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Guidelines for how to prevent food allergies in children are changing. Until very recently, it was avoid, avoid, avoid exposing babies or young children to any potential allergens. Remember parents being advised that if an allergy to X (whether pets or food) runs in the family, then absolutely avoid exposing the child to the potential allergen? Well, recent research (herehere, and here) found that the opposite is true - that in the first year of life the baby should be exposed to potential allergens (whether animals or food) which stimulates the child's developing immune system in beneficial ways.

Physicians at a recent conference of allergists said that evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life. The new 2017 medical guidelines will recommend introducing small amounts of peanuts (mixed in with other foods), when children are 4 to 6 months of age..

About two years ago a landmark study (LEAP study) found that when infants at a high risk of developing peanut allergy consumed peanuts on a regular basis, their risk of peanut allergy was dramatically reduced. And the opposite was also true: peanut avoidance in the first year of life was associated with a greater frequency of peanut allergy. Which made doctors start to rethink their strategies of how to avoid food allergies. From Medscape:

Allergenic Foods Should Be Introduced to Infants Early

Although the evidence shows that allergenic foods — including peanuts, eggs, and milk — should be introduced in the first year of life, guidelines are lagging behind, said an allergist speaking here at the American College of Allergy, Asthma & Immunology (ACAAI) 2016 Annual Scientific Meeting. Official guidelines to be issued early in 2017 will address only peanuts, recommending introduction when children are 4 to 6 months of age.

"There is now a large body of observation and trial data for other foods, including egg, that show that delaying the introduction of allergenic solids increases the risk of those particular food allergies," said Katrina Allen, MBBS, PhD, from the Murdoch Childrens Research Institute in Melbourne, Australia. Policy changes are needed to help guide parents' decisions, she said. In fact, there is evidence showing that changes to policy — namely, infant-feeding guidelines — mirror the rise in the incidence of food allergies.

Not everyone agrees on exposure amount and timing in the case of egg allergy. In a recent trial, researchers looked at the early introduction of allergenic foods in breast-fed children (N Engl J Med. 2016;374:1733-1743). The prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group, as was the prevalence of peanut allergy and egg allergy. And a study Dr Allen was involved in, which introduced cooked egg in small amounts, showed that early introduction reduced allergy (J Allergy Clin Immunol. 2010;126:807-813).

However, in a German study, where greater amounts of egg were introduced at 4 to 6 months, early exposure increased the risk for life-threatening allergic reactions (J Allergy Clin Immunol. Published online August 12, 2016). And in the STEP study, there was no change in the number of food allergies in 1-year-old children when egg was introduced early (J Allergy Clin Immunol. Published online August 20, 2016). However, that did not take into account high-risk infants, particularly those with eczema, who are known to have a higher incidence of egg allergy and are likely to see a much greater benefit from the early introduction of egg.

The new peanut guidelines — coauthored by Amal Assa'ad, MD, from the Cincinnati Children's Hospital, who is chair of the ACAAI food allergy committee — will recommend that children with no eczema or egg allergy can be introduced to peanut-containing foods at home, according to the family's preference. And for children with mild to moderate eczema who have already started solid foods, the guidelines say that peanut-containing foods can be introduced at home at around 6 months of age, without the need for an evaluation. However, the guidelines caution, peanut-containing foods should not be the first solid food an infant tries, and an introduction should be made only when the child is healthy. The first feeding should not happen when the child has a cold, is vomiting, or has diarrhea or another illness.

For eggs, there is no official recommendation as of yet....The early introduction of allergenic foods is not the only policy that needs to be changed to lower the incidence of food allergies, Dr Allen told Medscape Medical News. Other factors, particularly environmental factors — mostly written up in observational studies — are contributing to an increasing intolerance to allergenic foods. Policies advocating that kids "get down and dirty," have more exposure to dogs, and bathe less are also warranted....Dr Allen and Dr Assa'ad agree that delaying the introduction of foods such cow's milk and egg until after 12 months is harmful. Guidelines should encourage families to introduce these foods in the first year of life, once solids have commenced at around 6 months, but not before 4 months.

Yes! Treating young children who have peanut allergies with doses of peanut protein (oral immunotherapy or OIT) for one month works in treating the peanut allergies in the overwhelming majority of young children in an important study. Several studies have now shown that early exposure to nuts is important for prevention of nut allergies, and in this study the researchers showed that both lower and higher dose oral immunotherapy works in treating nut allergies in young children (9 to 36 months of age). Note that this is a paradigm change - before this the thinking was avoid, avoid, avoid for the child to not get or to not worsen the allergy (whether nuts or animals), but now it's early exposure is good in preventing and treating allergies. From Futurity:

Can therapy before 3 wipe out a peanut allergy?

Preschool children with a peanut allergy were able to start eating peanuts after taking part in oral immunotherapy, a new study shows. The findings confirm and extend previous results that show oral immunotherapy (OIT) can protect children from potentially life-threatening anaphylaxis caused by peanut exposure.

The phase two clinical trial results, published online in the Journal of Allergy and Clinical Immunology, show that one month after completing the OIT protocol, almost 80 percent of trial participants achieved “sustained unresponsiveness,” the highest rate yet reported.

“These findings, if confirmed in larger studies, could transform the care of peanut-allergic children early in life,” says Brian P. Vickery, lead investigator of the trial and assistant professor of pediatrics at the University of North Carolina at Chapel Hill. Approximately three million people in the United States report having allergies to peanuts and tree nuts. According to a study released in 2013 by the Centers for Disease Control and Prevention, food allergies among children increased approximately 50 percent between 1997 and 2011.

The initial allergic reaction to peanuts commonly occurs within the first year or two of life, and the condition persists in 80 percent of affected patients, placing them at life-long risk of anaphylaxis. Based on other studies suggesting that peanut allergies strengthen over time, researchers enrolled 40 peanut-allergic children aged 9 to 36 months in the trial, the first study to specifically target children under the age of three.

Children were randomly assigned to high-dose peanut OIT with a target daily dose of 3,000 milligrams of peanut protein or a low-dose regimen with a target dose of 300 milligrams. The trial was double-blinded. Participants took 3,000 mg of study protein, but for the low-dose group, 2,700 mg of placebo was added to the OIT medication. As in previous studies, nearly all participants experienced some side effects, most of which were mild and required little or no treatment.

After receiving OIT for 29 months on average, participants abstained from peanut exposure for four weeks before undergoing a final peanut challenge—where participants ingest a small amount of peanut in a controlled setting. If the challenge is successful, then doctors reintroduce normal amounts of peanuts—such as in a peanut butter and jelly sandwich—into the diets of participants. After the four-week period, nearly 80 percent of children in both the high- and low-dose groups consumed peanut with no allergic response and achieved sustained unresponsiveness.

The OIT-treated children were compared with a matched control group of 154 peanut-allergic children who avoided peanut. The OIT-treated children experienced beneficial changes in their immune responses to peanut and were 19 times more likely to successfully incorporate peanut into their diets. 

An amazing breakthrough for those suffering from peanut allergies. The bacteria Lactobacillus rhamnosus is added to some yogurts and kefir, but in smaller amounts.From The Telegraph:

Fatal peanut allergies could be cured by probiotic bacteria, say Australian doctors

A strain of probiotic bacteria could offer a cure for potentially fatal peanut allergies, according to scientists in Australia. The breakthrough followed a trial in which a group of children were given increasing amounts of peanut flour, along with a probiotic called Lactobacillus rhamnosus, over an 18-month period. About 80 per cent of the children who had peanut allergies were subsequently able to tolerate peanuts.

Mimi Tang, the lead researcher, said the families involved believed the treatment had "changed their lives". "These findings provide the vital first step towards developing a cure for peanut allergy and possibly for all food allergies," she told Melbourne's Herald Sun.

The randomised trial, involving a group of about 30 children, was conducted by Murdoch Childrens Research Institute in Melbourne. The children, aged one to ten, were given small amounts of peanut flour, gradually building up to two grams, or the equivalent of six or seven nuts.They were also given daily doses of Lactobacillus rhamnosus, which is found in yoghurt but was given in quantities equivalent to the amount found in 44 pounds of yoghurt.

Following the treatment, about 80 per cent of the children were able to tolerate four grams of peanut protein, equivalent to about 14 peanuts. Typically, about four per cent of children would have overcome their peanut allergy during this time.

Rates of peanut allergies have dramatically increased in the past two decades, particularly in developed countries. For most sufferers, the condition is lifelong.

A link to the press release from the Murdoch Childrens Research Institute (their researchers are doing the research), has more:

Oral Therapy Could Provide Treatment For Peanut Allergies

Over 60 peanut allergic children in the study were either given a dose of a probiotic, Lactobacillus rhamnosus, together with peanut protein in increasing amounts, or a placebo over 18 months to assess whether children would become tolerant to peanut.

The probiotic was a fixed daily dose, while the peanut oral immunotherapy was a daily dose of peanut protein starting at very low doses followed by a dose increase every two weeks until the maintenance dose (2 grams peanut protein) was reached. At the end of the treatment, the child's ability to tolerate peanut was assessed by a peanut challenge performed two to five weeks after stopping treatment.

23 of 28 (82.1%) probiotic treated children and one of 28 (3.6%) placebo-treated children were able to include peanut in their diet at the end of the trial. The likelihood of success was high - if nine children were given probiotic and peanut therapy, seven would benefit.

The need for a curative treatment is greatest for peanut allergy since this is usually lifelong, and is the most common cause of fatality due to food induced anaphylaxis. Further research is now required to confirm whether patients can still tolerate peanut years after the study has finished.