Researchers at the Children’s Hospital of Philadelphia (CHOP) found a significant decline in diagnoses of IgE-mediated food allergies after guidelines encouraged early peanut exposure.
The study used electronic health records from children aged 0-3 and compared periods before and after the 2015/2017 early-food-introduction recommendations.
After guideline rollout, peanut allergy diagnoses dropped from about 0.79% to 0.45% and any IgE-mediated food allergy dropped from about 1.46% to 0.93%.
Food allergies in children can be scary and complex — hives, swelling, breathing troubles — all triggered when the immune system reacts to a food.
That’s the case with IgE-mediated food allergies, the kind the body treats like a threat when really it’s just eating something ordinary (like peanuts or eggs).
But there’s been a shift in thinking lately: instead of avoiding allergenic foods, some pediatric experts now suggest introducing them early — and in some cases earlier than we used to — to help the immune system learn tolerance rather than fear.
A recent study conducted by researchers at CHOP showed that these guideline-driven changes may already be having a real impact.
“Everyone has been wondering whether these landmark public health interventions have had an impact on reducing rates of IgE-mediated food allergies in the United States,” researcher Stanislaw Gabryszewski, MD, PhD, said in a news release.
“We now have data that suggest that the effect of this landmark public health intervention is occurring.”
The study
The CHOP team looked at electronic health records from a multi-state pediatric primary-care network (the American Academy of Pediatrics Comparative Effectiveness Research through Collaborative Electronic Reporting (CER²) database) to see how often IgE-mediated food allergies were diagnosed among children aged 0-3.
They divided the data into cohorts by time periods: one before the introduction of early-allergen guidelines (roughly 2012-2014), one after the initial 2015 guideline, and one after the 2017 addendum guideline.
They compared the number of new peanut allergy diagnoses with any IgE-mediated food allergy, tracked trends over time, and adjusted for certain risk factors like atopic dermatitis.
Importantly: this is observational data (not a controlled experiment), so the study shows associations, not definitive cause-and-effect.
The results
Among children seen in the pre-guideline period, the diagnosis rate for peanut IgE-mediated allergy was about 0.79%; in the post-addendum period, it dropped to 0.45% — a roughly 43% relative reduction.
For “any IgE-mediated food allergy” (not just peanuts), the rate went from about 1.46% down to 0.93% — about a 37% reduction.
Also noteworthy: peanuts went from being the most common food allergen diagnosis to the second most common (with eggs ahead) in this cohort post-guideline.
The authors estimate that for about every 200 infants introduced to allergenic foods early, one child might be prevented from developing a food allergy.
Still, the reduction in the real-world setting is less dramatic than the 2015 landmark LEAP trial (which showed about an 80% reduction in a tightly controlled setting). The authors emphasize the need for improved implementation, awareness, and further study.
“Our findings have relevance from those of us who treat patients to those caring for infants, and more awareness, education, and advocacy could further increase the positive results we observed in this study,” senior study author David Hill, MD, PhD, said in the news release.
“Future studies could potentially explore specific feeding practices that help us better understand the timing, frequency and dose of foods that optimize protection against food allergies.”