An estimated 40,000 children avoided peanut allergy diagnoses after the guidelines for when to first expose kids to the food allergen changed, according to new research.
The dramatic drop in childhood peanut allergies arrives a decade after a watershed study found that feeding peanut products to babies reduced their chances of developing an allergy by over 80%.
For decades, parents were advised to avoid feeding common allergens, such as peanuts, to infants. In 2015, guidance shifted around peanuts for high-risk kids and expanded two years later.
A study published Monday in the journal Pediatrics found that peanut allergy rates in children under the age of 3 dropped by roughly 43% after the recommendations were expanded in 2017. Rates for all food allergies dropped by about 36%.
“What I was surprised by was the magnitude of the results,” said Dr. David Hill, an attending allergist at the Children’s Hospital of Philadelphia and senior author of the study. Even being able to say that allergy rates plateaued “would be huge news, but the fact that we actually saw a reduction in the onset of new food allergy in kids under 3 is incredible.”
Hill and his colleagues analyzed electronic health records from nearly 50 pediatric practices to track diagnoses of food allergies in about 120,000 children between 0 and 3. Fifteen months marks the peak onset of peanut allergy, according to the study.
Kids were deemed newly allergic if they received a diagnosis code by a provider for a food allergy and were prescribed an EpiPen, Hill said.
The reductions in diagnoses were found even though only about 29% of pediatricians and 65% of allergists reported following the expanded guidance issued in 2017, surveys found.
Confusion and uncertainty about the best way to introduce peanuts early in life led to the lag, according to a commentary that accompanied the study. Early on, medical experts and parents alike questioned whether the practice could be adopted outside of tightly controlled clinical settings.
Sung Poblete, chief executive of the nonprofit Food Allergy Research and Education, who was not involved in the study, hailed it for its focus on real-world data.
While it’s clear that the practice of “eat early, eat often” for foods that can provoke allergic reactions works in a clinical setting, “it’s really important to know that in the real world, this can also decrease incidence and prevalence for the infant population,” she said.
When a person has a peanut allergy, their body responds to the proteins in peanuts as though they’re dangerous. The immune system tries to fight them off, triggering symptoms ranging from hives and diarrhea to anaphylaxis, a life-threatening condition.
Poblete said that the findings highlight the need to change policy to further drive down life-threatening allergy diagnoses. That could include the U.S. Department of Agriculture including peanut products in their infant food packages, she said.
Food allergy prevalence has been on the rise, with 2.2% of U.S. children having a peanut allergy, according to commentary on the new study. Besides delayed introduction of allergenic foods, other risk factors include cesarean section births and antibiotic exposure, according to Hill.
“This is just a call to double down our efforts to understand why it is that children develop food allergies and how we can better treat and ultimately cure these diseases,” Hill said.
Since the period the researchers studied, children’s food guidelines have expanded further. In 2021, the Academy of Pediatrics recommended introducing major food allergens, including peanuts and egg, to all infants between four to six months of age.
The Associated Press contributed to this report.
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