Are families following recent medical guidelines for early allergen introduction? And are the guidelines helping to lower the percentage of children with peanut allergies? The EarlyNuts study starts to answer these questions by examining early peanut introduction rates – and peanut allergy rates – in Australian children.
Recent medical guidelines around the world recommend feeding infants common allergens, such as peanut, in the first year of life. These guidelines were prompted by clinical studies, including the LEAP (Learning Early About Peanut Allergy) study, which showed a reduced risk of peanut allergy among infants who consumed peanut products early and often in the first year of life.
But are families following these guidelines? And are the guidelines helping to lower the percentage of children with peanut allergies? The EarlyNuts study answers these questions by examining early peanut introduction rates – and peanut allergy rates – in Australian children. Here’s what parents need to know about the EarlyNuts study.
The EarlyNuts Study: Introduction
The EarlyNuts study is the first study to find out the impact of early peanut introduction guidelines among children who were introduced to peanut within their own homes. It was conducted in Australia, a country with one of the highest reported childhood food allergy rates.
This study focused on the impact of the 2016 Australian Society of Clinical Immunology and Allergy (ASCIA) guidelines, which recommend introducing allergens – including peanut – to all infants starting before 12 months of age. Notably, the 2016 Australian guidelines (and other recent international guidelines) represent a reversal of previous guidance given in the 1990s. The 1990s guidelines recommended delaying peanut introduction for 1-3 years, but were not supported by science.
The researchers involved in the EarlyNuts study investigated whether the 2016 Australian peanut introduction guidelines have led more families to introduce peanut to infants before their first birthday. Following up on this, the researchers examined whether peanut introduction guidelines have led to a decrease in peanut allergy rates.
To answer these questions, this cross-sectional study compared early peanut introduction rates among two different populations: one from before the guidelines were released (2007-2011), and one from after the guidelines were released (2016-2019).
The EarlyNuts Study: Breaking Down the Findings
Here’s an overview of the EarlyNuts study for families:
Who was involved in the study?
Infants who were 12 months old after the 2016 Australian allergen introduction guidelines were released:
The above infants were compared to a cohort of 5,276 infants who were part of the earlier HealthNuts study. The HealthNuts study infants were 12 months old between 2007 and 2011 – before the most recent Australian allergen introduction guidelines were established.
How did the study work?
Parents were given a questionnaire where they reported the timing and frequency of peanut introduction.
And if a child appeared to have a peanut allergy, they were given a skin prick test and a food challenge to determine whether they were allergic.
Did early peanut introduction rates increase since the 2016 guidelines?
88.6% of the infants in the 2016-2018 EarlyNuts group were introduced to peanut by 12 months of age.
Only 28.4% of the infants in the 2007-2011 group were introduced to peanut by 12 months of age.
In other words, more than triple the babies were introduced to peanut in their first year following the publication of the new peanut introduction guidelines.
Note: 77.7% of the infants in the 2018-2019 group consumed peanut by 12 months of age. That still reflects a 2.5 times increase compared to 2007-2011.
Are families introducing peanut to their babies at an earlier average age since the 2016 guidelines?
Yes. In the 2016-2018 group, most parents introduced their babies to peanut at or before 6 months of age.
But between 2007 and 2011, 71.6% of parents did not introduce peanut at all until after baby’s first birthday. And the small number that did introduce peanut before then usually waited until 10-11 months of age.
Did the families in the EarlyNuts study introduce peanut often?
76.3% of the EarlyNuts infants (2016-2018) were introduced to peanut at least four times before 12 months of age, and 53.7% were eating peanut in large amounts.
But based on preliminary results, only about 30% of infants were eating peanut at least two times per week.
Have peanut allergy rates decreased since the new Australian guidelines were published?
Yes. The EarlyNuts study showed a 16% decrease in peanut allergy rates.
Adjusted for population changes, the percentage of children who developed peanut allergies in the 2018-2019 group was 2.6%. In the 2007-2011 group, 3.1% of children developed peanut allergies.
Even with these positive results, though, the EarlyNuts study reports that “the prevalence of peanut allergy was still high despite the majority of infants consuming peanut within the first year.”
Do results of the EarlyNuts study show that consuming peanut early can reduce peanut allergy risk?
Yes. In the 2018-19 group, 2.6% of the infants who consumed peanut before 12 months of age developed a peanut allergy.
Meanwhile, 4.8% of the 2018-2019 group who weren’t introduced to peanut until after 12 months developed a peanut allergy.
What does this mean for families?
The EarlyNuts study is notable because it looked at early peanut introduction in the average home – not early peanut introduction that was closely supervised as part of a trial.
The results from the EarlyNuts study show that early peanut introduction guidelines are very powerful. These guidelines have encouraged families to follow the research on introducing peanut early, and have helped decrease peanut allergy rates in children.
It’s important for all babies to be introduced to peanut early, before their first birthday. Be sure to use baby-safe forms such as peanut flour, peanut powder, or watered down smooth peanut butter.
Families can also take comfort in the fact that most allergic reactions that did occur in the EarlyNuts study were mild. This is consistent with other recent research that shows severe allergic reactions are the least common in infants, meaning infancy is the safest time to introduce common allergen foods like peanut.
Keep in mind: the results of studies that have inspired global early peanut introduction guidelines stress that sustained peanut introduction is just as crucial for reducing food allergy risk as starting early. In the LEAP study, infants were introduced to 2 grams of peanut at least three times per week.
Another notable finding of the EarlyNuts study is that healthcare providers’ awareness of early introduction guidelines, and guidance in helping parents follow them, is crucial.
As the EarlyNuts study reports, “There is often a significant lag in changes to culture/clinical practice after new clinical guidelines are published, particularly if they introduce opposing recommendations from prior held beliefs. One contributing factor to this rapid uptake [of these new guidelines] might be the ongoing relationship and communication between food allergy researchers… and [maternal and child health nurses] who provided most of the infant feeding advice to parents.”
In the United States, it’s pediatricians who most commonly give health advice, including feeding advice, to families of young children. So, it’s imperative that pediatricians are aware of, and encourage families to follow, guidelines that recommend allergen introduction before a child’s first birthday.
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