LEAP Study Prompts New Peanut Introduction Guidelines for Physicians

in Food Allergy, Peanut & Tree Nut
Published: June 9, 2015

Update: The final peanut introduction guidelines were released in January 2017. Read the article on them here.

June 2015 – Multiple medical organizations from around the world have come together to create new interim guidelines for infant peanut consumption following a landmark study that showed early, rather than delayed introduction of peanuts can protect against the development of allergy.

The British LEAP (Learning Early About Peanut Allergy) study, published earlier this year in The New England Journal of Medicine, found that feeding peanut to young infants with heightened allergy risk – as defined as having egg allergy, eczema or both – reduces the odds that a peanut allergy will develop by a remarkable 70 to 80 percent.

“This consensus communication addresses the need for interim guidance to help physicians integrate the LEAP study findings to other similar high-risk children while food allergy guidelines undergo updates,” said AAAAI president Dr. Robert Lemanske Jr.

When presenting the LEAP findings at the 2015 AAAAI annual meeting in Houston, study author and professor of pediatric allergy at King’s College London Dr. Gideon Lack noted that, there appears to be a “narrow window of opportunity to prevent peanut allergy.” These interim guidelines are designed to help health-care providers identify these areas of opportunity and make the necessary interventions.

Key Points of the Interim Guidelines

  • Given LEAP’s findings, infants should be introduced to peanuts or peanut-containing products between ages 4 to 11 months of age.
  • Infants who show signs of eczema or egg allergy within the first 4 to 6 months of life should be tested for peanut allergy with a skin prick test and possibly also a medically supervised peanut challenge. Families with such a child should work with a physician to facilitate safe, early introduction of peanut if possible.
  • Though LEAP details many aspects of how peanut can be introduced, physicians should note that it does not discuss alternative doses of peanut, the minimal length of treatment necessary to induce tolerance, the potential risks if peanut consumption is stopped early, or what happens if the infant does not consume peanut on a regular basis.

Current guidelines do not state that introduction should be delayed, however, they also do not actively recommend early introduction for high-risk children between 4 to 6 months of age – the optimal window for inducing tolerance according to LEAP study findings.

The recommendations, published in the Journal of Allergy and Clinical Immunology, are the result of a collaboration between a dozen medical organizations from countries including the U.S., Japan, Australia, Israel and Canada, as well as the European Academy of Allergy and Clinical Immunology and the World Allergy Organization.

More extensive formal guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) are expected to follow within the year. (Update: now released – see article.)

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