Early Peanut Introduction Linked to Reduced Allergy Rates in US Infants, Real-World Study Shows
New research provides compelling evidence that updated guidelines recommending early introduction of peanut products to infants are associated with a notable decrease in peanut and overall food allergies across the United States. The study, published in Pediatrics (DOI: 10.1542/peds.2024-070516), analyzed real-world data and found a measurable decline in new diagnoses following the release of national guidelines in 2015 and 2017.
Researchers, lead by S.J. gabryszewski and colleagues, compared data from before and after the guideline changes. They observed a drop in the cumulative incidence of peanut allergy from 0.79% to 0.45% – a roughly 45% reduction in risk (Hazard Ratio [HR] 0.55, p < 0.0001). The incidence of any IgE-mediated food allergy also decreased, falling from 1.46% to 0.93%, representing a 37% reduction in risk (HR 0.63, p < 0.0001).
However, the benefits weren’t global. Children with pre-existing atopic dermatitis (a known risk factor for food allergies) did not experience a significant reduction in peanut allergy risk. Interestingly, while cow’s milk allergy rates declined, egg allergy rates remained stable and even surpassed peanut allergy as the most commonly identified food allergen after the guidelines were implemented.
The study also noted a concurrent increase in the diagnosis of atopic dermatitis (p < 0.0001), which researchers suggest may reflect improved identification of at-risk infants by pediatricians. Demographic shifts were also observed, with fewer Black, Asian/Pacific Islander, and Hispanic children being diagnosed with food allergies in the post-guideline period.
An interrupted time series analysis confirmed a significant decline in any food allergy diagnosis, though the reduction for peanut allergy alone did not reach statistical significance.
The authors emphasize that this observational study demonstrates an association between the guidelines and reduced allergy rates, but does not prove direct causation. They also point out that the observed reductions were more modest than the 81% decrease seen in the controlled LEAP trial, suggesting room for enhancement in how the guidelines are implemented in practice. Furthermore, the study period concluded before the potential impact of the 2021 guidelines could be evaluated.
“The present study is one of the first to provide methodologically robust, real-world evidence suggesting the public health benefits…may be occurring,” the researchers conclude. They believe the findings support the guidelines as a “valuable step towards a healthy and allergy-free childhood.”
