Posted on 10/23/2025 10:15:08 AM PDT by nickcarraway
Study shows protective effect of recommending peanut product consumption in infancy
Key Takeaways
=In this study, physician-diagnosed peanut allergies in children ages 0-3 declined by 27.2% after guidelines recommended early peanut product introduction.
-The 2017 national guidelines recommended introducing peanut products by 11 months for low-risk infants, and by 6 months for those at high risk. Further analyses are needed to validate these trends in larger, more diverse samples using food allergy testing or oral food challenges.
-Fewer toddlers developed peanut allergies after guidelines recommended introducing peanut products in infancy, a large primary care registry study showed.
Physician-diagnosed peanut allergies in children ages 0-3 declined by 27.2% after the key trial and resulting interim guidance on peanut product introduction in 2015, reported researchers led by David A. Hill, MD, PhD, of the Children's Hospital of Philadelphia, in Pediatrics.
The cumulative incidence of peanut immunoglobulin E (IgE) food allergy fell from 0.79% to 0.53%, with a hazard ratio of 0.65 in 2015-2017 (95% CI 0.55-0.77) compared with a similar period from 2013-2014. Cumulative incidence of any IgE food allergy likewise dropped from the pre- to post-guidelines period (1.46% to 1.02%; HR 0.69, 95% CI 0.61-0.78, P<0.0001).
Exposing babies to peanuts by 11 months was shown in the 2015 LEAP trial to reduce development of peanut allergies, prompting interim guidelines later that year.
The effect was even greater after the full 2017 Prevention of Peanut Allergy Guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), which recommended introduction of peanut products by 11 months for low-risk infants, and by 6 months for those at high risk.
Although adherence to these guidelines has been slow, the study showed that the cumulative incidence of peanut allergy further dropped to 0.45% in 2017-2019, for a 45% reduction compared with the pre-guidelines period (HR 0.55, 95% CI 0.46-0.66). The cumulative incidence of any IgE food allergy by age 3 years fell to 0.93% (HR 0.63 vs pre-guidelines period, 95% CI 0.55-0.72, P<0.0001).
"Our results are supportive of the intended effect of these landmark public health recommendations," Hill's group concluded.
According to an accompanying editorial by Ruchi S. Gupta, MD, MPH, of the Center for Food Allergy & Asthma Research at Northwestern University in Chicago, and colleagues, the reductions are an "encouraging" sign of a "possible shift in food allergy epidemiology."
However, they called for further analyses "to validate these trends in larger, more diverse samples using expanded diagnostic criteria, such as food allergy testing and oral food challenges," noting that the data represented a subset of participating practice sites (both independently owned and affiliated with academic health systems) that may not be fully representative of the broader U.S. pediatric population.
The study used electronic health record data from the multistate, primary care-based American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting network for children ages 0-3 years during three time periods categorized as pre-guidelines (38,594 children with cohort entry Sept. 1, 2012 to Aug. 31, 2014), post-guidelines (46,680 children with entry from Sept. 1, 2015 to Aug. 31, 2017), and post-addendum guidelines (39,594 children with entry Feb. 1, 2017 to Jan. 31, 2019). The children were observed for at least 1 or 2 years.
Although the findings were confirmed in an interrupted time-series analysis, the editorialists noted some concerns.
"First, it is somewhat surprising to observe a decrease in food allergy prevalence so soon after the LEAP publication. Given that the LEAP trial findings themselves were not a guideline and that the 2017 Addendum Guidelines followed 2 years later, the immediacy of this trend raises questions about other contributing factors," Gupta and co-authors wrote.
"Specifically, the study also identified decreases in milk allergy incidence, but not in egg allergy, despite the guidelines' primary focus on peanut," they added. "This discrepancy suggests a potential spillover effect, in which broader shifts in pediatric dietary practices or diagnostic approaches may be influencing trends in food allergy more generally."
"Finally, the potential role of improved diagnostic clarity should not be overlooked," they noted. "The 2010 NIAID guidelines on food allergy diagnosis may have influenced provider behavior in ways that contributed to more accurate identification of true immunoglobulin E-mediated food allergy, possibly reducing overdiagnosis in subsequent years."
Hill and colleagues pointed out that another limitation was a lack of data on "actual infant and toddler feeding patterns, such as when specific foods were introduced and the amounts and frequencies of ingestion following initial introduction."
Indeed, the peanut allergy reduction seen in the study was more modest than that seen in the LEAP trial, which suggests room for improvement in implementation, they added.
"If confirmed," Gupta's group wrote, "these findings would represent a meaningful public health advance -- affirming that clinical research, when coupled with clear guidelines and committed dissemination, can indeed shift the trajectory of childhood food allergy."
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I’m 80....in my whole life..I haven’t met anyone that has peanut allergies.
Maybe because PB&J was a staple when I was a kid...and still is in a lot of families.
Now they are too hard to make and people buy them frozen.
I never saw or even heard of autism until I was in my 30s or 40s.
I was same way until I had 2 out of 4 with nut allergy. Sure it was new vaccines and schedule.
They seemed to have less allergies.
There might be value in this.
Wow....did they outgrow it??
I wonder how much of the modern peanut allergies we never heard of growing up is connected to pesticides used on peanuts.
We started introducing small amounts of known common allergens with solid food. Peanut butter in hot cereal, egg whites scrambled and minced shrimp. No allergies to thses items!
Hochul’s henchmen murdered Peanut last year.
No, they didn’t totally. They can have a little contamination now but not much.
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