When the American Academy of Pediatrics (AAP) released its 2000 guidelines advising parents to avoid feeding their babies all of the major allergens, it dealt the peanut industry a blow. In 2008 the AAP changed its mind, but by then it had become standard practice for physicians to advise parents to avoid feeding peanut foods to infants.
Sherry Coleman Collins, registered dietitian, nutritionist, consulting for the National Peanut Board, delivered a presentation at the Southern Peanut Growers Conference held recently in Panama City Beach, Fla., that explained what increased awareness about peanut allergies and solidified peanut avoidance.
“Some of the fear around peanut allergies was media-driven, and part of it was driven by a true increase in prevalence. The increase may have been due to avoidance during infancy, and the ‘hygiene hypothesis theory’ that occurs when children are kept in extremely clean environments, which research has subsequently shown leads to higher rates of all types of allergic disease, including hay fever, asthma, and food allergies,” says Coleman Collins.
LEAP study and diagnostics
A study partially funded by peanut farmers through the NPB looked at high-risk infants with eczema and existing allergies — two things that predispose babies to developing peanut allergies. “The outcome was incredible,” says Coleman Collins. “When they fed peanut foods to these high-risk babies starting between 4 to 11 months old, the risk of developing peanut allergies was reduced by up to 86 percent.”
The “Learning Early about Peanut Allergies” (LEAP) study was preceded by an earlier study that found a big difference in genetically similar children from Israel and the UK, with the Israeli children being 10 times less likely to develop peanut allergies. The difference was because mothers in Israel fed their children a peanut-rich food called Bamba.
The LEAP study built on this difference through randomized clinical trials comparing what happened when high-risk infants ate peanut foods early, and what happened when peanut foods were avoided. “The study was published in the New England Journal of Medicine and the researcher who designed the study won multiple international awards which gives it immense credibility,” says Coleman Collins.
On top of the issues that may have driven a true increase in food allergies, inaccurate allergy tests added to the problem of misdiagnosis because of their often 50 to 60 percent false-positive rate. “Self-diagnosis also became rampant, and up to 90 percent of the time, those diagnosing themselves were wrong,” says Coleman Collins. “Better diagnostic tools now available could improve medical diagnosis moving forward.”
The NPB is focusing some of its efforts on pediatricians and other health care providers, partnering with the AAP to engage the larger universe of pediatricians.
“While some parents want branded products to use for early intervention, they are not necessary,” says Coleman Collins. “For those who already have peanut allergies, there are oral immunotherapy (OIT), skin patch therapy, and other treatments currently being researched. “We hear concerns about reactions to OIT and those should definitely be considered, but it also greatly improves a person’s quality of life once they have been through it.”
To effect change, this effort will take time and persistent messaging and the NPB is leading the charge.