It may seem radical, but it works: eat peanuts slash the chance of a peanut allergy, at least in children high risk of developing a much- anticipated study finds. The results are likely to catapult a theory that ingestion of potential food allergens is a way to prevent allergies-in traditional medicine.
"This is on study," says Rebecca Gruchalla long, a specialist in immunology allergy to the University of Texas Southwestern Medical Center in Dallas, who has not was involved. The data, she said, are "just amazing."
The trial, whose results are published today in The New England Journal of Medicine to coincide with their presentation to a large gathering of allergy in Houston, Texas, is by far the largest and oldest of its kind, with 640 children followed for 4 years. It was launched in 06 when the United States and the United Kingdom recommended that parents keep away from peanut products for high-risk youth until they reach 3, counseling families of others often follow Western countries, too. But as these children have avoided peanut butter, doctors increasingly certain that their recommendations were sound. Peanut allergies, which can be fatal, were rising in the very countries that grew avoidance: In the US, the prevalence of peanut allergy has more than tripled between 1997 and 08, 1 , 4%. In Israel, meanwhile, where the environment is not significantly different from other industrialized countries, only 0.17% of schoolchildren were allergic. What was different there? For one, many Israeli infants consume a very popular snack of peanut puffs called Bamba at the time they are 6 months old
The rationale was simple avoidance :. It is impossible to become allergic to a food less exposed to it, and the doctors thought the guts and the immune systems of older children may be better able to tolerate potential allergens, which makes the body less likely react badly to new foods. But completely avoiding peanuts or, more specifically, the peanut protein can trigger an allergic reaction in some people is extraordinarily difficult. In the UK, a study there more than a decade has suggested that many children allergic to peanuts had been slathered with cream layers containing peanut oil in infancy. Gideon Lack, a professor of pediatric allergy at King's College London, reported in 2013 that the peanut protein persisted on the hands and in the saliva up to 3 hours after peanuts were eaten, suggesting that infants could be exposed through their skin in tiny amounts with their parents or older brothers and sisters. We "really did not appreciate until recently ... the amount of peanut protein is in the environment," says Hugh Sampson, a pediatric allergist at the Medical School Icahn Mount Sinai in New York.
Although evidence has continued to mount, even there 10 years 8 or avoidance was already questioned. so Lack and colleagues undertook to check whether the feeding of infants and young children peanut products could help them learn to tolerate peanut protein, inhibition of allergy. All babies were between 4 and 11 months when they were enrolled, and all had an allergy egg, severe eczema, or both-putting at high risk for a peanut allergy on the road because 98 of them have already been moving in this direction. They have been tested positive for mild peanut sensitivity in a prick test. This means that these babies have already churning out antibodies against peanut protein. Eating peanuts in the future could trigger an allergic response.
The team divided the babies into two groups. Half was to avoid eating peanut products until they are 5 years old. The other half received at least 6 grams of peanut proteins per week, spread over at least three meals until they are 5 years old. Bamba was the preferred offering, although picky eaters who rejected it got the creamy peanut butter.
Around the 5th anniversary of the test subjects came the big test. Children consumed a peanut portion larger than what they were used to in one sitting, and the results were clear. Among 530 children who had had a negative prick test when they were babies, 14% who avoided peanuts were allergic to them, against 2% of those who had been eating. In the even higher risk group, children who were educated, 35% of peanut-avoiders were allergic against just over 10% of eating peanuts.
"This study really prove cause and effect," Sampson said, adding that he "certainly hopes" it will change clinical practice. "When someone asks me in my practice, I will encourage them to get peanuts in the diet in the first year of life."
As with any study, there are still a number of unanswered questions. The first is whether preventing allergies will persist in children if they abandon their regular meals hazelnut. Lack and colleagues plan to follow to answer this question. Another is whether the results are applicable to other food allergens, too. Gruchalla sees no reason why they would not, and the first results are encouraging: An Australian study of the egg exhibition in 86 high-risk babies reported in 2013 that he saw notes that eating eggs were babies less likely to become allergic. The same group, led by allergy researcher Debra Palmer at the University of Western Australia, is currently testing it in 820 infants and hope to have results in about a year
Then there is the difficult question of treatment :. Can people who already have peanut allergies to be exposed carefully to the peanut protein as a way to minimize their reaction? Given the risks, the researchers tread carefully, but Sampson conducted a study presented yesterday at the annual meeting of the American Academy of Allergy, Asthma & Immunology, the presentation of results of a study to do so. The 221 participating adults and children were offered either a patch delivering peanut protein in healthy skin or a placebo patch. After 1 year, those who got the highest dose patch can tolerate 10 times more protein-four total peanut peanuts, as they had been able to start the study. With such tolerance, people with allergies may be less fear of accidental exposure to small amounts of the nut.
Treatment of exposure as it still needs further testing. But for the prevention of life-threatening allergies, the landscape has changed. "Now," Gruchalla said, "we have something to do."
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