Infant Peanut Exposure

Since a study last year there has been an increased interest in the possible effect of early exposure of allergens on a children thought to be at ‘high risk’ of allergy . In the last 10 years the prevalence of peanut allergies has doubled in the western world and is becoming increasingly apparent in Africa and Asia where previously it had far fewer cases- with the hygiene hypothesis and vitamin D deficiency being the most probable causes for this.

640 infants who were between 4 and 11 months with severe eczema and or egg allergies were instructed to either consume or avoid peanuts until 60 months old, infants were selected for either group depending on a pre-existing sensitivity to peanuts that was determined by prick testing. The results showed that of the 530 who originally had a negative prick test, 13.7% of the avoidance group and 1.9% of the consumption group had developed a peanut allergy by 60 months. Of the98 originally positive prick tests, 35.3% of the avoidance group and 10.6% of the consumers developed a peanut allergy at 60 months. Thus it was concluded that the early consumption of peanuts significantly decreases the probability o developing a peanut allergy. Although the results are extremely persuasive, there would need to be far more research carried out with similar concluding data before policy could be changed.

 
Prick tests

Enrolment of Sample Subjects:

The recruitment of the sample was based of pre-existing eczema and egg allergy as in the general population the prevalence of peanut allergy is only 2% whereas within a population of those with there pre-existing conditions the prevalence of peanut allergy is up to 20%. hence by limiting the study group with these conditions the sample size can be largely decreased, thus also reducing cost.

Inconclusive participants:

7 of the participants randomly assigned to the consumption group had a positive original prick test and therefore parents chase to stop their child’s consumption of peanuts- at 60 months old 4 of there participants obtained a second positive test.

What can we take from this study?

Among low risk children (80-90% of population) that do not have signs of eczema in the first 6-12 months or evidence of food allergies, peanut and peanut protein should be consumed in any possible forms depending on culture. Peanut butter should be consumed as soon as weaning commences, although you do not want it to be the first solid food a child consumes as it may be misinterpreted an allergic manifestation due to a child’s possibility inability to consume solid foods as a result of poor coordination.

Among higher risk children there should be greater medical supervision during early consumption, although following a negative early prick test the child may be encouraged to try peanuts at home based on advice from their paediatrician or GP.

Despite the success of this study there has been very little conclusive evidence in the combat of other allergens at this developmental stage.

Hopefully future studies will reveal a clear path for future demise of allergies.

 

 

link to study

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1414850

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