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The Peanut Puzzle
February 12, 2017

The Peanut Puzzle

As a parent of one daughter with a peanut allergy and another with avocado and kiwi allergies, Eric Katzman decided, with his second child, to introduce peanut products early.

"So far, there have been no peanut issues with my youngest," said Katzman, a Stroudsburg resident who works in New York.

"With my oldest, we found out the hard way at 13 months, luckily, it was not full-out anaphylactic shock, just a few hives, but scary nonetheless," Katzman said, adding that he will continue to check labels and call ahead to restaurants for all allergies.

Katzman's early introduction of peanut products to his newest child has apparently caught on.

The U.S. National Institutes of Health have concluded that babies at increased risk for peanut allergy should have peanut-containing foods added to their diets as early as 4 months of age.

The latest recommendation was also given the thumbs up by other health experts.

"Peanut allergy and food allergy in general has been on the rise, but is still very rare. I think parents need to understand that," said Dr. Lindy Lee Cibischino, a pediatrician at St. Luke's University Health Network in Stroudsburg.

"That being said, everyone must take peanut allergy seriously. Approximately 20 years ago, there was a recommendation to avoid peanut contact and ingestion until the child was about 18 months old. That recommendation did not seem to stop the rise in number of children allergic to peanuts, so the recommendation changed to waiting until 3 years to start offering peanuts," Cibischino said.

"This also did not seem to help and new research seems to support early feeding may be more helpful," she said.

Researchers said the advice is based on a pivotal clinical trial called LEAP, funded by the U.S. National Institute of Allergy and Infectious Diseases, and first published in 2015.

That study turned old thinking about peanut allergies on its head, according to a published report by the U.S. National Library of Medicine.

By 2010, roughly 2 percent of U.S. children had peanut allergy — up from about 0.4 percent in 1999, according to national surveys.

The LEAP trial — Learning Early About Peanut allergy conducted by the Immune Tolerant Network — tested a new idea: Could peanut allergies be prevented by giving high-risk babies peanut-containing foods early on?

"Approximately one year ago, there was an announcement based on some of the LEAP findings that early introduction of peanuts into children's diet decreased the incidence of peanut allergy by 80 percent.

"The experimental evidence is very strong for the early introduction of peanuts into a child's diet; by simply reversing the 2000 guidelines, we have reversed the dramatic rise in severe peanut allergy in children that was observed between 1999 and 2005," said Dr. Christopher Scott Little, an associate professor of bio-medical sciences at Philadelphia College of Osteopathic Medicine whose area of research focuses in part on severe and life-threatening food allergies — particularly immune reactions following the consumption of peanuts.

"To my knowledge, no trial or large-scale study was ever performed that showed any benefit to avoidance of peanuts early in life, which would have provided scientific justification for the guidelines in 2000," Little said.

"Interestingly, many of the same experts who worked on those guidelines consulted on the current recommendations which reverse the 2000 guidelines, which came about as the result of just such a large-scale study as the LEAP trial," he said.

The LEAP notion was partly based on an observational study of Jewish children living in the United Kingdom and Israel, Dr. Alkis Togias, a researcher at the U.S. National Institute of Allergy and Infectious Diseases who helped write the new guidelines.

It turned out that peanut allergies were far less common in Israel – where parents commonly feed their babies peanut-containing foods before their first birthday, Togias said in a NIH post.

The LEAP trial recruited more than 600 babies who were considered to be at high risk of peanut allergy because they had severe eczema, egg allergy or both.

Half of the parents were randomly assigned to regularly give their baby peanut-containing foods, while the other half avoided peanuts.

By Stacy M. Brown For the Pocono Record

As Featured in the Pocono Record