About Food Allergies

Prevention

Research on how to prevent food allergy has made significant advances. Most of this work has focused on peanut allergy. (It’s important to remember that once a food allergy has developed, the only way to ensure that no reactions occur is to avoid the problem food.)

Preventing Peanut Allergy

In January 2017, the National Institute of Allergy and Infectious Diseases (NIAID) released new guidelines recommending early introduction of age-appropriate peanut foods for infants with egg allergy or severe eczema to lower their risk of developing peanut allergy. The guidelines were authored with input from many experts in the field, including Dr. James R. Baker, Jr., CEO and chief medical officer of FARE, and Maria Acebal, member of FARE’s Board of Directors.

2017 NIAID Addendum Guidelines for the Prevention of Peanut Allergy in the United States

The three new guidelines are based on a child’s risk of developing peanut allergy:

Guideline 1: Babies with severe eczema, egg allergy or both are at highest risk for peanut allergy. Introduce age-appropriate peanut foods to these high-risk infants as early as 4 to 6 months of age, after introducing other foods first to make sure the baby is ready for solid food. Your doctor should consider testing for peanut allergy before the baby eats peanut for the first time, using a blood test, a skin prick test, or both. Test results can help your doctor decide if your child should be introduced to peanut at home, in a doctor’s office, or at a specialized medical facility where experienced personnel can conduct an oral food challenge.

Guideline 2: If your baby has mild to moderate eczema, introduce age-appropriate peanut foods at around age 6 months, consistent with your family’s diet, to reduce your child’s risk of developing peanut allergy. A doctor’s evaluation is optional before giving your baby peanut. Introduce other foods before peanut to make sure the baby is ready for solid food.

Guideline 3: Babies with no eczema or food allergy can be introduced freely to age-appropriate peanut foods, in keeping with the family’s diet.

Research on Timing of Peanut Introduction

Guidance on when to introduce allergenic foods to a child’s diet has reversed in the past two decades:

  • 2000: The American Academy of Pediatrics (AAP) recommends delaying peanut introduction until age 3 years for children at high risk for peanut allergy.
  • 2008: An AAP report cites a lack of evidence that delaying the introduction of solid food beyond ages 4 to 6 months had a protective effect against food allergy.
  • 2010: NIAID’s food allergy guidelinessuggest that introduction of allergenic foods not be delayed beyond age 4 to 6 months.
  • 2017: NIAID’s addendum guidelines recommend that infants at high risk for peanut allergy be introduced to peanut foods between ages 4 and 6 months.

What happened between 2000 and 2017 to change these recommendations? Evidence accumulated that delaying allergenic foods was making food allergies more likely, not less likely.

  • 2008: Peanut allergy is found to be 10 times more common in British children than Israeli children of similar background. Most Israeli children eat a peanut-based snack during infancy.
  • 2008-2016:  FARE, NIAID and others fund the prevention studies LEAP and LEAP-On.
    • Learning Early About Peanut allergy (LEAP) was a prospective study of early peanut feeding in hundreds of infants at high risk for peanut allergy due to egg allergy and/or eczema. Infants with clinical peanut allergy were excluded. Half the children avoided peanuts, the other half ate peanut foods regularly, starting in infancy.
    • Persistence of Oral Tolerance to Peanut (LEAP-On) was a follow-up study to LEAP. Participants from both LEAP study groups avoided peanut foods for 12 months, from ages 5 to 6.
  • 2015: Results from the LEAP studyshow that, among children at high risk for peanut allergy, the group who ate peanut foods early and regularly were 81 percent less likely to develop peanut allergy than the group who avoided peanuts until age 5. Some children who ate peanut early still developed peanut allergy, but peanut allergy was much more common in the children who delayed peanut introduction. LEAP study findings formed the basis for the 2017 NIAID addendum guidelines.
  • 2016: Results from the LEAP-On studyshow that, at age 6, the group who had eaten peanut until age 5 continued to have much lower rates of peanut allergy than the group who had avoided peanut since infancy.

FARE is pleased to have played a role in this groundbreaking work through the funding of the LEAP studies as well as the involvement of FARE experts who served as co-authors of the guidelines.