May 102016
 

Hope for the Prevention of Peanut Allergyno peanut pic

Summary of this Blog Post: In March 2016, the results of a study about preventing peanut allergy were published. It was found that early introduction of peanuts at 4-11 months of age significantly reduced the development of peanut allergy. Feeding peanuts to your baby should be done only under close medical supervision from your pediatrician.

An allergy is a problem with the body’s immune system. Normally the immune system attacks legitimate threats to the body, such as germs. But sometimes the immune system goes awry and attacks a harmless substance that it thinks will hurt the body. This harmless substance is referred to as an allergen. An allergen can be something that is eaten (a food–usually a protein), something that is inhaled (pollen or dust), or something that touches or enters the body through the skin (latex gloves or a cosmetic lotion). The immune system perceives the harmless allergen as a danger to the body and causes an allergic reaction, which can involve sneezing to get the allergen out of the body through the nose and mouth, or vomiting to get it out through the mouth, or even pooping to get it out in diarrhea. The majority of allergic reactions are not serious, but some are very severe and can be fatal, such as anaphylaxis.

Anaphylaxis or anaphylactic shock is a very serious allergic reaction that can be life-threatening. It can cause a sudden drop in blood pressure and it can cause the tongue to swell and the throat to constrict, thereby causing problems with breathing (see links about anaphylaxis below). For safety, people at risk of anaphylaxis should always wear a medical bracelet, patch, or sticker and carry a pre-loaded epinephrine injection. Epinephrine keeps anaphylactic symptoms under control for only several minutes until the person could be rushed to an emergency room. Perhaps you know someone with an allergy to bees who always carries an EpiPen®, which is one of the most common brands of epinephrine injectors. Like bee allergy, peanut allergy is known for its risk of anaphylaxis.

Peanut allergy is on the rise. Peanut allergy is one of the most common food allergies in children, and it is on the rise. Peanut allergy has more than tripled from 1997 to 2008. Currently, approximately 1-3 children out of 100 have peanut allergy. Because peanut allergy is so dangerous and on the increase, it is considered a public health hazard.

Avoidance. Peanut allergy currently has no cure and is rarely outgrown–approximately 20% of children outgrow peanut allergy. The only option for people with peanut allergy is to avoid peanuts altogether. Total avoidance is difficult in an age where peanuts are in many processed foods–candy bars with peanuts, peanut snacks on airplanes, ballgame peanuts (as in “buy me some peanuts and Cracker Jax®”) and even Oreo®cookies with Reese’s® peanut butter cups. Laws are currently in effect for mandatory food label warnings on food packages containing peanuts and other common allergens (see links below).

Schools. In some schools, children with peanut allergy are now set-apart in the cafeteria at “no-peanuts” tables. Some schools have gone totally peanut-free–no peanuts allowed at all in any part of the school or playground–causing battles between parents of children with peanut allergy and parents who want their children to be able to take peanut butter and jelly sandwiches to school.

Parents worry that other people just don’t realize the severity of peanut allergy and the fact that it may mean life or death for their allergic children. A child with peanut allergy who eats peanuts, even a trace amount, can go into anaphylactic shock.

Since there is currently no cure for peanut allergy, hope lies in its prevention. Preventing peanut allergy would involve somehow “teaching” the immune system not to react to peanuts. And this teaching would have to be done BEFORE a full-blown peanut allergy developed in the child. So researchers raise the question, “How do we prevent peanut allergy before it starts?”

Bamba Peanut Snack

Bamba Peanut Snack
Photo Courtesy of National Institutes of Health (NIH.gov)

The answer seems to have been found during observation of the rate of peanut allergy in Jewish children living in Israeli. Their rate is ten times lower than that of Jewish children of similar ancestry living in the United Kingdom. In Israel, children are typically fed peanuts starting when they are about 7 months old in a snack food called Bamba® (see picture on right). In the UK, doctors recommended not feeding peanuts to babies until they are three years old, because of fear of peanut allergy. Because of the large difference in the rates of peanut allergy in these two groups, scientists began to hypothesize that early introduction of peanuts might actually help prevent peanut allergy.

The LEAP Study. To find out if this hypothesis was true, Dr. Gideon Lack of King’s College in London lead a study named “LEAP” (Learning Early About Peanut allergy). The study’s participants included 640 babies who were between 4 and 11 months old, since peanut allergy usually begins very early in life and 4-11 months is a significant age for the development of the immune system. The babies were deemed to have high risk of peanut allergy because they already had severe ezema or an egg allergy or both.

The LEAP study involved dividing the babies randomly into two cohorts: a peanut-consumption group who ate peanuts during the study and the peanut-avoidance group who did not eat peanuts. The peanut-consumption group was exposed to peanut protein three times per week until they were 5 years old by feeding them either Bamba or smooth peanut butter.

Results of the LEAP Study. The peanut-consumption group remarkably had more than an 80% reduction in peanut allergy. Therefore, the early introduction of peanuts DID help to prevent peanut allergy in most of the children in the LEAP study. Results of the LEAP study were published in February 2015 at NEJM.org (see link below).

AAP Recommendations. In the US, from 2000 to 2008, the American Academy of Pediatrics (AAP) recommended that parents not feed their babies peanuts until age 3 years. They have since retracted that recommendation. Currently, the AAP stresses that parents work with their pediatricians BEFORE feeding peanuts to their babies. This is especially true for babies with first-degree relatives (parent or sibling) with allergies, who are at very high risk of allergy. ANY allergy in the family, including allergies to peanuts, tree nuts, bees, pollen, pet dander, gluten, latex, etc., should be discussed in depth with your pediatrician before you feed your baby peanuts.

How ironic that the practice of avoiding feeding peanuts to babies in the UK actually raised the rate of peanut allergy, and not insignificantly!


WARNINGS ABOUT FEEDING PEANUTS TO YOUR BABY:  Please note that the children in the LEAP study were fed peanuts under close medical supervision. Please do not feed your children peanuts without first getting your pediatrician’s approval.

Professional recommendations about the foods to feed your baby change frequently. Baby food books and websites may have old information, therefore, it is very important that you first discuss with your pediatrician ANY foods you want to introduce to your baby BEFORE you feed them to your baby. Your doctor should be knowledgeable about the latest professional recommendations.

WARNINGS ABOUT CHOKING: Whole peanuts should never be fed to small children because they are choking hazards. Peanuts should first be ground to a powder in the blender and then mixed in with baby cereal, purrées, smoothies, etc. Thick peanut butter is also a choking hazard. Peanut butter should be thoroughly mixed with liquid until it is thin and spead thinly on bread or crackers. See the links below for the healthiest way to feed a baby peanuts.


The LEAP-ON Study. When the LEAP study concluded, the researchers had a follow-up question: “Did the children have to continue eating peanuts regularly to keep peanut allergy from developing?” To answer this, a follow-up study named “LEAP-ON” (Persistence of Oral Tolerance to Peanut) was begun with 556 children from the LEAP study. This time, both the peanut-avoidance and the peanut-consumption groups were NOT given any peanuts for a year. At the end of the year, the children were then given peanuts. And in almost all of the children, yes, tolerance to peanuts did continue after a year of not eating peanuts. Therefore, the LEAP-ON study found that avoiding peanuts for a period of one year would not (significantly) raise the incidence of the development of peanut allergy. Results of the LEAP-ON study were published online in March 2016 at NEJM.org (see link below).

Future Studies on Peanut Allergy. Researchers now ask if tolerance to peanut allergy would continue if children avoided peanuts for more than one year. To answer that question, future studies on peanut allergy are planned for much longer avoidance periods.

SPONSORED LINKS

Bamba Peanut Snack
I actually purchased Bamba from Amazon.com to try it. The texture of Bamba is like that of Jax® puffed cheese curls, but it tastes like peanuts. Most children in the LEAP study liked Bamba and many ate more than was required by the study. If you wish, click here to buy Bamba.

Super Healthy Nuts and Seeds
Raw, unprocessed peanuts, nuts, and seeds are powerhouses of nutrition. Peanuts are actually biologically not nuts, but legumes, but people tend to consider them nuts. Nuts and seeds contain healthy oils–peanut oil, flaxseed oil, sunflower seed oil,etc.–that go rancid quickly when exposed to air, light, or heat. Perhaps you have seen flaxseed oil in dark bottles refrigerated at the supermarket. The best way to feed your baby nuts and seeds is to buy them organic, whole, and raw and grind them in the blender immediately before feeding them to your baby before the oils have any chance of turning rancid.

Super Healthy Peanut Butter and Other Butters
Feeding your baby healthy peanut butter, almond butter, pumpkin seed butter, tahini (sesame seed butter), and other nut and seed butters is another way to include to include nuts and seeds in your baby’s diet. After opening the jars, keep them in the refrigerator and discard them at the expiration date. The healthy oils in natural nut and seed butters will separate and float to the top in the bottles, so you may want to store them on their sides in the fridge. Place them in the fridge where you easily see them and give them a quarter turn every so often to keep the oil mixed throughout the butters.

Allergies Health Center from WedMD
WebMD has lots of great information about allergies and anaphylaxis on their website. Click the links below:
A list of symptoms of anaphylaxis.
Anaphylaxis: Managing Life-Threatening Allergies
VIDEO: Anaphylaxis: Managing Life-Threatening Allergies
Anaphylaxis. Act Fast — Why Every Second Counts
Severe Allergies Video: Teach Your Child How to Use Epinephrine
Allergic to Nuts? Surprising Foods to Watch Out For
WebMD: LEAP and LEAP-ON studies

The LEAP and LEAP-ON website

New England Journal of Medicine–NEJM.org
NEJM: LEAP Study-Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy 
NEJM: LEAP-ON Study-Effect of Avoidance on Peanut Allergy after Early Peanut Consumption

Food Labels
Food Allergen Labeling info from FoodAllergy.org
Frequently Asked Questions About Food Allergen Labeling from KidsWithFoodAllergies.org

Studies on Already-Existing Peanut Allergy
The above blog post is about the LEAP and LEAP-ON studies, which were about the prevention of peanut allergy before it developed in children. For those who already have peanut allergy, there are some studies going on for the treatment of an already-developed peanut allergy.
WebMD: New Therapy May Knock Out Peanut Allergy–Experimental Treatment Gives Patients Tiny Amounts of Peanut Protein
WebMD: Common Bacteria Helps Treat Food Allergies–Promising Results in Animal Studies Offer Hope for Treatment in Humans.
NIH: Therapy Shows Promise for Peanut Allergy

Food Allergy Resources
American Academy of Allergy, Asthma and Immunology (AAAAI). www.AAAAI.org
Kids With Food Allergies (KFA). www.kidswithfoodallergies.org
Food Allergy Research & Education (FARE) www.foodallergy.org

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