PEANUT CONSUMPTION IN INFANCY PREVENTS PEANUT ALLERGY

Introduction of peanut products into the diets of infants at high risk of developing peanut allergy was safe and led to an 81 percent reduction in the subsequent development of the allergy, a clinical trial has found. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and was conducted by the NIAID-funded Immune Tolerance Network (ITN).

The results appear in the current online issue of theNew England Journal of Medicine and were presented today at the annual meeting of the American Academy of Allergy, Asthma and Immunology.

Researchers led by Gideon Lack, M.D., of King's College London, designed a study called Learning Early About Peanut Allergy (LEAP), based on observations that Israeli children have lower rates of peanut allergy compared to Jewish children of similar ancestry residing in the United Kingdom. Unlike children in the UK, Israeli children begin consuming peanut-containing foods early in life. The study tested the hypothesis that the very low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption beginning in infancy.

"Food allergies are a growing concern, not just in the United States but around the world," said NIAID Director Anthony S. Fauci, M.D. "For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention."

LEAP compared two strategies to prevent peanut allergy--consumption or avoidance of dietary peanut--in infants who were at high risk of developing peanut allergy because they already had egg allergy and/or severe eczema, an inflammatory skin disorder.

"The study also excluded infants showing early strong signs of having already developed peanut allergy. The safety and effectiveness of early peanut consumption in this group remains unknown and requires further study," said Dr. Lack. "Parents of infants and young children with eczema or egg allergy should consult with an allergist, pediatrician, or their general practitioner prior to feeding them peanut products."

More than 600 high-risk infants between 4 and 11 months of age were assigned randomly either to avoid peanut entirely or to regularly include at least 6 grams of peanut protein per week in their diets. The avoidance and consumption regimens were continued until 5 years of age. Participants were monitored throughout this period with recurring visits with health care professionals, in addition to completing dietary surveys by telephone.

The researchers assessed peanut allergy at 5 years of age with a supervised, oral food challenge with peanut. They found an overall 81 percent reduction of peanut allergy in children who began early, continuous consumption of peanut compared to those who avoided peanut.

"Prior to 2008, clinical practice guidelines recommended avoidance of potentially allergenic foods in the diets of young children at heightened risk for development of food allergies," said Daniel Rotrosen, M.D., director of NIAID's Division of Allergy, Immunology and Transplantation. "While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage a serious public health problem."

A follow-up study called LEAP-On will ask all LEAP study participants to avoid peanut consumption for one year. These results will determine whether continuous peanut consumption is required to maintain a child's tolerance to peanut.

A PEANUT THAT WONT CAUSE ALLERGIC REACTION

A university of Florida scientist has moved one step closer to his goal of eliminating 99.9 percent of peanut allergens by removing 80 percent of them in whole peanuts.

Scientists must eliminate peanut allergens below a certain threshold for patients to be safe, said Wade Yang, an assistant professor in food science and human nutrition and member of UF’s Institute of Food and Agricultural Sciences.

If Yang can cut the allergens from 150 milligrams of protein per peanut to below 1.5 milligrams, 95 percent of those with peanut allergies would be safe. It’s challenging to eliminate all peanut allergens, he said, because doing so may risk destroying peanuts’ texture, color, flavor and nutrition. But he said he’s using novel methods like pulsed light to reach an allergen level that will protect most people.

Yang, whose study is published online in this month’s issue of the journal Food and Bioprocess Technology, cautioned that he has done peanut allergen experiments only in a laboratory setting so far. He hopes to eventually conduct clinical trials on animals and humans.

Dr. Shih-Wen Huang, professor emeritus in the Department of Pediatrics and Head of the Pediatric Allergy Clinic at UF Health, is familiar with the UF/IFAS research. Huang outlined more steps in the peanut allergen research.

The first is to see if the allergic antibody in the serum of peanut allergy patients will still bind with the residual allergy protein from the refined peanut products. The second is to see if the refined peanut extract would elicit skin-test reactions in peanut allergy patients.

The third step would be to conduct a double blind, placebo-controlled test to see if patients develop allergy symptoms after eating the refined products.

“I am pleased to see their work is progressing well,” Huang said. “However, more challenges are waiting until the final products are accepted from the public, especially the patients with peanut allergies.”

Two years ago, Yang was using his technique on peanut extract. He’s now testing it on the peanut itself. In his 2012 study, he removed up to 90 percent of the allergic potential from peanut protein extracts.

“This process proves that pulsed light can inactivate the peanut allergenic proteins and indicates that pulsed light has a great potential in peanut allergen mitigation,” Yang said.

About 1.9 million people, or 0.6 percent of U.S. residents, are allergic to peanuts, according to the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Reactions can range from skin rashes to anaphylaxis, which can be fatal. Currently, the best way for those allergic to peanuts to stay safe is to avoid them, according to the NIH. Many people carry epinephrine injectors that help offset their allergy symptoms until they reach a hospital.

In the latest study, Yang and his colleagues applied the pulsed ultraviolet light technology to whole peanuts. That makes the findings more useful, because peanut processing usually starts from whole-peanut roasting, and roasted peanuts are then packaged to sell as whole peanuts or made into peanut butter, he said.

“The latest study moves one step closer to the actual production,” Yang said.

For the study, Yang used a pulsating light system – two lamps filled with xenon, two cooling blowers, one treatment chamber with a conveyor belt and a control module ─ to direct concentrated bursts of light to modify the peanut allergenic proteins. That way, human antibodies can’t recognize them as allergens and begin to release histamines.

Histamines create allergy symptoms such as itching, rashes and wheezing. The pulsing light reduced the allergenic potential of the major peanut proteins Ara h1-h3.