The past several years have provided hopeful news for peanut allergy sufferers because of research being conducted around the causes. Most focus is around the Learning Early About Peanut (LEAP) allergy study conducted by the Immune Tolerant Network in the UK and published in the New England Journal of Medicine in 2015. The study is the first randomized trial to prevent food allergy in a large cohort of high-risk infants. It demonstrates “that consumption of a peanut-containing snack by infants who are at high-risk for developing peanut allergy prevents the subsequent development of allergy.”
To learn more, we spoke with Sherry Coleman Collins, MS, RDN, LD about the work she’s doing on peanut allergies. Ms. Collins owns Southern Fried Nutrition, a nutrition consultancy where she has a particular expertise in food allergies. One of her clients is the National Peanut Board who are leading the way with many of these efforts.
Can you tell us about the work being done in regard to peanut allergies?
This is an extremely exciting time in food allergy research. Peanut allergies have been a significant focus for researchers for more than a decade and that focus is starting to pay off. For instance, immunotherapy to help increase tolerance to peanut allergens has been quite successful and there could be one or two new products on the market, pending FDA approval, as soon as next year to help treat peanut allergy. To date, there is no treatment for food allergies outside of treating symptoms.
Great research is underway in developing better diagnostics, since current laboratory tests are unreliable on their own and oral food challenges carry significant cost and risk. We are also continuing to see studies that better describe how we can intervene to prevent peanut allergies in the perinatal and early infant periods. Researchers are also doing more to understand true risk for casual contact, impact on quality of life, and other psychosocial aspects of living with food allergies.
Why is the Learning Early About Peanut Allergy (LEAP) study so significant?
At one time, experts thought the immune system needed time to develop and mature before introducing potential allergens – thus the recommendation to wait to introduce these foods to young children. However, subsequent research showed that wasn’t true.
The LEAP study showed that, in fact, early oral introduction of peanut foods helps reduce the risk for developing peanut allergies by as much as 86% in high-risk infants. Although researchers had suspected this to be the case, the LEAP study was the first rigorous randomized controlled trial to prove the theory that early introduction is protective when it comes to peanut allergies.
What did it teach us? How are allergy practices changing as a result?
Prior to the LEAP study, the American Academy of Pediatrics official statements about complementary feeding (the introduction of solid foods to the infant’s diet of breastmilk or formula) stated the evidence did not support withholding allergens as a means to prevent food allergies. However, the guidelines didn’t specifically encourage introduction and many practitioners were ambivalent or cautioned to wait until after 12 months or longer.
After the LEAP study was published in the New England Journal of Medicine, more than a dozen professional pediatric and allergy organizations came together to create a consensus statement recommending early introduction of peanut foods. This was followed by formal guidelines by the National Institute of Allergy and Infectious Disease (NIAID) that provide specific recommendations and steps for professionals to encourage the early introduction of peanut foods for all infants in the U.S.
What are the “latest recommendations for introducing peanut foods”?
The NIAID guidelines recommend peanut foods be introduced in safe and age-appropriate ways starting as early as 4-6 months, depending on a child’s risk. High-risk infants, those with severe eczema or existing egg allergy, should be evaluated by their pediatrician before introducing peanut foods. The majority of infants will not need evaluation, however, and can begin eating peanut foods (such as peanut butter thinned with warm water or breastmilk) at or around 6 months.
If you’re a person with a peanut allergy, what should you do?
Those with existing, medically-diagnosed peanut allergy should strictly avoid peanuts. Peanut allergic individuals should consult with their allergist on a regular basis for specific instruction on managing their peanut allergy.
In addition to avoidance, those with any food allergy should carry their emergency medication, have an up-to-date food allergy anaphylaxis plan, and ensure those around them in the family, in schools, and in the workplace are aware of the allergy and how to treat a reaction.
If you’re the parent of an infant or young child who seems to be allergic to foods, what actions should you take?
If a parent suspects an infant or young child may have food allergies, they should see a pediatrician and/or allergist versed in food allergies. They should not try to diagnose the allergy themselves or overly limit foods, as that can lead to over and unnecessary restriction, and could increase the risk for developing true food allergies.
Is one of the recommendations of the LEAP study that parents should introduce all foods to infants rather than withhold some?
The LEAP study specifically researched peanut allergies. Other studies have shown that introducing potential allergens early is safe and may reduce the risk of developing food allergies. Research has not shown any support for withholding any food to prevent allergies.
Infants and children with a first-degree relative (parent or sibling) who has a food allergy are at a slight increased risk and may want to consult their pediatrician about when and how to introduce potential allergens.
For those lucky enough to not be allergic to peanuts, what is your favorite way to eat them?
It’s important to know 99% of Americans are NOT allergic to peanuts. While we want to take care when it comes to protecting and respecting those with peanut allergies, most people can enjoy them without any risk.
My personal favorite ways to enjoy peanuts are straight out of hand – crunchy, salty Virginia peanuts are my personal favorite for snacking. I also LOVE peanut butter by the spoonful, spread on toast with my homemade jam, or on noodles as a spicy peanut sauce.
Why attracted you to working with the National Peanut Board?
I love that the National Peanut Board is dedicated to providing accurate information about peanuts, nutrition and health, and food allergies to empower consumers and professionals.
Peanuts are a power house of nutrition and have been proven to have positive effects on health, including reducing the risk of cardiovascular disease, stroke and type 2 diabetes. I have long been a lover of peanuts and peanut butter and have eaten them often my whole life.
I’m also a native Georgian and peanuts are the #1 crop for our state. All of this together makes it really easy for me to promote peanuts!