July 2024
Peanut introduction in infancy shown to prevent peanut allergy into adolescence
By Melanie Hinze
Early peanut consumption, from infancy to age 5 years, results in lasting tolerance to peanut into adolescence, irrespective of peanut consumption during childhood, research published in NEJM Evidence has shown.
Sponsored by the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the LEAP-Trio trial was a long-term follow up study of 508 participants from an earlier randomised peanut consumption trial – the Learning Early About Peanut Allergy (LEAP) trial. The LEAP trial showed that early consumption of peanut protected 80% of infants at high risk of allergy against peanut allergy.
In the LEAP-Trio trial, researchers found that in participants aged 12 years, peanut allergy remained significantly more prevalent in those from the original peanut avoidance group than among those from the original peanut consumption group (15.4% vs 4.4%).
The researchers concluded that regular, early consumption of peanut achieved durable tolerance into adolescence, with a 75% reduction in peanut allergy in the intent-to-treat analysis.
Professor Mimi Tang, Group Leader of the Allergy Immunology Researcher Group and Director of the Allergy Translation Centre at the Murdoch Children’s Research Institute in Melbourne, said the initial LEAP parent trial was a seminal study.
‘It was the first high-quality randomised trial to generate evidence that early introduction of allergenic foods in the first year of life can reduce the risk of developing allergy to that particular food, in this case peanut, compared with delayed introduction – with avoidance until age 5 years.’
Professor Tang said findings from the parent LEAP trial, published in 2015, led to changes in allergy prevention advice globally shortly thereafter – moving from advising delayed introduction of allergenic solids to actively encouraging inclusion of allergenic solids as the infant was introduced to complementary foods during infancy.
She explained that long-term follow up was crucial as it was unclear from this first study whether the initial benefits would be lost over time.
Professor Tang told Medicine Today that the current study provided strong support for the updated allergy prevention advice that was implemented following the study. Although this paper only examined the effect of introducing peanut on rates of peanut allergy, it was likely that similar immune effects would be observed for other allergenic foods.
‘The current study confirmed that the benefit of early introduction of peanut containing foods between 4 months and 11 months of age had lasting protection against peanut allergy into adolescence,’ she said. ‘This provides strong support for the updated allergy prevention advice from 2016 onwards.’
Professor Tang said that, as an aside, research at the Murdoch Children’s Research Institute had shown that in Australia updated guidelines were adopted by most families and there were shifts in peanut allergy rates and food anaphylaxis admission rates that correlated temporally with these changes.
‘Specifically, we found a modest reduction in peanut allergy rates in a community sample of Melbourne infants (published in JAMA in 2023) and reduced food anaphylaxis admissions nationally (published in J Allergy Clin Immunol in 2022),’ she said.