allergy at King’s College London, led the London-based clinical trials which enrolled 640 infants between 4 to 11 months old. Within the intention to treat cohort, peanut snacks were administered in six gram doses three or more times on a weekly basis until the participants reached five years of age. (1)
At the end of the trials, a final peanut challenge revealed striking results – early introduction of peanut dramatically decreased the risk of developing peanut allergy by approximately 70 to 80%. The immune system tolerance due to early consumption was observed in infants with prior exposure to environmental peanut as well as those with no initial peanut sensitivity.(1)
Out with the old guidelines?
“Developed countries have more allergies related to food & environment compared to less developed (…) countries,” – Family practitioner on SERMO’s discussion thread.
US clinical practice guidelines had been in place since 2000 that recommended allergenic foods be excluded from the diets of high risk infants and their mothers during pregnancy and lactation. (6) In the UK, such guidelines had been in place since 1998.(5)
Dr. Gideon Lack conducted his own crowd poll at a talk he gave in Israel nearly 15 years ago. (3) After learning from the audience that only three attendees were actively treating peanut allergy patients, a team of researchers issued questionnaires to Jewish families from Israel and the UK to see if there was a connection between dietary choices and peanut allergy prevalence. (4)
In 2008, the team shared that peanut allergy was ten times more prevalent in the UK and that peanut is eaten more frequently and in larger quantities in Israel.(4) That same year, the avoidance recommendations were no longer promoted by the American Academy of Paediatrics (AAP) (7).
“My goodness, hasn’t this thing gotten out of hand?” exclaimed a family medicine doctor on SERMO threads. As physicians currently deliberate the best way to recommend peanut consumption for high risk patients, LEAP’s research, and the SERMOpoll opinions, indicate that guideline changes may be imminent and the tides may turn against peanut allergy prevalence in the next decade.
But will it last?
The LEAP clinical trials participants are currently being monitored for one year to determine if oral tolerance lasts after discontinuing regular peanut consumption (LEAP-On Study).
Do you agree with the research findings or is more evidence needed to prompt guideline changes from the American Academy of Paediatrics (AAP), and the UK’s Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment?
How would early consumption recommendations be received in western countries? Will US and UK families with high risk children be wary of introducing snacks such as Bamba Osem, the Israeli peanut snack, or smooth peanut butter?
We will continue to discuss clinical topics related to food allergies and other current trends in healthcare on SERMO. If you are an M.D. or D.O. in the US or UK, please join us.