A unique child: Allergies - In a nutshell

Removing peanuts from young children's diets may be exacerbating the very allergy epidemic that such a move was seeking to avert, according to a recent report. But a review and study are under way to establish whether eating or avoiding peanuts is the best way to prevent nut allergies.

The recent House of Lords report on allergies became the latest to question current guidance that where a child is at high risk of developing a peanut allergy, the mother may wish to:

- avoid eating peanuts while pregnant and breastfeeding

- avoid feeding a child foods containing peanuts until the child has reached the age of three.

These recommendations, based on medical evidence reported nine years ago, have been the advice of health authorities in the UK, Canada and the US. Yet it is these very countries that have seen the dramatic rise in the incidence of peanut allergies.

One possible explanation for the apparent failure of avoidance advice is that avoidance has been incomplete. However, in numerous countries in Africa and Asia, where children eat foods containing peanuts from infancy, there is little or no allergy in the population.

Many scientists now believe that repeatedly exposing a young child's immune system to peanut may allow the child's body to build up a tolerance to peanut proteins and so prevent an allergic reaction from developing.

The findings of the LEAP (Learning Early about Peanut Allergy) study, involving London's Evelina Children's Hospital, may provide important new evidence. The study is recruiting 480 children, aged between four and 11 months and suffering from eczema or egg allergy, as this group has a 20 per cent chance of developing a peanut allergy. Half will avoid eating foods containing peanuts until age three; half will be fed a peanut snack three times a week. The two groups of children will be tracked until the age of five, when the incidence of allergies in each group will be used to determine whether avoidance or consumption is the better approach.

Professor Gideon Lack, principal investigator in the LEAP study, says, 'Peanut allergy affects almost one in 50 schoolchildren in the UK. For the majority this is a life-long, frightening disease that significantly impacts on quality of life. If we can determine whether early avoidance or early introduction of peanut is the better strategy, this will influence public health policy and potentially prevent suffering in tens of thousands of children over the next decade.'

But with the study results some five years away, advice from the LEAP team is that parents and early years practitioners 'should continue to follow current advice on avoidance of peanut in the infant's diet' (see box).

That advice may change next year, however. The Food Standards Agency is commissioning a review of recent allergy research, to be completed by next spring and analysed by independent advisory body, the Committee for Toxicity. A Department of Health spokesperson says, 'We will reconsider our guidance once we have received advice from the COT in light of the FSA's review.'

Vicky Field, spokesperson for the Anaphylaxis Campaign, says it was never intended that all mothers follow the DoH guidance, but 'a study carried out in Portsmouth found that many pregnant women with no history of allergy were following it'.

She adds, 'At the moment we just don't what is causing the rise in peanut allergy or if we're doing anything good or bad or having any impact at all on curbing the rise. That's why the LEAP research is so important.'

FURTHER INFORMATION:

- The LEAP Study: call 0800 234 6522, e-mail info@leapstudy.co.uk or visit www.leapstudy.co.uk

- House of Lords Science and Technology Committee, 6th Report of Session 2006-07 - Allergy, www.publications.parliament.uk/pa/ld/ldsctech.htm#reports

- The Food Standards Agency: www.food.gov.uk/

- The Anaphylaxis Campaign: www.anaphylaxis.org.uk

DEALING WITH ALLERGIES

With the incidence of peanut allergy rising by 117.3 per cent between 2001 and 2005, looking after children with peanut allergies has become commonplace for many nurseries.

Advice from the LEAP study team is that children with peanut allergies should have a personalised emergency management plan that is: issued to both parents and the school/nursery; is easily accessible; accompanies the emergency medications; and outlines in a step-wise fashion exactly what should be done in case of an allergic reaction.

Information on how to prepare such a plan is available at www.allergyinschools.org.uk, a site administered by the Anaphylaxis Campaign and including specific advice for early years settings.