45 Years of Caring
Allergy and Asthma Medical Group and Research Center welcomes you to our office. Since 1969 we have provided quality subspecialty care for allergy and asthma patients in the greater San Diego area. Allergy and asthma diagnosis and treatment requires the services of a highly-trained team of physicians, nurses, medical assistants and office personnel with special skills and an understanding of the impact of these disorders on patients and their families. This is the type of team we provide at Allergy and Asthma Medical Group and Research Center. Information on this website is for educational and reference purposes only.
The Office will be CLOSED on May 25th,2015 in observance of Memorial Day
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IN THE NEWS:
Preventing Peanut Allergy Through Early Consumption of Peanut
Ready to Put into Action?
The idea to do a study investigating whether feeding children early on with peanut might prevent peanut allergy came from an interesting observation in England. Du Toit et al (JACI 2008) noted that the prevalence of peanut allergy among Jewish children in London who were not given peanut-based products in the first year of life was 10 times as high as that among Jewish children in Israel who had consumed peanut-based products before their first birthday. Other studies published around the same time that evaluated the early introduction of other allergenic foods, like cow’s milk and egg, also showed that earlier introduction of milk and egg into an infant’s diet was associated with a decrease in the development of allergy.
So, Dr. Du Toit and colleagues decided to do an experiment to check out the hypothesis that early introduction (before age 1 year) of peanut would lead to the prevention of peanut allergy in high-risk infants (Du Toit et al NEJM 2015). He defined infants at risk as ones who had significant eczema, or egg allergy, or both. All were tested for peanut allergy (skin testing and specific serum IgE testing) before entry. More than 500 infants at high risk for peanut allergy were randomly assigned to receive peanut products (consumption group) or to avoid them (avoidance group). Some children had to be excluded from participation because they had a significantly positive allergy skin test to peanut. Others who had only a mild positive reaction to peanut and tolerated an oral food challenge in the clinic were kept in the study (and randomly assigned to the consumption or avoidance group) but their outcomes were analyzed separately.
Children in the consumption group were fed at least 6 grams of peanut protein per week, using either a snack food called Bamba, or peanut butter, until age 5 years. The control group (avoidance) strictly avoided peanut until the same age. At the end of the period, all children were tested for the presence of peanut allergy using an oral food challenge with peanut, and allergy testing.
The results were striking - at age 5, the consumption group had a prevalence of peanut allergy of 3.2% compared to 17.2% for the avoidance group. Giving children on a regular basis from early on in life clearly had a strong protective effect for peanut allergy. Even the sub-group of children who had a mild sensitivity to peanut at the outset of the treatment period obtained protection from peanut allergy – only 10.6% who were fed regular peanut developed allergy versus 35.3% in the avoidance group.
What does it all mean from a practical standpoint? These results indicate that the early introduction of peanut dramatically decreases the chance of developing peanut allergy. Should we be recommending all infants be introduced to peanuts before age 1 year? This question along with many other ones need to be addressed, and not all the answers are in yet. However, the results of this trial are so compelling, and the problem of increasing prevalence of peanut allergy so alarming, new official guidelines about peanut in the diet of infants are likely to be coming soon.
In the meantime, we suggest the following:
-Infants age 4 mos and 1 year who are at risk for peanut allergy (i.e. known allergy to another food e.g. egg, milk; significant eczema; and/or sibling with peanut allergy), should undergo allergy testing (skin testing, serum specific IgE) for peanut.
-If the IgE results are clearly positive, the child should avoid peanut and peanut products (e.g. peanut butter).
-If the IgE results are negative, the child should be started on a diet that includes 2 gms of peanut protein 3 days a week for at least 3 years. The first exposure should be done carefully, perhaps using small and then increasing amounts over time at home.
-If the results of allergy testing show only a mild sensitivity, the child should undergo a peanut a carefully supervised oral food challenge. Children who are non-reactive on challenge should be started on the peanut containing diet.
Who should be performing the above evaluation and making the decision on early introduction of peanut – the pediatrician or the pediatric allergist? Since peanut allergy can be a serious food allergy, it is probably best that the allergist be the one directing this new approach to food allergy prevention. Later on, as more is learned about this process, and guidelines are fully established, this approach may become more main stream, and referral to the allergist will not always be needed. Until then, the allergists at Radys Childens Hospital San Diego are more than happy to see the kids you feel could benefit from this treatment.
To schedule your injection appointment, please call (858) 292-1144 option #7.
If we are unable to take your call because we are busy assisting a patient, please leave a voice mail message with your name, date of birth, and the day you plan to come in for the injection, and we will schedule your appointment accordingly.