For many decades, children have been routinely vaccinated at early ages against various diseases, and the list of ‘standard’ vaccinations has been growing: Between birth and age 18, vaccinations now are supposed to be provided at prescribed intervals for no fewer than 11 diseases – 13 if you count the three comprising the MMR (Measles, Mumps, Rubella) vaccine separately.
Another type of protection, hardly likely to become mandatory (as many of the 11 are), is a special approach to reducing the risk an at-risk child will develop allergies to peanuts and peanut-containing products.
This is, for those who suffer from it, a very serious condition and, according to Wikipedia, the most common cause of food-related anaphylaxis death in the Western world.
Even non-life-threatening peanut reactions can result in hospital visits and, even when not that severe, considerable amounts of anxiety in sufferers, their loved ones and friends.
(I’ve seen how easily, and how frighteningly, an accidental run-in with a product containing even a trace of peanut can throw a household into panic mode: A nephew through my first marriage – a child when I knew him – fell victim to such ‘traces’ on several occasions I’m aware of. His family was more aware than many of the risks, and how to react to attacks of the allergy, because the boy’s father was a doctor.)
The pre-treatment for peanut allergies is based, essentially, on the same principal as injected vaccines: Provide a potential victim with a small dose of the allergen to build immunity.
(Where there’s a family history of alcoholism, this is not a recommended approach – to inject small amount of booze into a baby’s formula – to ward off down-the-road alcohol abuse/addiction!)
The idea to expose kids at risk (through family history or whatever) to peanuts when they’re very young, in hopes doing so will ward off that allergy, stemmed from observed experiences in Israel, where it is not uncommon for children to start consuming peanuts and products featuring peanuts at an early age. And lo and behold, those who do so seem to be resistant to – immune from, to a greater or lesser degree – peanut allergies!
The validity of this concept was confirmed in a study supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The study was conducted by the NIAID-funded Immune Tolerance Network (ITN), and the results, which appeared recently in the online edition of the New England Journal of Medicine, were presented earlier this month (March 2016) at the annual meeting of the American Academy of Allergy, Asthma and Immunology.
A clinical trial found an 81% reduction of the subsequent development of the allergy through the use of the practices recommended by and demonstrated in the study.
Researchers led by Gideon Lack, M.D., of King’s College London, designed a study called Learning Early About Peanut Allergy (LEAP), based on observations that Israeli children have lower rates of peanut allergy compared to Jewish children of similar ancestry residing in the United Kingdom. Unlike children in the UK, Israeli children begin consuming peanut-containing foods early in life. The study tested the hypothesis that the very low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption beginning in infancy.
“Food allergies are a growing concern, not just in the United States but around the world,” said NIAID Director Anthony S. Fauci, M.D. “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention.”
LEAP compared two strategies to prevent peanut allergy—consumption or avoidance of dietary peanut—in infants who were at high risk of developing peanut allergy because they already had egg allergy and/or severe eczema, an inflammatory skin disorder.
“The study also excluded infants showing early strong signs of having already developed peanut allergy. The safety and effectiveness of early peanut consumption in this group remains unknown and requires further study,” said Dr. Lack. “Parents of infants and young children with eczema or egg allergy should consult with an allergist, pediatrician, or their general practitioner prior to feeding them peanut products.”
More than 600 high-risk infants between 4 and 11 months of age were assigned randomly either to avoid peanut entirely or to regularly include at least 6 grams of peanut protein per week in their diets. The avoidance and consumption regimens were continued until 5 years of age. Participants were monitored throughout this period with recurring visits with health care professionals, in addition to completing dietary surveys by telephone.
The researchers assessed peanut allergy at 5 years of age with a supervised, oral food challenge with peanut. They found an overall 81 percent reduction of peanut allergy in children who began early, continuous consumption of peanut compared to those who avoided peanut.
“Prior to 2008, clinical practice guidelines recommended avoidance of potentially allergenic foods in the diets of young children at heightened risk for development of food allergies,” said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation. “While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage a serious public health problem.”
A follow-up study called LEAP-On will ask all LEAP study participants to avoid peanut consumption for one year. These results will determine whether continuous peanut consumption is required to maintain a child’s tolerance to peanut.