By Allergen Bureau

Does early introduction help to prevent peanut allergy?

Australian researchers have assessed whether guidelines that recommend earlier introduction of peanut to infants’ diets are associated with decreased prevalence of peanut allergy.

Australia’s infant feeding guidelines were changed in 2016 to recommend early peanut introduction for all infants. This change came in response to international evidence that introducing peanut into an infant’s diet early (before the age of 6 months) can prevent peanut allergy in select high-risk populations.

Melbourne-based researchers recruited two population-based cross-sectional samples of infants 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Over 7,200 infants were recruited from immunization centres around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate, regardless of history of peanut exposure or allergy history.

All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time.

The prevalence of peanut allergy in the later vs earlier cohort was 2.6% vs 3.1%, a difference that was not statistically significant. This indicates the introduction of a guideline recommending early peanut introduction was not associated with a statistically significant change in prevalence of peanut allergy across the population.

In an editorial accompanying the publication of these findings, the authors say that given the potential for benefit and the low risk of harm, the results of this study should not dissuade clinicians from following current consensus guidance that recommends early peanut introduction for infants.

The latest findings contradict a study reported by the same group in early 2021 that showed changes to food allergy guidelines had led to a 16 per cent decrease in peanut allergy among infants. That study showed peanut consumption by age 12 months increased from 28 per cent to 89 per cent in the 10 years to 2019, and this was thought to have contributed to the decreased number of infants with peanut allergy.

2022 Reference: Soriano et al. 2022. Journal of the American Medical Association. Vol 328(1) pp. 48-56. DOI:10.1001/jama.2022.9224

2022 Editorial Reference: Dantzer et al. 2022. Journal of the American Medical Association. Vol. 328(1) pp. 25-26. DOI:10.1001/jama.2022.6263

2021 Reference: Soriano et al. 2021. Journal of Allergy and Clinical Immunology. DOI: 10.1016/j.jaci.2020.12.009