Peanut allergies in babies and children up to age 3 dropped by more than one-quarter since the first consensus statement recommending the introduction of peanut products in infancy was issued in 2015, according to a new study published in Pediatrics.

Although guidelines on early peanut introduction were published nearly a decade ago, their effect on changing rates of food allergy in real-world clinical practice had not been examined, said David A. Hill, MD, PhD, a pediatric allergist, immunologist, and attending physician at Children’s Hospital of Philadelphia, Pennsylvania, who led the study.

“We were encouraged, but not entirely surprised, to see a clear decline in peanut and overall IgE-mediated food allergy rates following the 2015 and 2017 early introduction guidelines,” said Hill. “Clinicians should feel confident recommending introduction of peanut-containing foods around 4-6 months of age for nearly all infants, without waiting for allergy testing.”

Hill and his team reviewed electronic health records from 31 practices within academic health systems and 17 independent practices in the mid-Atlantic region. The study population included two groups: those who received care before the 2015 guidelines were published (38,594 children; mean age, 1.2 years), and another who received care in the 2 years following (46,680 children; mean age, 0.9 years). 

Participants were observed for a minimum of 2 years for the development of atopic dermatitis and immunoglobulin E-mediated food allergy (IgE-FA). 

Hill and his colleagues also conducted a 1-year “post-addendum” cohort with entry between February 2017 and January 2019 to reflect the publication of addendum guidelines in early 2017 (39,594 children; mean age, 0.8 years). These guidelines formally recommended early peanut introduction for all infants at low risk for developing peanut allergy and for infants deemed at high risk due to severe eczema or egg allergy. 

The cumulative incidence of peanut IgE-FA, one or more IgE-FAs, and two or more IgE-FAs decreased significantly, by 27.2%, 37.9%, and 29.1%, respectively, over a 2-year period (P < .0001 for all).

The decreases in cumulative incidences of peanut IgE-FA were even lower in the post-addendum cohort compared to the pre-guidelines group, with decreases of 43% for cumulative incidence, 28.6% for one or more food allergy, and 28.6% for two or more (P < .0001 for all). 

The August 2015 brief consensus statement on introducing allergenic foods to infants was cosigned by the American Academy of Allergy, Asthma & Immunology, the American Academy of Pediatrics, and the American College of Allergy, Asthma & Immunology, among others. 

The statement followed the publication of the landmark Learning Early about Peanut Allergy (LEAP) study, in which significantly fewer infants randomized to peanut exposure developed peanut allergies than those who avoided the food completely. 

Takeaways and Research Gaps

The findings mirror what researchers from LEAP trial found, but the current study shows that the effect extends to the population outside of the clinical trial, Hill said. 

“The reduction was smaller than in the tightly-controlled LEAP trial, likely because real-world implementation is more variable, and many clinicians and families still introduce allergens later than recommended,” he noted.

The takeaway of the new study is that early and sustained introduction of peanut and other allergenic foods works, Hill told Medscape Medical News. 

The current study reinforces that this strategy is both safe and effective, and pediatricians play a key role in ensuring that conversations about food allergy prevention happen during routine well-child visits, he said.

Notably, the guidelines describe infant-safe forms of peanuts, and clinicians should remind families peanuts and peanut butter are choking hazards for babies, said Scott H. Sicherer, MD, a professor of pediatrics and director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, New York City, who was not involved in the study.

The National Institute of Allergy and Infectious Diseases describes safe and specific instructions for providing peanut protein at home. The findings may encourage more uptake of the recommendations and a greater protective outcome for the population, Sicherer told Medscape Medical News. 

“Although the advice has been out for years, studies have suggested some parental reluctance and even some health provider reluctance to follow the advice, probably because it is so different than what was suggested 15-20 years ago, and because peanut is such as well-recognized allergen,” he said. 

The study received support from the National Institutes of Health, the Food Allergy Fund, the American Academy of Pediatrics, among others. The researchers reported no financial conflicts to disclose. Sicherer reported no financial conflicts but served as an author on the early introduction guidelines.