Some 60,000 children avoided peanut allergies thanks to landmark 2015 advice, study finds

A decade after a landmark study proved that feeding young babies peanut products could prevent the development of life-threatening allergies, new research reveals the change has made a big difference in the real world.

About 60,000 children have avoided developing peanut allergies after guidelines first published in 2015 shook up medical practice by recommending introducing the allergen to infants as young as 4 months old.

“It’s a remarkable thing, isn’t it?” said Dr. David Hill, an allergist and researcher at Children’s Hospital of Philadelphia and author of a study published Monday in the medical journal Pediatrics. Hill and colleagues analyzed electronic health records from dozens of pediatric practices to track food allergy diagnoses in young children before, during and after the guidelines were released.

“I can actually come to you today and tell you that there are fewer children with food allergies today than there would have been if we had not implemented this public health effort,” he added.

“Our findings are relevant to both those of us who treat patients and those who care for infants, and more awareness, education and advocacy could further increase the positive results we observed in this study,” he continued. “Future studies could potentially explore specific dietary practices that help us better understand the timing, frequency and dose of foods that optimize protection against food allergies.”

Researchers found that peanut allergies in children ages 0 to 3 decreased by more than 27% after the recommendations for high-risk children were first released in 2015 and by more than 40% after the recommendations were expanded in 2017.

These efforts have not yet reduced the overall increase in food allergies in the United States in recent years. Approximately 8% of children are affected, of whom more than 2% are allergic to peanuts.

Peanut allergy occurs when the body’s immune system mistakenly identifies proteins in peanuts as harmful and releases chemicals that trigger allergic symptoms, including hives, respiratory symptoms and, sometimes, life-threatening anaphylaxis.

For decades, doctors have recommended delaying feeding children peanuts and other foods that can trigger allergies until they are 3 years old. But in 2015, Gideon Lack of King’s College London published the groundbreaking trial Learning Early About Peanut Allergy, or LEAP.

Lack and colleagues showed that introducing peanut products in early childhood reduced the future risk of developing food allergies by more than 80%. Subsequent analysis showed that protection persisted in about 70% of children into adolescence.

The study immediately led to new guidelines calling for early introduction of peanuts – but implementation has been slow.

Only about 29% of pediatricians and 65% of allergists reported following the expanded guidelines published in 2017, according to surveys.

Confusion and uncertainty about the best way to introduce peanuts early in life led to this disconnect, according to a commentary accompanying the study. From the beginning, medical experts and parents questioned whether the practice could be adopted outside of tightly controlled clinical settings.

Data for the analysis comes from a subset of participating practice sites and may not represent the entire U.S. pediatric population, notes the commentary led by Dr. Ruchi Gupta, a childhood allergy expert at Northwestern University.

However, the new research offers “promising evidence that early introduction of allergens is not only embraced, but could have a measurable impact,” the authors conclude.

Advocates for the 33 million people with food allergies in the United States have welcomed signs that the early introduction of peanut products is catching on.

“This research reinforces what we already know and highlights a significant opportunity to reduce the incidence and prevalence of peanut allergy nationally,” said Sung Poblete, executive director of the nonprofit group Food Allergy Research & Education, or FARE.

The new study emphasizes current guidelines, updated in 2021, that call for introducing peanuts and other major food allergens between four and six months of age, without prior screening or testing, Hill said. Parents should consult their pediatrician with any questions.

“It doesn’t have to be a lot of food, just small tastes of peanut butter, milk-based yogurt, soy-based yogurt and tree butters,” he said. “These are really good ways to allow the immune system to be exposed to these allergenic foods safely.”

Tiffany Leon, 36, a Maryland-based registered dietitian and director of FARE, introduced peanuts and other allergens to her own sons, James, 4, and Cameron, 2, early on.

At first, Leon’s own mother was shocked by the advice to feed babies such foods before age 3, she said. But Leon explained how science had changed.

“As a dietitian, I practice evidence-based recommendations,” she said. “So when someone said to me, ‘This is how it’s happening now, these are the new guidelines,’ I just thought, ‘OK, well, this is what we’re going to do.'”