Nearly 40,000 children avoided a peanut allergy diagnosis after recommendations about when to first expose children to the food allergen were changed, according to a new study.
Dramatic decline in childhood peanut allergy occurs ten years after watershed survey found that feeding children peanut products reduced the likelihood of developing an allergy by more than 80%.
For decades, parents have been advised to avoid feeding their infants common allergens such as peanuts. Peanut recommendations for at-risk children changed in 2015 and expanded two years later.
A The study was published Monday in the journal Pediatrics. found that the rate of peanut allergy in children under 3 years of age dropped by about 43% after guidelines were expanded in 2017. Rates of all food allergies decreased by approximately 36%.
“What surprised me was the magnitude of the results,” said Dr. David Hill, an attending allergist at Children's Hospital of Philadelphia and senior author of the study. Even to be able to say that allergy levels had stabilized “would be huge news, but the fact that we actually saw a reduction in the occurrence of new food allergies in children under three is just incredible.”
Hill and colleagues analyzed electronic medical records from nearly 50 pediatric clinics to track food allergy diagnoses in approximately 120,000 children ages 0 to 3 years. According to the study, fifteen months marks the peak of peanut allergy development.
Children were considered to have a first-time allergy if they received a food allergy diagnosis from a doctor and were prescribed an EpiPen, Hill said.
A decline in diagnoses was found, although only about 29% of pediatricians and 65% of allergists reported compliance with the expanded guidelines issued in 2017, surveys found.
Confusion and uncertainty about how best to introduce peanuts early in life has contributed to the lag, according to a commentary accompanying the study. Early on, medical experts and parents alike questioned whether the practice could be applied outside of strictly controlled clinical settings.
Sung Poblete, executive director of the nonprofit Food Allergy Research and Education, who was not involved in the study, praised its focus on real-world data.
While it's clear that the practice of “eat early, eat often” for foods that can trigger allergic reactions works in clinical settings, “it's really important to know that in the real world it can also reduce incidence and prevalence in the pediatric population,” she said.
When a person has a peanut allergy, their body reacts to the proteins in peanuts as if they were dangerous. The immune system tries to fight them, causing symptoms ranging from hives and diarrhea to anaphylaxis, a life-threatening condition.
Poblete said the findings highlight the need for policy changes to further reduce the number of life-threatening allergy diagnoses. That could include the USDA including peanut products in baby food packages, she said.
The prevalence of food allergies is on the rise, with 2.2% of U.S. children having a peanut allergy, according to commentary on new research. In addition to late introduction of allergenic foods, other risk factors include C-section and exposure to antibiotics, Hill said.
“This is just 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.
During the period the researchers studied, recommendations for children's nutrition expanded even further. In 2021, the Academy of Pediatrics recommended introducing major food allergens, including peanuts and eggs, to all babies between four and six months of age.
The Associated Press contributed to this report.
