CONSISTENT peanut consumption, starting in infancy and continuing to 5 years of age, provides a lasting tolerance to peanuts which continues into early adolescence, according to recent research.
A previous trial compared the rates of peanut allergy in participants who avoided peanut consumption between infancy and five years of age, compared to those that didn’t. It was found that consuming peanuts during this period prevented the development of a peanut allergy. Additionally, after one year of subsequent peanut avoidance, the participants remained tolerant to peanuts.
In a follow-up trial, researchers investigated if this effect persisted with subsequent ad libitum peanut consumption. Of the 640 participants in the initial trial, 497 were assessed at 144 months (12 years of age). The analysis revealed that at 12 years, participants in the original peanut avoidance group were significantly more likely to develop a peanut allergy than the consumption group (15.4% versus 4.4%; p<0.001). This finding was associated with higher levels of Ara h2-specific immunoglobulin E (an antibody for Ara h2, a protein highly associated with anaphylaxis) in the peanut consumption group (0.03±3.42 kU/L) compared to the peanut avoidance group (0.06±11.21 kU/L) at 12 years of age. Similarly, participants in the peanut consumption group had higher levels of peanut-specific immunoglobulin G4 of 535.50±4.98 μg/L, whereas participants in the peanut avoidance group had levels of 209.3±3.84 μg/L.
This research highlights the clinical importance of early peanut consumption in preventing peanut allergies. Introducing peanuts in infancy and maintaining consumption until 5 years of age, has shown long-term tolerance, irrespective of subsequent peanut consumption. Thus, significantly reducing allergy rates compared to avoidance.
Future research should explore the underlying mechanisms behind sustained tolerance and the potential for similar strategies with other allergens, offering promising pathways for broader allergy prevention practices.
Katrina Thornber, EMJ
Reference
Du Toit G et al. Follow-up to adolescence after early peanut introduction for allergy prevention. NEJM Evid. 2024;3(6):EVIDoa2300311.
