Early Peanut Introduction Reduces Risk for Peanut Allergy

By David J. Amrol, MD

Peanut consumption from infancy through age 5 decreases development of peanut allergy in high-risk infants, according to a New England Journal of Medicine study.

Some 640 U.K. infants (age range, 4–11 months) with severe atopic dermatitis or egg allergy were randomized to peanut consumption (2 g peanut protein 3 times/week) or peanut avoidance until age 5. Infants who reacted to an oral peanut challenge were excluded. At age 5, all children underwent another peanut challenge.

Among children with negative skin-prick tests at baseline, the prevalence of peanut allergy at age 5 was significantly lower with peanut consumption than with avoidance (1.9% vs. 13.7%). Likewise, among patients with positive skin-prick tests at baseline, peanut allergy at age 5 was also significantly less common with the intervention (10.6% vs. 35.3%).

Although we don't know if these findings extrapolate to other foods, we should no longer recommend avoidance of allergenic foods in infants. An accompanying editorial recommends skin-prick testing of all high-risk infants, and in those with negative skin tests or challenges, regular consumption of peanuts until age 5. This may be logistically difficult, but the benefits could be tremendous in light of the surging prevalence of peanut allergy.

Dr. Amrol is a contributing editor with NEJM Journal Watch General Medicine.