LEAP study and peanut allergy questions
Question:
LEAP study after 5 years of treatment peanut 6 - 8 grams weekly1.9% & no treatment 10.6 % positive challenges.
What was a positive test?
What recommendations were given to these parents who were ingesting peanut?
New guidelines recommend similar doses weekly and made me think more about recommendations.
Answer:
We have forwarded your question to Dr. Amal Assad of the University of Cincinnati and Cincinnati Children's Hospital. We were not completely sure of the exact intent of your questions but we attempted to address the most likely issues raised.
I thank you for the questions and comments about the LEAP study.
In the LEAP study, and after the intervention of either totally avoiding peanut in the diet of infants and toddlers or giving them frequent amounts of peanut for up to five years of age, the now five year old toddlers were assessed for peanut allergy by an oral food challenge to peanut in the office and monitoring for clinical symptoms.
The positive food challenges clinical symptoms were assessed under major and minor criteria. The major criteria were: confluent erythematous pruritic rash, wheeze, inability to speak, stridor, dysphonia, and/or aphonia , ≥3 urticarial lesions, ≥1 site of angioedema, hypotension for age not associated with vasovagal episode, evidence of severe abdominal pain that persists for ≥3 hours. The minor criteria were vomiting, diarrhea, persistent rubbing of nose or eyes that lasts for ≥3 minutes, persistent rhinorrhea that lasts for ≥3 minutes and persistent scratching that lasts for ≥3 minutes.
During the study, the parents of the peanut avoidance group were asked not to administer any peanut containing food to the infant or toddler. They were not asked to remove peanut completely from the home. However, when they looked at the peanut protein in the dust of the homes, the homes of the peanut avoidance group had far less peanut in their dust than the ones who were in the peanut consumption group, which may indicate that the avoidance group decreased the overall presence of peanut in their homes.
As regards guidelines, the recently published NIH Expert Panel Addendum to the Guidelines do recommend the early introduction of peanut containing foods, in an age appropriate form, in the diet of infants at risk of peanut allergy, which include those with severe eczema and/or egg allergy, and the continued consumption of peanut containing foods 2-3 times a week for at least five years. The same is suggested to be applied to infants with less severe eczema. For the general population, with none of the above risk factors, it is recommended to introduce the peanut containing foods at around 6 months of age and give them more or less ad lib.
I hope this answers your questions and comments and is a help to your patients.
Amal Assa’ad, MD, FAAAAI
Dennis K. Ledford, MD, FAAAAI