For years, the widespread recommendation for preventing food allergies was to completely avoid feeding children any types of allergenic foods. New parents were staunchly advised to keep their kids far away from dairy, peanuts, shellfish and any other foods typically associated with allergies. This theory was reflected in medical blogs, parenting magazines, academic guidelines and well-meaning tips from relatives and friends.
However, over the past decade, the discussion has shifted dramatically. In the early 2000s, concerned members of the scientific community began to suspect that the steadfast practice of early avoidance lacked merit. Many began to hypothesize that, in fact, the opposite was true: that eating allergenic foods early in life could help prevent developing allergies.
One such scientist was Dr. Gideon Lack, a pediatric allergist and professor at King’s College in London. Having family from Israel, Dr. Lack had spent time there and noticed that the peanut allergy rates were unusually low. After conducting an observational study, he discovered that the allergy rates among Jewish children living in Israel were 10 times lower than those of Jewish children living in England. Dr. Lack suspected the disparity could be attributed to the immense popularity of Bamba, a peanut-flavored snack, among Israeli children. He decided to test his theory with another experiment, called the LEAP (Learning Early About Peanuts) study.
“Israelis eat Bamba very early in life, and by eating it so early, you can affect the immune system in a unique way and therefore have a much lower rate of allergy,” explained Dr. Marshall Plaut, NIAID (National Institute of Allergy and Infectious Diseases) food allergy expert and co-author of the LEAP study, in an interview with this article’s author. “The LEAP study was an attempt to (replicate) that.”
The LEAP study was a clinical trial that included 640 infants who were all considered at risk for developing a peanut allergy, having shown early signs such as severe eczema and/or an egg allergy. Starting from the age of 4-11 months, they were randomly assigned to either eat peanut-containing foods three times a week, or to avoid eating them completely. After five years of following these diets, the children were tested. From the group that avoided peanuts, 17 percent had developed an allergy. Incredibly, only 3 percent of children who regularly ate peanuts had developed an allergy. In that group, the rate was reduced by 81 percent.
“That (the LEAP study) was direct evidence that eating early does something… that it is clearly beneficial for prevention of peanut allergy to eat peanuts beginning in infancy, and on a regular basis,” said Dr. Plaut. “That was the basis for a new understanding that early consumption of foods that have the potential for causing allergies might actually be able to prevent it.”
While this may seem paradoxical, the logic behind it lies in the very nature of how allergies develop. Allergies occur when the immune system encounters an allergen, such as a peanut protein, and views it as a dangerous foreign substance, triggering an immune reaction ranging anywhere from an annoying sniffle to life-threatening anaphylactic shock. Feeding a child peanuts at an early age allows his or her immune system to be exposed to the potential allergen, so it can recognize it later as a harmless substance.
But despite validation of the new theory in the academic world, there still remains a need to raise awareness to the public, and to make sure parents are properly equipped to reduce their children’s risk of allergies. “What people had heard, what had been publicized, was that you should avoid allergenic foods early in life, so there was a need to reeducate,” Dr. Plaut explained. “The (updated) recommendations… were published approximately six months ago, with as much publicity as can be reached. The physician groups have certainly heard about it, and we’re trying to do other studies to make people more aware of these new recommendations.”
The new recommendations detail how and when peanuts should be introduced, including separate guidelines for children with varying risk levels. They also discuss precautions parents should take. “In high-risk groups, you have to make sure the infant is not already allergic even very early in life,” Dr. Plaut said. “If the child is already allergic, then it’s not safe to introduce the peanut.” In addition to testing for allergies, the guidelines recommend in some cases to have doctor supervision for the first time introducing the peanut. They also warn against using whole peanuts, which present a choking hazard.
Current recommendations advise about using the early exposure method just with peanuts, but scientists hope this is only the beginning. “We’d like to know if this study, which has to do with peanuts, is potentially relevant to other foods, too” said Dr. Plaut. With further research, it is possible that this groundbreaking method will be able to help prevent many kinds of allergies. And for now, if it can help some kids to not have to suffer from just one, well, that’s pretty great, too.
This article is meant to provide general information only and should not be used as a medical resource. For more information and specific questions, please consult your physician and the NIAID website at https://www.niaid.nih.gov/diseases-conditions/guidelines-clinicians-and-patients-food-allergy, which has links to recommendations designed for parents and caregivers.
By Rachel Retter
Rachel Retter is a summer intern and contributor to The Jewish Link.
