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Impact on Peanut Allergy of Avoidance after Early Peanut Consumption

George du Toit, M.B., B.Ch., F.R.C.P.C.H., Peter H. Sayre, M.D., Ph.D.,* Graham Roberts,* M.R.C.P.C.H., D.M., Michelle L. Sever, M.S.P.H., Ph.D., Kaitie Lawson, M.S., Henry T. Bahnson, M.P.H., Helen A. Brough, F.R.C.P.C.H., Ph.D., Alexandra F. Santos, M.D., Ph.D., Kristina M. Harris, Ph.D., Suzana Radulovic, M.D., Monica Basting, M.A., Victor Turcanu, M.D., Ph.D., Marshall Plaut, M.D., and Gideon Lack, M.B., B.Ch., F.R.C.P.C.H., for the Immune Tolerance Network LEAP Study Team
N Engl J Med 2016; 374 | March 4, 2016 | DOI: 10.1056/NEJMoa1514209

Early introduction of peanut in high-risk infants prevented peanut allergy in LEAP. The LEAP-On Study asked whether the rate of peanut allergy would remain low after 12 months of peanut avoidance in those who had consumed peanut during LEAP, compared to those who avoided. 

At the end of LEAP all participants were instructed to avoid peanut for 12 months. The primary outcome was the percentage with peanut allergy at the end of the 12 month period when the participants were 72 months of age.

LEAP-On enrolled 556 (88.5%) of 628 eligible participants from LEAP; 550 (98.9%) had a complete primary outcome. Adherence to avoidance was high (LEAP avoiders: 97.1%; LEAP consumers: 76.7%). Peanut allergy at 72 months was significantly more prevalent in LEAP avoiders than consumers (18.6% (52/280) versus 4.8% (13/270), p<0.001). There were three new allergy cases in each arm, but there was no statistically significant increase in allergy in LEAP consumers after 12 months of avoidance (3.6% (10/274) at 60, 4.8% (13/270) at 72 months, p=0.250). There were fewer LEAP consumers with high Ara h2 (a component of peanut protein)-specific IgE and peanut-specific IgE than avoiders. They also continued to have higher levels of peanut-specific IgG4 and peanut-specific IgG4:IgE ratios. 

In infants at high-risk for allergy in whom peanut was introduced in the first year of life and continued until age 5, a 12 month period of peanut avoidance was not associated with an increase in peanut allergy. Longer term effects are not known. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT01366846).

Originally Appeared in The New England Journal of Medicine on March 4, 2016.

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The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is seeking public comment on a draft update to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States to address the prevention of peanut allergy. The public comment period begins March 4 and will remain open for 45 days, ending April 18. NIAID encourages health care professionals and interested members of the public to review the draft update and participate in the open comment period [niaid.nih.gov/topics/foodAller...].&nbsp;

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