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Dr. Gideon Lack’s Lightbulb Moment

Dr. Lack’s Lightbulb Moment

By Dr. Gideon Lack, Head of The Department of Pediatric Allergy, Kings College, London & Lead Author of the LEAP Study

Eighteen years ago, I gave a lecture to a group of approximately 200 pediatricians and allergists in Tel Aviv. I had been asked to speak about peanut allergy, as there were a growing number of reports that this problem was on the rise in the UK and USA. I asked the audience for a show of hands as to how many of the doctors had seen a child with peanut allergy in the last year. To my great astonishment, only two or three Israeli doctors raised their hands in the entire audience.  After delivering the lecture, I spoke with my Israeli colleagues and parents of young children, who told me that almost universally, babies in Israel were being fed peanut snacks, early in the first year of life. I immediately connected this observation with my early experiences as a research fellow, when I learned that the early feeding of foods such as egg, milk and peanut to young mice, prevented the development of food allergies. This important phenomenon was called oral tolerance induction.   

The other possible explanation for the low rate of peanut allergy in Israel was genetic differences. However, I was aware that Jewish children in London who shared the same ancestral heritage as Israeli children, were developing peanut allergy in the UK. In order to confirm this hunch and exclude the possibility of a genetic explanation, we therefore launched a comparative study of approximately 5,000 Jewish children in each country. We found that the rate of peanut allergy in the UK children was 10-fold higher than in Israel.

Israeli infants were eating approximately 1.7 grams of peanut protein per week, starting very early in the first year of life, whereas in the UK (like the U.S.), the vast majority of babies were eating no peanut. The Israeli practice was at odds with the UK and USA guidelines at the time, recommending that babies avoid peanuts early on in life. It was at that moment that I realized that maybe our advice to prevent peanut allergy was not only incorrect, but was unintentionally contributing to the rise in food allergies.

However, these observations did not amount to concrete evidence that could lead to a change in policy. I therefore conducted the LEAP Study (Learning Early About Peanut allergy) with my colleagues, which was supported by the National Institutes of Health and the Immune Tolerance Network. We enrolled 640 children ages 4-11 months, who were at high risk of developing peanut allergy due to severe eczema or an existing egg allergy. Half of them were randomly allocated to eat peanut-containing foods, and half were asked to completely avoid peanuts. We hoped to see a modest reduction in peanut allergy and were delighted that when the children turned five years of age, we had reduced the rate of peanut allergy in the babies consuming peanut snacks by more than 80%. This Randomized Controlled Trial confirmed the hypothesis that early introduction of peanuts would prevent peanut allergy, and that the previous avoidance strategy adopted in many countries was incorrect and possibly contributing to the problem.

Based on the new research, the avoidance guidelines have changed in many countries to encourage early peanut introduction. That has fueled a need for products that make early introduction easy, like Mission MightyMe. I hope this change will lead to a significant reduction in the rate of peanut allergies and save many children from the burden of living with a food allergy.