Follow-up on the LEAP Study - Q&A with FARE CEO James R. Baker, Jr., MD

FARE has received many questions about the new findings from the Learning Early About Peanut Allergy study, recently published in the New England Journal of Medicine. Information about the study’s findings are available here.

To help address these questions and clear up some misperceptions about the study’s results, FARE CEO James R. Baker, Jr., MD weighs in with key takeaways from the study and what it means for our growing body of scientific knowledge about food allergy.

What did the LEAP study find?

This study showed that being introduced to peanut at an early age (before age 1) and regularly eating a peanut-containing snack reduced the likelihood of developing peanut allergy among children with certain risk factors for peanut allergy.

Why is this study important?

The LEAP study is very important because it is the first large-scale, prospective study to examine whether feeding infants specific food was likely to increase or decrease the risk of allergy. The size and scope of the study increases its quality and the likelihood that it will apply to a larger group of patients. While this topic has been explored in many smaller studies, they were neither large nor well-controlled enough to definitively answer the question.

Who did this study follow?

  • High-risk infants, defined as having eczema or egg allergy. The infants could have a positive skin test to peanut (wheal less than 4mm in diameter) as long as they were not clinically allergic.
  • Infants entered the study at 4-11 months of age and were followed until 5 years of age.
  • The study DID NOT follow infants who already had a peanut allergy or those who had a skin test resulting in a wheal larger than 4 mm in diameter.

Is this a new treatment for food allergy?

This is not a treatment for food allergy. This study specifically showed that feeding peanut early in life might prevent the development of food allergy in non-allergic children who are at risk for peanut allergy. This study did not examine the effect of feeding peanut to children who already have a peanut allergy. In fact, children with peanut allergy were specifically excluded from the study.

Does the method used in the LEAP study work to prevent peanut allergy for everyone?

Feeding this peanut candy three times a week reduced the likelihood of developing peanut allergy by approximately 75 percent in the patient population that was identified to participate (non-allergic, high-risk infants). However, while the feeding of peanut was effective in preventing many patients from developing peanut allergy, it did not prevent all patients from developing this allergy.

Does this study have any findings related to whether a mother’s diet during pregnancy had an effect on whether her child developed peanut allergies?

This study made no assessment of the effect of a mother's diet on the development of peanut allergy.

This completely changes what I was told when introducing my children to solid foods – how did the medical and scientific community get things so wrong before?

The prior studies that examined feeding food were small and not definitive. The reason FARE supported this study was because we felt it was important to absolutely know whether feeding a potential allergen to children at risk for food allergy was a good or bad idea. Because of the large nature of the study and the long period of exposure, this is the first definitive answer for this question.

The news headlines about this study seem to imply that I should start feeding peanut products to my infant – is that true?

Many of the news headlines surrounding the study were inaccurate and have caused pain and consternation among parents of young children. If your child has no risk for peanut allergy, it is probably safe to feed him or her peanuts. If your child has risk for peanut allergy, such as eczema, egg allergy or a family history, an allergist should evaluate him or her before peanut is introduced. If your child is allergic to peanut, you should never feed him or her peanut unless your child is receiving the allergen under a physician’s supervision in a controlled clinical study.

Besides food introduction, what other factors are at play when it comes to developing food allergies?

Many factors are thought to contribute to the development of food allergy. Environmental factors such as environmental food dust, genetic factors and other as yet unknown issues all play a role in the development of food allergy.

People outside the food allergy community appear to be using the study findings as fodder to blame parents for their kids having food allergies – what’s the best response to this?

The best response is to point out that this study did not prevent food allergy in children who were already allergic and did not prevent all food allergy in children who were assigned to eat peanut. It is also important to remind people that peanut allergy is something that can happen to any child -- and it's critical for everyone to not only try to prevent reactions but also be accommodating to children who already have peanut allergy. It is also crucial to develop effective therapies that will allow children with peanut allergies – and other food allergies -- to be safe.  FARE is working with the academic and pharmaceutical communities to help develop therapies to treat children with food allergies.