Early Peanut Introduction Decreases Rates of Peanut Allergies

Victoria Soriano, BSc

New guidelines have increased the number of parents who introduce their children at 12 months to the peanut in order to avoid any potential peanut allergies down the road.

Researchers in the past have found in randomized, controlled-trials the early introduction of the peanut has shown evidence it could prevent peanut allergies.

A team, led by Victoria Soriano, BSc, Murdoch Children’s Research Institute/University of Melbourne/Centre for Food and Allergy Research (CFAR) Australia, evaluated the change in peanut allergy prevalence following changes to infant feeding practices since a pair of population-based studies conducted 10 years apart led to changes in infant feeding practices in 2016.

The research was presented in a late-breaking poster at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2021 Annual Meeting.

Comparing 2 Samples

The researchers recruited a population-based sample of 1933 infants at 12 months old between 2018-2019 and compared the data to a sample of 5276 infants recruited 10 years early between 2007-2011. The investigators used the same sampling frame and methods and collected questionnaires on demographic and infant feeding data.

Each infant in the study sensitized underwent skin prick tests and food challenges and the investigators compared the prevalence between the 2 cohorts using direct standardization and marginal effects models. The data was adjusted for known risk factors for food allergy—parent’s country of birth, family history of allergy, dog ownership, and number of siblings.

Differences in Peanut Allergies

Overall, the adjusted peanut allergy prevalence in 2018-2019 was 2.6% (95% CI, 1.9-4.0%). This was lower than the 3.1% (95% CI, 2.6-3.6%) found in the 2007-2011 cohort.

After making a further adjustment for eczema, the investigators found little difference (2.7%; 95% CI, 2.1-3.2%).

For the current study, 77.7% (95% CI, 75.7-79,5%) of infants consumed peanuts before 12 months. Of this subgroup, 2.6% were peanut allergic, compared to 4.8% of the infants who avoided peanuts until they were older than 12 months (P = 0.041).

“We showed a 16% decrease in peanut allergy following earlier introduction of peanut; however, the prevalence of peanut allergy was still high despite the majority of infants consuming peanut within the first year,” the authors wrote.

Early Introduction During COVID-19

Since the COVID-19 pandemic began, clinicians have opted for a new system of virtually supported home peanut introduction for infant patients at risk of developing peanut allergies.

Prior to initiation of the virtual programs infants were screened for eligibility in a private-practice allergist setting using the telehealth platform Doxy.me.

Patients were eligible if they had physician-diagnosed severe eczema, physician diagnosed egg allergy, SPT≥3 mm or ≥0.35 kU/L without prior ingestion, perceived high-risk by caregiver, or had caregiver anxiety to introduce a particular food.

During this first consultation, parents or guardians were informed about the risks and benefits of either prolonging peanut avoidance until the first in-person visit or participating in the virtually-support food introduction process.

If they chose to proceed with the program, then consent was obtained, and they were prescribed an epinephrine autoinjector and rupatadine.

The study, “Has the Prevalence of Peanut Allergy Changed Following Earlier Introduction of Peanut? The Early Nuts Study,” was published online by AAAAI 21.