Peanut Allergies, a Thing of the Past?

Reversing Fate

Peanut allergies have become a growing concern in Australia, where rates of food allergies are some of the highest in the world. Experts remain uncertain about why Australia has emerged as the allergy capital, but the impact is clear, particularly among children. Peanut allergy is one of the most common childhood food allergies, and unlike some other food sensitivities, children rarely grow out of it.

From here, a natural research angle has emerged in Australia; what if we could prevent peanut allergies altogether? With 3% of infants 1 year of age suffering from a peanut allergy, this question has sparked a new wave of research and hope among scientists, parents, and healthcare professionals alike. Early peanut introduction has emerged as a promising strategy, but could future research unlock new methods to not only reduce, but potentially eliminate the risk of peanut allergies entirely?

The only evidence-based strategy to prevent peanut allergies is the early introduction of peanuts into a child’s diet. Research, including a meta-analysis of randomised clinical trials conducted in the UK, has shown that introducing peanuts by 11 months significantly lowers the risk of developing the allergy. These findings prompted a major shift in Australia’s infant feeding guidelines in 2016, recommending the introduction of peanut products before 12 months of age, which differed from earlier guidelines that encouraged delaying allergenic foods until the age of 1 to 3 years.

Despite these revised guidelines, many parents were still cautious, with studies showing that between 2007 and 2011, only 28% of Australian infants were introduced to peanut products in their first year of life. However with better awareness programs, by 2018, this figure had surged to 89%, marking a significant change in infant feeding practices. While the long-term effects of these changes on peanut allergy prevalence are still being studied, early signs suggest a positive shift.

Australian Data

Recent research aimed to explore the impact of early peanut introduction on the prevalence of peanut allergies in Australian infants following these updated 2016 feeding guidelines. The study recruited two large groups of infants, ten years apart, from immunisation centres around Melbourne to assess whether the new guidelines were associated with a decrease in peanut allergy rates. By using the same sampling methods across both groups, researchers ensured that the data collected—ranging from demographics to peanut exposure—was comparable. Each infant was screened for peanut allergies through skin prick tests, and those showing potential allergies underwent further testing through oral food challenges. The goal was to evaluate whether introducing peanuts early in life could reduce peanut allergy rates not just in high-risk groups, but across the general population. 

The study examined two cohorts of infants, one from 2007-2011 and the other from 2018-2019, to assess the impact of early peanut introduction on peanut allergy prevalence. In the 2018-2019 cohort, researchers approached the parents of 1933 infants, with 73.5% of participants completing skin prick tests to evaluate peanut allergies. The remaining participants provided questionnaire data, often citing that their child was already tolerating peanuts or had previously undergone an allergy assessment.

The earlier cohort from 2007-2011 had a similar participation rate of 74%, with 5072 infants providing peanut allergy outcomes. Both groups were closely matched in terms of median age at recruitment, though the 2018-2019 group had a higher percentage of infants from East Asian ancestry—a known risk factor for food allergies—and were more likely to have parent-reported eczema and a family history of food allergies.

Despite some demographic differences between the cohorts, the data from this research provides valuable insights into how early peanut introduction is being implemented across populations and its potential in reducing peanut allergies.

Can We Avoid Peanut Allergies?

The study from the Murdoch Children’s Research Institute tested significant changes in the timing of peanut introduction between the two cohorts. In the 2018-2019 cohort, and as previously mentioned, 85.6% of infants were introduced to peanuts before 12 months, compared to just 21.6% in the 2007-2011 cohort — showing a great uptake to the new guidelines. However, disparities were noted between different ancestries, with fewer infants of East Asian ancestry consuming peanuts before 12 months in both cohorts. Interestingly, early-onset eczema did not impact peanut introduction in the 2018-2019 group as it had in the earlier cohort.

When examining the association between age of introduction and peanut allergy, the study found a significant reduction in peanut allergy risk among infants of Australian ancestry who were introduced to peanuts earlier. In contrast, no significant association was observed for infants of East Asian ancestry.

Despite these changes in feeding practices, the overall prevalence of peanut allergy remained unfortunately stable. In 2018-2019, the peanut allergy prevalence was 3.1%, similar to the 3.1% observed in 2007-2011. There was also no significant reduction in peanut allergy rates when adjusting for factors such as ancestry or early-onset eczema. However, among infants with early-onset eczema, there was a modest, though not statistically significant, decrease in peanut allergy prevalence from 14.1% in 2007-2011 to 9.3% in 2018-2019. The findings suggest that while early peanut introduction may reduce allergy risk in certain groups, more research is needed to understand its broader impact across populations.

Mixed Results

The results of this study highlight the complexities of peanut allergy prevention, revealing that while early peanut introduction remains a key strategy, it is far from a universal solution. Despite widespread adoption of new guidelines encouraging peanut introduction before 12 months, the overall prevalence of peanut allergy in Australia has not significantly decreased. Interestingly, early peanut introduction appeared to reduce the risk of peanut allergies in infants of Australian-born parents but not in those of East Asian ancestry, raising important questions about genetic and environmental influences. This disparity suggests that factors beyond diet, such as maternal gut health or early-life environmental exposures, may play a critical role in the development of food allergies. It’s clear that early peanut introduction alone may not be enough to curb the rising rates of allergies, and further research is needed to understand the full scope of contributing factors. As we continue to investigate, the hope remains that more targeted, multi-faceted approaches can make a meaningful impact on allergy prevention.

The ADAPT OIT Program

A groundbreaking new program is poised to revolutionise the management of peanut allergies in Australian infants, marking a significant step forward in the fight against food allergies. The ADAPT Oral Immunotherapy (OIT) Program, launched by the National Allergy Centre of Excellence (NACE) and hosted at the Murdoch Children’s Research Institute, is the world’s first nationwide initiative offering standardised peanut allergy treatment to babies under 12 months. Partnering with ten paediatric hospitals across five states in Australia, the program will provide free, evidence-based oral immunotherapy aimed at building tolerance to peanuts in children diagnosed with peanut allergies. For the first time, this treatment model is being rolled out in Australian hospitals outside of clinical trials, representing a monumental shift in how peanut allergies are managed at a national scale.

The program’s structured approach involves a daily dosage of peanut powder administered at home over two years. Families on the program are closely monitored by medical teams and have access to allergists on-call to manage any potential reactions. To safeguard against allergic episodes, children are also prescribed an Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan and an adrenaline injector. This careful, medically supervised process helps ensure the treatment’s safety while giving families the tools they need to manage peanut allergies in their everyday lives.

For general practitioners around Australia, this program represents a crucial new resource in helping infants with peanut allergies. GPs can now refer eligible infants to one of the participating hospitals, where capacity will be based on demand and available resources. With access to the ADAPT OIT Program, GPs will be able to offer families a treatment plan that could prevent lifelong peanut allergies, significantly reducing the risks of severe allergic reactions and improving long-term health outcomes. Information on referrals and eligibility can be found on the NACE ADAPT OIT Program webpage.

Peanut allergies, a leading cause of food-related emergency department visits, are becoming increasingly prevalent in Australia, which has been labelled an allergy capital of the world. This places an enormous strain on the healthcare system, with a rising number of hospital presentations for food-related allergic reactions. The ADAPT OIT Program seeks to reduce this burden by addressing peanut allergies early in life, before they develop into more severe or life-threatening conditions. 

Moreover, the program introduces a unified, nationwide approach to peanut allergy treatment, providing consistency and expertise across multiple paediatric hospitals. Unlike international programs, which vary in methodology and approach, the ADAPT OIT Program ensures that every family receives the same level of care, benefiting from a coordinated national strategy. The collaboration between allergists, researchers, and healthcare providers sets a new standard for allergy treatment in Australia, positioning the country as a leader in allergy management globally. This represents a significant leap forward in managing one of Australia’s most pressing health issues.

Soriano VX, Peters RL, Moreno-Betancur M, et al. Association Between Earlier Introduction of Peanut and Prevalence of Peanut Allergy in Infants in Australia. JAMA. 2022;328(1):48–56. doi:10.1001/jama.2022.9224