From the 600-plus children enrolled in LEAP to the continuing work in his clinic in London, Du Toit has already recommended early introduction of peanuts to hundreds of families. He specializes in work with young babies who face higher peanut allergy risk because of eczema or egg allergy. Today, except in cases where allergy testing indicates an at-risk baby shows peanut sensitivity, “we make this recommendation on a daily basis.”
Allergic Living speaks to Du Toit about how to ease common fears parents have about early introduction as well as the common misconceptions that have followed the LEAP study.
How do parents get past the psychological barrier of thinking: this could be dangerous and my baby is so young?
George Du Toit: I tell them about the data that now exists that is very robust. I highlight that they have one or two choices – one is avoidance and the other is consumption.
We know that the approach of avoidance in many countries hasn’t helped suppressed the risk of peanut allergies so they may wish to consider consumption. We know that doing it in early infancy is safe. It helps to give them appropriate support and tell them about other countries that have been doing it for a long time.
Most parents are then keen to take it [peanut feeding] up. If they are anxious about doing so, we just supervise them. If they aren’t anxious and if they are in the low risk category, they can do it from home.
Would it be correct to say that avoidance may be the bigger danger for developing peanut allergy than introduction?
Du Toit: We now know from this robust data [LEAP] that avoidance is not the correct approach.
It may seem intuitive that avoiding peanuts when your child is young is a safer approach, but if they go on to develop a peanut allergy, then you’ve got a more dangerous outcome. Your child then carries this diagnosis for life. The passive approach in the longer term may not turn out to be best.
I have great empathy for parents, though, because the guidelines recently changed and we’ve been instilling this cultural avoidance for a long time. To suddenly turn things around 180 degrees is a paradigm shift. For many parents, it’s a simple process but for others, a great amount of consideration will be required.
Can you tell parents about the severity of the reaction in the LEAP study?
Du Toit: They were mild. There were a handful of children at the beginning of the study who had a reaction. Their symptoms included hives and a little bit of swelling. The symptoms settled with the use of antihistamine alone. None of the children required intramuscular adrenaline devices. Their symptoms settled down quite nicely.
It was shown in the LEAP study that, even among the children who were at risk, to be a very safe intervention.
How do we know the kids who went through LEAP won’t simply develop a peanut allergy later in life?
Du Toit: The LEAP study ran for five years. Then we took peanuts off the kids’ diets for a year to answer that question [the LEAP-On study]. After a year of avoidance, there were still very strong findings that you were better off consuming peanut rather than avoiding it.
We are now about to start an even longer term follow-up to make sure the benefit is still enjoyed into their nearly second decade of life. We will assess the kids at 10 years of age. It looks extremely favorable at the moment.
Over and above allergy, peanuts are proven to be a healthy food for young children. Food allergens are healthy foods, things like cow’s milk, peanuts, tree nuts, sesame. If you aren’t allergic, you want to be eating them in a balanced diet.
What would you say to people when they considered participating in the study?
Du Toit: The study commenced many years ago and back then, many were entrenched in the culture of avoidance.
We told parents that we wish to challenge the current hypothesis because we believe that avoidance hasn’t served countries well where it is being practiced and most parents accepted that.
There are a lot of misconceptions. What would you like to clarify?
Du Toit: It’s important for people to understand that this is an intervention for prevention; it is not an intervention for the treatment of peanut allergy. If a child is already allergic to peanut, they should not be following this approach.
It is also an intervention that has only been tried in young infants. I think what’s creating a bit of anxiety is that the public is confused about the difference between a treatment and a prevention strategy.