Peanut Allergies in Children: Lessons Learned from Two Decades

Highlights:

• Peanut avoidance was believed to reduce the cases of peanut allergy but it became a cause
• One in every 18 American children had peanut allergy
• Early peanut exposure reduced peanut allergies by 86% in children by the age of 5

Many specialists, in pediatric immunology and allergology are reassessing the 20 years old guidelines of restricting peanuts in children's diets recommended by American Academy of Pediatrics (AAP) 2000. The goal of the guidelines was to reduce the prevalence of peanut allergies but instead this paved the way for increased peanut allergies in U.S (1^✔).

Evolution of Peanut Allergy

The 1990s was the decade of peanut panic, where media covered death due to peanut allergies. In 1999, researchers estimated that the incidence of peanut allergy was 0.6% which was mild.

‘Did You Know?
Early exposure to peanuts can reduce the risk of developing peanut allergies by up to 86% by age 5, compared to children who avoided peanuts. #peanuts #peanut allergy #medindia’

But in 2000 they noticed a sudden rise in peanut allergy cases which were severe in affected children.

By 2004, peanut allergies in children had raised to a life threatening condition. By 2019, reports suggested that one in every 18 American children had developed a peanut allergy. Schools across the U.S. responded by banning peanuts entirely, while sales of emergency allergy medications, such as the EpiPen, skyrocketed

What was the AAP 2000 Guideline?

To address increased peanut allergies the AAP released the 2000 guidelines. But the problem was AAP did not know the precautionary measures to prevent peanut allergy. Instead of acknowledging it, the AAP released a guideline to completely avoid peanuts in

• Toddlers of age 0 to 3.
• Pregnant and lactating women who are at high risk of developing allergies.

These guidelines were strictly for high risk category but AAP thought that categorizing high risk infants was unsatisfactory. So they instructed parents to avoid peanuts if they had a family history of asthma or any other allergies.

Peanut Avoidance- Cure or Cause?

Dr. Jonathan Hourihane, professor of pediatrics in Dublin, expressed his frustration over the widespread misunderstanding and misuse of the original research. He had opposed the peanut avoidance recommendation from the beginning.

The dramatic rise in peanut allergies questioned the effectiveness of the guideline. It was believed that restricting peanuts prevented allergy but that only worsened the condition.

Dr. Stephen Combs of East Tennessee, a pediatrician who did not follow the AAP guidelines and none of his patients had peanut allergy. Dr. Combs attributed this to his teacher Dr. Rebecca Buckley, pediatric immunologist who had long argued that peanut avoidance could be harmful. She believed in the concept of immune tolerance.

What is Immune Tolerance?

Immune tolerance is the body's natural way of accepting foreign molecules present early in life. It is like the dirt theory, whereby newborns exposed to dirt, dander and germs may then have lower allergy and asthma risks.

Dr. Combs followed this approach, encouraging parents to introduce peanuts and other potential allergens like eggs and milk to their babies early on. This method proved effective, as his patients rarely developed allergies, and those who did had only mild reactions.

Inspite of increased evidence against peanut avoidance, it was not withdrawn till 2015 when Dr. Gideon Lack pediatric allergist and immunologist, disapproved the AAP guidelines. Early peanut exposure resulted in an 86% reduction in peanut allergies by the time the child reached age 5 compared to children who followed the AAP recommendation.

By 2017, AAP officially reversed its point of view and by 2019 the National Institute of Health (NIH) supported that early exposure of peanut can reduce peanut allergies. However, researchers argued that the correction came too late when an entire generation had to suffer severe allergies, which could have been easily avoided.

Dr. Lack reflected on how medical ideology can become established and is difficult to reverse misleading recommendations. To prevent allergic reactions parents should follow the feeding milestone 1-2-3 which advises to start feeding milk at the age of 1, eggs at 2 years and peanuts by 3 years of age. By introducing various foods to toddlers allergic reactions can be prevented.

Reference:

1. Seem like peanut allergies were once rare and now everyone has them? - (https:news.harvard.edu/gazette/story/2024/10/excerpt-from-blind-spots-by-marty-makary/)

Source: Medindia

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