Are We Going Nuts? The LEAP Study & How to Prevent Peanut Allergy in 2020


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By Pediatric Allergist Dr. David M. Anmuth, FAAAAI, FACAAI, Fairfax Neonatal Associates’ Pediatric Lung & Allergy Center

How Did We Get Here?
Peanut allergy truly began to rise in the 1990s. With this increase, there have been many theories as to why this has occurred (diet, hygiene, plastics, etc.). At this point, no one has a definitive answer, but we do know that if we are proactive, we may be able to reverse the trend and lower the rates for future generations to come.

The Brief History:
In 2000, the American Academy of Pediatrics recommended high-risk children avoid peanuts until they reached 3 years old.

In 2008, the Journal of Allergy & Clinical Immunology published the initial findings of the high prevalence of peanut allergy in British children compared to Israeli children.

In 2010, the National Institute of Allergy and Infectious Disease (NIAID) reported that there was not enough evidence to support the idea that waiting to feed children certain foods prevents food allergy. Their guidelines then changed to suggest feeding infants solid foods (include allergenic foods) no later than 4 to 6 months. However, most pediatricians continued to recommend avoidance of peanut and other common allergens at that time.

In 2015, the results of the Learning Early About Peanut Allergy (LEAP) trial were published in the New England Journal of Medicine. This was a revolutionary study.

By early 2017, NIAID officially changed its guidelines to support early introduction as a way to greatly reduce the risk of developing a peanut allergy.

So What is the LEAP Study?
A pediatric allergist and researcher, Dr. Gideon Lack, noticed that the rate of peanut allergy was 10 times higher among Jewish children in the United Kingdom than Israeli children. This huge difference could not be explained by genetics, socioeconomics, or allergic history.

However, there is one relevant cultural difference between the two countries. In Israel, infants start eating peanut-containing foods when they are about 7 months old, and they continue to eat them as part of a regular diet. But in the UK, children usually do not consume any peanut during their first year of life.

LEAP was the first large study to look at early allergen introduction as a way to prevent food allergy and more than 600 children (ages 4-11 months) participated.

LEAP showed that feeding peanut to high-risk infants early and often could prevent them from developing a peanut allergy. It reduced their risk by 81 percent, compared to a control group that avoided peanuts completely for the same five years.

What Does This Mean for New Parents?
There are currently 3 risk levels and parents should introduce peanuts based on their child’s risk level.

The NIAID feeding guidelines are as follows (parents should ask their doctor if they are unsure about their child’s risk level):

High Risk (child has severe eczema, egg allergy or both)
Introduce age-appropriate peanut-containing foods between 4 and 6 months after the child is professionally tested for peanut allergy (using either a skin prick test or blood test). This will help parents decide whether to introduce peanut at home or in a healthcare setting.

Moderate Risk (child has mild or moderate eczema alone)
Introduce age-appropriate peanut-containing foods at around 6 months. Parents may discuss this with their doctor if they have any specific concerns.

Low Risk (child has neither eczema nor food allergy)
Depending on family preferences and cultural practices, parents may introduce peanut-containing foods whenever desired (preferably within the first year).

Some Helpful Tips:
Peanut products should not be a baby’s first food. Other foods should be tried first in order to make sure the infant is ready for solids.

Parents should never give infants or small children whole peanuts or straight peanut butter, as they are choking hazards.

Safe forms of peanut described in the NIAID feeding guidelines are Bamba (peanut butter-flavored corn puffs softened with water for younger babies), smooth peanut butter thinned with water, smooth peanut butter mixed with pureed fruits or vegetables, and peanut butter powder or peanut flour mixed with pureed fruits or vegetables.

These products are available to everyone and are inexpensive. There are currently no sponsored “products” that work any better than any of the above recommendations.

Sometimes even when following the above directions, peanut allergy is still present. There is no fault when a child develops a peanut or other food allergy. Parents should not feel guilty or blame themselves.

We are still learning about what causes food allergies, how to treat them, and how to prevent them.

As parents and healthcare professionals, we do the best we can do with the information we have at the moment. With revolutionary research like the LEAP study, we are getting more answers every day. More is on the horizon. Stay tuned!

Article adapted from this source.


Fairfax Neonatal Associates’ Pediatric Lung & Allergy Center (PLAC) provides comprehensive care to infants and children needing allergy and immunology diagnoses and treatment. PLAC pediatric specialists provide a wide range of evaluations and testing for allergens, immune and lung function, oral food challenges, and more — all leading to individualized treatment plans with your child’s pediatrician.

Learn more about Dr. David M. Anmuth, this post’s author, here, and all of Fairfax Neonatal Associates’ providers here. Connect with Fairfax Neonatal Associates’ Pediatric Lung & Allergy Center online, or by calling your preferred location, including Leesburg, VA (703-289-1410) and Fairfax, VA (703-289-1410).


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