Guidelines encouraging parents to introduce infants to common food allergens have contributed to a steep reduction in food allergies, reports The New York Times.
When the landmark 2015 LEAP trial found that early exposure to peanuts acted as a prophylaxis against developing allergies, reducing likelihood by over 80 percent, it turned the conventional wisdom on its head. For decades, as the rates of food allergies climbed among young children, paediatricians had advised the opposite, telling parents to avoid peanuts, eggs and other common food allergens.
Some scientists thought that if early exposure could deliver such dramatic results for infants at risk of peanut allergy, advice to parents needed to change. In 2017, the US National Institute of Allergy and Infectious Diseases (NIAID) issued new guidance formally recommending early, low-level exposure for high-risk infants.
New research from the Children’s Hospital of Philadelphia in the US shows that, in the years since this new guidance, food allergies in young children have dropped sharply.
Researchers looked at 125,000 children from nearly 50 paediatric practices, using electronic health records to determine the prevalence of food allergies. They found that food allergy rates in children under 3 fell by more than a third (36%) after the guidelines were put in place, driven by a 43-percent decline in peanut allergies. That corresponds to around 57,000 fewer children with food allergies.
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While the results do not show that the guidelines caused the decline, they are promising. Around two-thirds of children with allergies are diagnosed by 3, and studies after LEAP found the protective effect of early exposure persisted beyond early childhood.
“We’re talking about the prevention of a potentially deadly, life-changing diagnosis,” Dr Edith Bracho-Sanchez, a pediatrician at Columbia University Irving Medical Center, who was not involved with the study, told the Times. “This is real world data of how a public health recommendation can change children’s health.”
The most recent guidelines, issued in 2021, supported the introduction of nine common food allergens to infants aged 4-6 months, regardless of allergy risk. Giving infants small amounts – like a pea-sized smear of peanut butter or a small bite of scrambled eggs, Bracho-Sanchez explained – can help train their immune systems.
A recent clinical trial found that paediatricians rarely recommend early, low-level exposure for infants, something Bracho-Sanchez attributes to limited awareness of the guidelines and time constraints on paediatric visits.
