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Early introduction of peanuts reduces risk of peanut allergy

Peanut allergy is one of the most common food allergies. Peanuts are not the same as tree nuts (almonds, cashews, walnuts, etc.), which grow on trees. Peanuts grow underground and are part of a different plant family, the legumes. Other examples of legumes include beans, peas, lentils and soybeans. Being allergic to peanuts does not mean you have a greater chance of being allergic to another legume.

The most severe allergic reaction to peanuts is anaphylaxis — a life-threatening whole-body response to an allergen. Symptoms include impaired breathing, swelling in the throat, a sudden drop in blood pressure, pale skin or blue lips, fainting and dizziness. Unless treated immediately with epinephrine, typically administered in an auto-injector, anaphylaxis can be fatal. Less severe symptoms include: itchy skin or hives, which can appear as small spots or large welts, an itching or tingling sensation in or around the mouth or throat, nausea, a runny or congested nose.

There are several misconceptions about peanut allergies. A peanut is a legume (belonging to the same family as soybeans, peas and lentils), not a tree nut. And while it was previously believed that an allergy to peanuts was lifelong, research by the National Institutes of Health shows that about 20% of individuals with a peanut allergy eventually outgrow it.

Evidence indicates early introduction of infant-safe peanuts reduces the risk of developing peanut allergies, according to a clinical report from the American Academy of Pediatrics (AAP). This is an update to the 2008 AAP report, which found “insufficient data to support a protective effect of any dietary intervention for the development of atopic disease,” reported Frank Greer, MD, FAAP, of the AAP Committee on Nutrition, Section on Allergy and Immunology, and the University of Wisconsin-Madison, and colleagues.

This report also enforces the 2017 recommendation from the National Institute of Allergy and Infectious Diseases (NIAID) which stated peanuts could be introduced as early as 4 to 6 months for infants with severe eczema and/or egg allergy, the authors wrote in Pediatrics. For infants with mild or moderate eczema, peanuts can be introduced as early as 6 months, and for infants with no history of eczema or food allergy, peanuts can be introduced after 6 months at the family’s discretion, they noted.

Peanut allergies are rising in prevalence with roughly 1.2 million U.S. children and teens affected as of last year. The AAP endorsed the NIAID-sponsored guidelines shortly after they were published in 2017, and is now updating their clinical guidance with this report.

Guidelines regarding earlier introduction of peanuts were primarily based on the results of the Learning Early About Peanut Allergy (LEAP) trial, in which introducing peanuts as early as 4 months reduced the number of peanut allergies by about 86% in a sample of over 500 infants, Greer and colleagues noted. The same reduction was not seen with egg allergies, and thus the evidence to support the early introduction of eggs is “less clear.”

Peanut.

New peanut allergy treatment ready for FDA review. It’s based on peanuts

A peanut a day… keeps peanut allergies at bay? New research says yes.

Peanut.

Image credits Nicole Köhler.

A new study presented today at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting reports that it’s possible to protect yourself against peanut allergies by building a tolerance to the food over time.

Peanut vs peanut

“We’re excited about the potential to help children and adolescents with peanut allergy protect themselves against accidentally eating a food with peanut in it,” says co-author Stephen Tilles, MD. “Our hope when we started the study was that by treating patients with the equivalent of one peanut per day, many would tolerate as much as two peanuts.”

Spoiler alert, they hoped right.

The team worked with participants ranging from 4 to 55 years old (most between 4 to 17 years old), all of whom were allergic to peanuts. One-third of the participants were assigned to the control (placebo) group, and the remainder were given daily doses of protein powder. This powder was administered in increasing amounts until reaching the “maintenance dose”, which remained unchanged for the rest of the study. This daily dose was roughly equivalent to one peanut.

All participants received the peanut powder as part of an oral food challenge (OFC). A person in an OFC is given a very small oral dose of the food under the supervision of a board-certified allergist to test for a severe reaction. OFCs are considered the gold standard for testing food allergy.

“We were pleased to find that two thirds of the people in the study were able to tolerate the equivalent of two peanuts per day after nine to 12 months of treatment, and half the patients tolerated the equivalent of four peanuts.”

By the end of the study, the patient’s “reactions from the [OFCs] were much milder than prior to treatment,” Dr. Tilles adds. On average, each participant was able to tolerate exposure to a 100-fold higher dose of peanut after the study compared to the initial result. Even better, their reaction to this 100-fold dose at the end of the study was milder than their reaction to the initial dose at the beginning of the study.

The approach was also met with fewer side effects than the team anticipated. Only six percent of participants dropped out of the study due to such complications. One-third of patients completed the study without experiencing anything more than mild side effects along the way.

All in all, the results are quite promising. Again, this isn’t meant as a be-all-end-all solution to peanut allergies; it’s simply meant to protect patients against life-threatening reactions (anaphylactic shock) when they unknowingly come into contact with a small dose of peanut. The team also reports that once a patient stops treatment, the protective effect wears off.

Should this treatment be approved by the FDA, it will provide the first treatment option for peanut allergies. It will be available by prescription, and patients will need to remain on it to stay protected against accidental consumption.

The paper “AR101 Oral Immunotherapy for Peanut Allergy” has been published in the New England Journal of Medicine.

Want to fight peanut allergies? Eat peanuts

In 2000, the American Academy of Pediatrics advised parents to keep children as far away from peanuts as possible, in order to avoid potential allergies – it seemed like a good idea at the time. But now, a new study has found that in the long run, that actually did more harm than good, and if we want to fight allergies, we should be feeding our children peanuts.

Special Mention: if your child is allergic to peanuts DON’T give him peanuts! This can go tragically wrong, for obvious reasons. You can, in certain conditions, under strict medical supervision (and only following a medic’s advice), administer small, incremental peanut doses which may help his condition – but there are a lot of if’s and a lot of maybe’s here.

What this study found is that small children who avoided peanuts for the first five years of their lives were up to seven times more likely to wind up with a peanut allergy than kids who ate peanuts regularly. So, if your child has no history with allergies, it’s safer to give him peanuts at a young age.

“Food allergies are a growing concern, not just in the United States but around the world,” said NIAID Director Anthony S. Fauci, M.D. “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention.”

[Also Read: Nut allergy cured in 80% of children participating in probiotic clinical trial]

Researchers led by Gideon Lack, M.D., of King’s College London, designed a study called Learning Early About Peanut Allergy (LEAP), based on observations conducted on Israeli children. They did this because Israelis generally consume high quantities of peanut butter from an early age, and they also have a very low incidence of peanut allergy – scientists suspected there might be a connection between the two, and as it turns out, they were right. They found a whopping 81% reduction of peanut allergy in children who consume peanuts regularly compared to those who avoided eating peanuts.

“The study also excluded infants showing early strong signs of having already developed peanut allergy. The safety and effectiveness of early peanut consumption in this group remains unknown and requires further study,” said Dr. Lack. “Parents of infants and young children with eczema or egg allergy should consult with an allergist, pediatrician, or their general practitioner prior to feeding them peanut products.”

The findings seem to offer fresh support for the so-called hygiene hypothesis. The hygiene hypothesis  states that a lack of early childhood exposure to infectious agents and parasites increases susceptibility to allergic diseases by suppressing the natural development of the immune system. The same thing could go for peanuts and other food products – if you’re not exposed to them as a child, you’re much more likely to develop an allergy to them.

The study may also help future dietary recommendations and may one day lead to reducing the incidence of peanut allergy, especially since the incidence of the allergy has grown dramatically, from 0.6% in 1997 to 1.4% in 2008 – it’s more than doubled in 11 years!

“Prior to 2008, clinical practice guidelines recommended avoidance of potentially allergenic foods in the diets of young children at heightened risk for development of food allergies,” said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation. “While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage a serious public health problem.”

Journal Reference: ​Du Toit G et al. Randomized trial of peanut consumption in infants at risk of peanut allergy. New England Journal of Medicine DOI: 10.1056/NEJMoa1414850 (2015).

 

peanut allergy

Nut allergy cured in 80% of children participating in probiotic clinical trial

Australian scientists have cured nut allergy in 80% of the children taking part in a probiotic clinical trial. These children’s lives how now been transformed forever, with many more – child or adult – to follow soon. Nut allergy is lifelong and the most common cause of death from food anaphylaxis.

Peanuts – back on the menu

peanut allergy

Image: Allergy Reliever

Peanuts are among the most common allergy-causing foods, and chances have it if you’re not allergic to peanuts, you know someone who is. Because their so dangerous for those allergic to them, many food manufacturers are mandated by law to visibly label peanut content even in those foods which you’d think don’t have any business with peanuts. The thing is, peanuts often find their way into things you wouldn’t imagine. Take chili, for instance: lots of producers thicken these with ground peanuts.

Here’s some useful trivia: peanuts aren’t actually a true nut, but a legume in the same family as peas and lentils. However, the proteins found in peanuts are similar in structure to those in tree nuts, so people with allergic to peanuts can also be allergic to tree nuts, such as almonds, Brazil nuts, walnuts, hazelnuts, macadamia nuts, pistachios, pecans, and cashews.

Our immune system is great at warding off infections, but when a person is allergic to nuts, the immune system overreacts to the proteins in these foods and treats them as “invaders”. This causes a severe allergic reaction called anaphylaxis in which chemicals called histamine are released in the body. Anaphylaxis may begin with some of the same symptoms as a less severe reaction, but then quickly worsen, leading someone to have trouble breathing, feel lightheaded, or to pass out. If it is not treated quickly, anaphylaxis can be life threatening. It’s also an allergy that haunts those afflicted all their lives, but a new groundbreaking research might prove to be a life raft.

Researchers gave about 30 allergic children a daily dose of peanut protein together with a probiotic (Lactobacillus rhamnosus) in an increasing amount over an 18-month period. At the end of the trial, 80% of the Aussie kids could eat peanuts without any reaction.

“Many of the children and families believe it has changed their lives, they’re very happy, they feel relieved,” said the lead researcher, Mimi Tang. “These findings provide the first vital step towards developing a cure for peanut allergy and possibly other food allergies.

Of course, this doesn’t mean that their allergies were cured for life. It’s possible of course, but many follow-up studies are mandated to assess whether patients can still tolerate peanuts in the years to come.

“We will be conducting a follow-up study where we ask children to take peanut back out of their diet for eight weeks and test them if they’re tolerant after that,” according to Tang.

If you’re thinking about doing this treatment on your own at home – don’t.

“Some families might be thinking about trialling this at home and we would strongly advise against this. In our trial some children did experience allergic reactions, sometimes serious reactions.

“For the moment this treatment can only be taken under the supervision of doctors as part of a clinical trial.”

Source: Murdoch Research