The allergen-specificity of early peanut consumption in the LEAP Study

Published online: October 2017

The LEAP Study demonstrates that early consumption of peanut in high-risk infants prevents the development of peanut allergy and that this protective effect persists following 12 months of peanut avoidance. However, atopic conditions rarely occur in isolation, thus it is necessary to establish whether the successful LEAP intervention which prevented peanut allergy in high risk infants is also an effective strategy for reducing the overall burden of atopic disease.

The Journal of Allergy and Clinical Immunology (JACI) as well as the last name of the lead author.
Du Toit et al, recently published the a priori analysis of the LEAP and LEAP-On Study secondary allergic outcome data in The Journal of Allergy and Clinical Immunology (JACI). The authors hypothesize whether the protective effect of early peanut consumption is allergen and allergic disease specific or whether the protective effect extends to other allergic diseases.  

Outcome measures included: allergic conditions, namely asthma, eczema and allergic rhinoconjunctivitis which were diagnosed by clinical assessment, reported allergic reactions and consumption of common food allergens (cow’s milk, hen’s egg, tree nuts and sesame) which were recorded by questionnaire and sensitization to food and aeroallergens which was determined by skin prick testing and specific IgE measurement

The authors found a high and increasing burden of food and aeroallergen sensitization and allergic disease across study time points; 76% of LEAP participants had at least one allergic disease at 60 months of age. At 72 months of age, 38% of participants had eczema, 58% rhinoconjunctivitis, 16% asthma and 41% had suspected food allergy (defined by at least one SPT≥ 5mm). Importantly, there were no differences noted in allergic disease between LEAP groups. There were small differences between LEAP groups in sensitization and reported allergic reactions for select tree nuts; levels were higher in children assigned to the early introduction of peanut. Significant resolution of eczema and sensitization to egg and milk occurred in LEAP participants; this was not affected by peanut consumption.

The author’s findings suggest that whilst early consumption of peanut in infants at high risk of peanut allergy is an effective strategy for the primary prevention of peanut allergy, this intervention is allergen-specific and does not prevent the development of other allergic disease, sensitization to other foods and aeroallergens, or reported allergic reactions to tree nuts and sesame. Furthermore, peanut consumption does not hasten the resolution of eczema or egg allergy. Different prevention strategies, or strategies that include multiple dietary interventions, need to be tested to assess whether the reduction in peanut allergy observed in the LEAP consumption group can be extended to other common food allergens and allergic diseases and in so doing reduce the overall disease burden suffered by atopic children.      

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter