Peanut allergies in children decrease following advice to give babies the allergen, study finds
About 40,000 children avoided a peanut allergy diagnosis after guidelines for when children should first be exposed to the food allergen changed, according to a new study.
The dramatic decline in childhood peanut allergies comes a decade after a landmark study found that feeding babies peanut products reduced their chances of developing an allergy by more than 80 percent.
For decades, parents have been advised to avoid giving their infants common allergens, such as peanuts. In 2015, the guidelines evolved around peanuts for high-risk children and were expanded two years later.
A study published Monday in the journal Pediatrics found that rates of peanut allergies in children under 3 fell about 43% after recommendations were expanded in 2017. Rates for all food allergies fell about 36%.
“What surprised me was the magnitude of the results,” said Dr. David Hill, an attending allergist at Children’s Hospital of Philadelphia and lead author of the study. Even being able to say that allergy rates have plateaued “would be huge news, but the fact that we actually saw a reduction in the occurrence of new food allergies in children under 3 is incredible.”
Hill and colleagues analyzed electronic health records from nearly 50 pediatric practices to track food allergy diagnoses in approximately 120,000 children ages 0 to 3. According to the study, fifteen months marks the peak of onset of peanut allergy.
Children were considered newly allergic if they received a diagnosis code from a provider for a food allergy and were prescribed an EpiPen, Hill said.
Reductions in the number of diagnoses were seen even though only about 29% of pediatricians and 65% of allergists reported following the expanded guidelines issued in 2017, according to surveys.
Confusion and uncertainty about the best way to introduce peanuts early in life led to this disconnect, according to a commentary accompanying the study. From the beginning, medical experts and parents questioned whether the practice could be adopted outside of tightly controlled clinical settings.
Sung Poblete, executive director of the nonprofit Food Allergy Research and Education, who was not involved in the study, praised the focus on real-world data.
While it’s clear that the practice of “eat early, eat often” for foods likely to cause allergic reactions works in clinical settings, “it’s really important to know that in the real world it may also decrease the incidence and prevalence in infants,” she said.
When a person is allergic to peanuts, their body reacts to the proteins in peanuts as if they were dangerous. The immune system tries to fight them off, triggering symptoms ranging from hives and diarrhea to anaphylaxis, a potentially fatal illness.
Poblete said the findings highlight the need for policy change to further reduce life-threatening allergy diagnoses. That could include the U.S. Department of Agriculture including peanut products in its infant food packages, she said.
The prevalence of food allergies is increasing, with 2.2 percent of U.S. children allergic to peanuts, according to comments in the new study. Besides delayed introduction of allergenic foods, other risk factors include cesarean births and exposure to antibiotics, according to Hill.
“This is simply a call to redouble our efforts to understand why children develop food allergies and how we can better treat and ultimately cure these diseases,” Hill said.
Since the period studied by the researchers, dietary guidelines for children have expanded further. In 2021, the Academy of Pediatrics recommended introducing major food allergens, including peanut and egg, to all infants aged four to six months.
The Associated Press contributed to this report.
