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A New Approach for Children at Risk for Peanut Allergy

Katlyn Joy | 5, April 2015


Children with a severe allergy to peanuts face many challenges. An accidental tiny exposure can set off hives. Ingesting more may result in breathing problems, anaphylactic shock, and in severe cases death. Even a kiss from someone who recently ate peanuts can result in an allergic reaction.

Until now, the conventional wisdom was to avoid any exposure to peanuts if a child seemed predisposed towards peanut allergies, such as children with a family history of the allergy, or if the baby has severe eczema or an allergy to eggs.

At the annual meeting in February of the American Academy of Allergy, Asthma and Immunology, Dr. Gideon Lack of King's College in London, England, presented information from his study on peanut allergies which was also published in the New England Journal of Medicine.

Dr. Lack is a pediatric allergist and for the study he and his team recruited hundreds of babies between the ages of 4 and 11 months. Each baby was considered at elevated risk for developing peanut allergies. Each infant was tested for peanut allergy through a skin prick test. Any child who had a severe reaction was removed from the study. This whittled the group down to 530 participants.

From there, the study divided children into two groups; the first received no peanut products while the second group was given small doses of peanut a minimum of 3 times a week. This continued for about four years.

The results were convincing. Of the children who were exposed to peanut butter, the rate of peanut allergy at age 5 was just under 2 percent while those who had no peanut products had a rate of 14 percent.

Another test group was comprised of the 98 children who had a milder reaction to the skin test. Of those infants, the rate of allergy at age 5 among the children exposed to peanut butter was 10.6 percent while the avoidance group the allergy rate was a whopping 35.3 percent.

Peanut Allergy Advice Flip Flops

In 2000, American Academy of Pediatrics issued guidelines that parents should keep all peanut products from children at risk of an allergy. However, in 2008, the AAP reversed the decision to advise abstaining from peanut products in those cases. Only in the case of an actual severe allergy was total avoidance recommended. However, for those in between, there was no consensus in how to deal with these children with a history in the family or some allergic symptoms or eczema.

Another concern is that peanut allergies are skyrocketing. The rate was at .4 percent in 1997. By 2010, it was over 2 percent. Other allergists noted some trends. Dr. George Du Toit coauthored the King's College study, and he and Lack noted in 2008 that peanut allergy rates greatly differed between Jewish children living in Britain compared to those in Israel. The difference appeared to be traceable to one thing; British kids eat peanuts later than Israeli children.

Robert Wood, director of pediatric allergy and immunology at Johns Hopkins University in Baltimore says, ""This is the first real data to support that emerging theory," that earlier exposure to peanuts may well save them from severe or life-threatening allergies to peanuts.

Dr. Rebecca Gruchalla of University of Texas Southwestern Medical Center in Dallas, Texas, and Dr. Hugh Sampson of Icahn School at Mount Sinai in New York City authored the editorial on rising peanut allergies in the February 23 New England Journal of Medicine.

The pair believes the newest study should result in new guidelines being set. "The results of this [new] trial are so compelling, and the problem of the increasing prevalence of peanut allergy so alarming." The two state a new guideline should be that at-risk children should be tested for peanut allergy at 4 to 8 months of age. Those without allergic reactions to the test should be given 2 grams of peanut protein 3 times a week for 3 years.

However, many questions remain. Should all children be given peanuts before their first birthday? Is it important that infants be given about eight peanuts three times a week for a full five years? If the regular ingestion of peanuts stops, will the allergy risk rise once more? Clearly, more studies are needed at this point to answer all questions, but the latest study is setting a new standard that may very well stem the explosion in the rates of the deadly allergy.

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