Research led by Dr. Gideon Lack has revealed significant insights into the management of peanut allergies, challenging long-held conventions. His early investigations into food allergies highlighted a stark contrast between the number of peanut allergy cases in children in London and in Israel, igniting further inquiry into the role of diet in early childhood, reports BritPanorama.
Peanut allergies affect more than 2% of children in the United States and display similar prevalence rates in the UK. However, during a lecture in Israel around 25 years ago, Lack noted that few local doctors recognized peanut allergies in their patients, prompting him to investigate further.
Lack, who was observing high rates of peanut allergy among children in London’s Jewish community, found that Israeli children were being introduced to peanut-based snacks — specifically, Bamba peanut puffs — at a much earlier age than their UK counterparts. His research suggested this early dietary exposure played a protective role against the development of allergies.
A guiding principle that had been followed — to exclude peanuts in infancy to prevent allergies — was, as Lack described, “completely backward.” His findings indicated that introducing peanuts early could significantly reduce the chances of developing an allergy, a notion he and his colleagues sought to prove through comprehensive studies conducted over 15 years.
‘Mother, father, Bamba’
In Israel, the cultural practice of introducing peanut snacks around 4 to 6 months old seems to have garnered widespread acceptance among parents. Lack emphasized the stark dietary differences — UK babies consumed an average of zero grams of peanuts weekly, while Israeli children averaged about 2 grams, translating to approximately 10 peanuts weekly.
This practice raised questions about how different dietary patterns might influence allergy development. He stated that while the observation was notable, it was not definitive proof, urging caution in attributing the findings solely to diet without considering other possible factors such as genetic predispositions.
To explore this further, Lack and his team conducted a randomized controlled trial involving 640 infants, funded by the US National Institutes of Health. The trial sought to determine whether early introduction of peanuts could indeed lower allergy rates, particularly among children at high risk due to conditions like severe eczema or egg allergies.
The results of the trial, known as the LEAP study, were conclusive: introducing peanuts before age one led to an 80% reduction in peanut allergy development among those who consumed them. These findings, published in 2015, marked a pivotal moment in allergy research and advocacy for changing dietary recommendations.
Medicine’s zigzags
Despite the promising outcomes, there remained a challenge in shifting long-standing medical guidelines and beliefs among parents and pediatricians. In 2000, the American Academy of Pediatrics issued recommendations that called for delaying the introduction of potential allergens like peanuts, a stance that many had followed without question.
Lack acknowledged following these outdated guidelines himself with his sons, reflecting on the scientific evolution that led to updated recommendations. Changes in guidelines were finally made following the LEAP study, with subsequent updates in 2017 and 2021 that advocated for early allergen exposure.
Current research continues to evolve as Lack co-leads the SEAL study, investigating the potential protective effects of early eczema treatment against food allergies. This study builds on the understanding that early exposure to food proteins through the gut may foster immune tolerance, contrasting against exposure through inflamed skin, which can lead to sensitization.
If the dual-exposure hypothesis holds true, the implications could significantly adjust how allergies are addressed moving forward in medical practice and public health recommendations.
