At Mission MightyMe, we believe in advocating and educating for food allergy awareness all year long (after all, we’re on a BIG mission to end the food allergy epidemic – that doesn’t happen overnight!). With May marking Food Allergy Awareness Month, we’re shouting a little louder this time of year and we want to take a moment to look back at one of the biggest discoveries in the world of food allergies and the doctor who led the charge, our very own co-founder and world-renowned food allergy prevention expert (plus, a dad himself), Dr. Gideon Lack. 

With his groundbreaking research, Dr. Lack and his research team have made a *major* contribution to children’s health that’s hard to overstate: discovering that food allergy prevention is possible, which forever changed the health trajectory of future generations. Let’s take a look back at how his work has altered how we think about prevention and changed feeding guidelines globally — all while helping kids and their families avoid the lifelong burden of food allergies along the way.

The lightbulb moment

It all began more than two decades ago, when Dr. Lack gave a lecture to a group of approximately 200 pediatricians and allergists in Tel Aviv. He was speaking on the topic of peanut allergy, which was a growing issue in the UK and U.S. After asking the audience how many had seen a child with peanut allergy in the last year, he was shocked when only two or three Israeli doctors raised their hands. He soon learned that, almost universally, babies in Israel were being fed peanut puffs early in the first year of life. Dr. Lack had observed a similar correlation in his early experiences as a research fellow, when he’d learned that the early feeding of foods such as egg, milk and peanut to young mice prevented the development of food allergies (known as oral tolerance induction).

The Israeli practice was at odds with the UK and U.S. guidelines at the time, which actually recommended that babies avoid peanuts and other allergens early on in life. At that moment, Dr. Lack had a strong hunch that perhaps the advice to avoid peanut foods was not only incorrect – it was unintentionally contributing to the rise in food allergies. But he needed more evidence to make his case. Dr. Lack and his colleagues launched an observational study to quantify the difference in peanut allergy rates in the UK where peanuts were avoided in infancy versus Israel, where peanut puffs were a common first food for babies. The results were dramatic: Jewish babies in the UK had *TEN TIMES* the rate of peanut allergy as babies of similar genetic ancestry living in Israel. The next question Dr. Lack needed to answer: why? His hunch was that the differences in feeding practices was the key. 

The LEAP Study – and how it changed everything

Dr. Lack and his colleagues soon started working on the landmark LEAP Study (Learning Early About Peanut Allergy), supported by the National Institutes of Health and the Immune Tolerance Network. The team enrolled 640 babies 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 for the first five years of life. Dr. Lack had expected to see a modest reduction in peanut allergy. It turned out to be much more: when the children turned 5 years old and the results of the clinical trial were unblinded, the rate of peanut allergy in the babies consuming peanut foods was up to 86% lower than the avoidance group. Said differently, avoiding peanut foods increased the risk of developing a peanut allergy five-fold.

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. As a direct result of Dr. Lack’s groundbreaking findings, pediatric feeding guidelines (including the American Academy of Pediatrics, NIH/NIAID and USDA) have since changed around the globe to encourage early allergen introduction and regular consumption, starting in infancy, especially for peanut foods. 

The food allergy prevention research continues

Thanks to his work on the LEAP Study, Dr. Lack was awarded the prestigious David Sackett Trial of the Year Award for “a randomized clinical trial that improves the lot of humankind.” But Dr. Lack didn’t stop there. His impressive body of research work continued marching along after the LEAP Study and has continued to provide key insights around the science of food allergy prevention. Here’s a helpful overview of what each study showed, and why the results – especially digested as a whole – matter:

• LEAP (2015)

A large-scale clinical trial, led by Dr. Lack, that found sustained peanut consumption in high-risk infants starting between 4-11 months until age 5 reduced the rate of peanut allergy by up to 86%.

• LEAP-ON (2016)

A follow-up study by Dr. Lack demonstrated that the peanut allergy prevention results achieved in the LEAP Study from early and consistent peanut consumption until age 5 persist even after peanuts were then avoided for one year.

• EAT (2016)

This study by Dr. Lack looked at 1,300 babies with no risk factors who were given 6 allergens (peanut, egg, milk, white fish, sesame and wheat) from 3-6 months of age until age 3. Demonstrated a 67% reduction in egg allergy and a 100% reduction in peanut allergy in children who consumed sufficient amounts of these foods.

• Meta-Analysis of LEAP and EAT studies (2023)

In 2023, new studies published in the Journal of Allergy and Clinical Immunology and the European Journal of Allergy and Clinical Immunology took that research a step further: the meta-analysis showed that early peanut introduction in a mainstream population is not only highly effective at preventing peanut allergies, but also crucial to bringing down the overall rate of peanut allergies in the general population. The studies modeled data from 1,943 children in a meta-analysis from the Enquiring About Tolerance (EAT Study), which focused on a low-risk population, and the LEAP Study, which focused on a high-risk population. There were several important takeaways:

• Early peanut introduction is beneficial for all babies regardless of risk factors

• The earlier, the better (once a baby is ready for solids)

• Early peanut introduction is protective for all ethnicities

• To maximize the prevention of peanut allergy in the population, all infants should start eating peanut foods by 6 months of life; infants with eczema, especially severe eczema, should start as early as 4 months of age. 

• Early introduction for just high-risk infants only reduced the overall burden of peanut allergy by 4.6 percent, whereas early introduction for ALL infants reduced the burden by 77 percent.

You can read more here. Overall, the great news from the study was that early peanut introduction is protective for all babies.

• LEAP-Trio (2024)

The LEAP-Trio, confirmed that there is a long-term protective effect to early and regular peanut consumption. It became the first study to establish long-term oral tolerance as a protective strategy against peanut allergy, and provides conclusive evidence that starting babies on peanut foods early and keeping them in the diet regularly until age five achieves long-term peanut allergy prevention through adolescence – even without continued consumption of peanuts beyond five years of age. Dr. Lack and his team followed the original LEAP participants until age 12 and older. The study found that children who consumed peanuts early and regularly for the first five years of life had a 71% reduction in peanut allergies in adolescence compared to the avoidance group, even if peanut foods were avoided after age five.

Latest feeding guidelines and potential long-term impacts 

As a direct result of Dr. Lack’s seminal research, today, leading health organizations recommend introducing peanuts and other common food allergens early and often, once a baby starts solid foods. Here’s a summary refresher on the some of the latest advice:

• 2017 National Institute of Allergy and Infectious Diseases (NIAID/NIH): Based on the strength of the LEAP findings, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), worked with 25 professional organizations, federal agencies, and patient advocacy groups to develop clinical practice guidelines to address the prevention of peanut allergy. The resulting guidelines state: 

• “If your infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), he or she should have peanut-containing foods introduced into the diet as early as 4 to 6 months of age. This will reduce the risk of developing peanut allergy.”

• “If your infant has mild to moderate eczema, he or she may have peanut containing foods introduced into the diet around 6 months of age to reduce the risk of developing peanut allergy.”

• “If your infant has no eczema or any food allergy, you can freely introduce peanut-containing foods into his or her diet. This can be done at home in an age-appropriate manner together with other solid foods, keeping in mind your family’s dietary routines and preferences.”

• 2019 American Academy of Pediatrics (AAP): The AAP endorsed the above guidelines and three-pronged approach based on risk factors from NIAID’s expert panel, recommending the introduction of infant-safe forms of peanuts to infants, on the basis of the level of risk for peanut allergy and the results of the LEAP trial.

• 2020 United States Department of Agriculture (USDA): The Dietary Guidelines for Americans, 2020-2025, states: “Potentially allergenic foods (e.g., peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy) should be introduced when other complementary foods are introduced to an infant’s diet. Introducing peanut-containing foods in the first year reduces the risk that an infant will develop a food allergy to peanuts.” It also notes: “If an infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), age-appropriate, peanut containing foods should be introduced into the diet as early as age 4 to 6 months. This will reduce the risk of developing peanut allergy.”

• 2020 Leading Allergy Organizations (AAAAI, ACAAI, CSACI): The leading allergy organizations in the U.S. and Canada released a consensus statement, "To prevent peanut and egg allergy, introduce peanut and egg to all infants, starting around 6 months of life. Other allergens should be introduced around this time as well. Once introduced, regular ingestion should be maintained."  

• 2021 Food and Drug Administration (FDA): The FDA issued a rare authorized health claim that reads, "For babies with an increased risk of peanut allergy (babies with severe eczema, egg allergy or both), introducing age-appropriate, peanut-containing foods as early as 4 months may reduce the risk of developing a peanut allergy. Caregivers should check with the baby’s healthcare provider before feeding the baby peanut-containing foods."

Let’s take a moment to stop and understand the potential real-world impact here: if these latest pediatric feeding guidelines – to introduce peanuts early and often – are fully implemented on a global scale, we could potentially prevent more than 100,000 new cases of peanut allergy worldwide every year. That's a whopping *one million children* who could be spared from the burden of peanut allergies in just a decade.

Brush up more in-depth on the latest clinical guidelines, linked all in one place, here.

So, what do we know now?

We know…that was a lot of info to take in! So what does it all mean? Here’s a quick recap of what we know and where we stand:

• Food allergies among children have doubled and nut allergies in particular have tripled in the last two decades. Experts believe outdated advice that recommended avoiding those foods in infancy may be partially to blame.

• Babies aren’t born with food allergies. They develop over time.

• Dr. Lack’s research has shown that the majority of peanut allergies are preventable with early peanut introduction and consistent consumption until age 5.

• Plus, early peanut introduction is protective for all babies – which means if peanut allergy guidelines are successfully implemented across the entire population, we have the potential to nearly eliminate peanut allergies in the future!

• The latest: there is a confirmed long-term protective effect to early and regular peanut consumption that endures through adolescence. 

• Based on Dr. Lack and his team's research, feeding guidelines globally have changed to recommend early and regular allergen introduction, especially peanut foods, once babies start solids.*

THANK YOU, Dr. Lack!

This Food Allergy Awareness Month, we want to express our immense gratitude and appreciation for the truly revolutionary and trailblazing research contributions of Dr. Lack and his colleagues and research teams over the years. With his invaluable expertise, he’s also helped us here at Mission MightyMe perfect the first and only pediatrician-developed puffs made with peanuts and multiple tree nuts in sufficient quantities, making it deliciously simple for parents to include a wide variety of nuts in their children's diets early and often. We're incredibly grateful to Dr. Lack for his impact on children's health, and we're not alone. 

“Dr. Gideon Lack is someone who I think can confidently say that work he’s done has changed, and saved, lives.” -Emily Oster, Parenting Economist & ParentData Host

“The [LEAP study] results have the potential to transform how we approach food allergy prevention … we’re talking about saving thousands and thousands of kids from peanut allergies.” -Dr. Anthony Fauci, former NIAID Director

“[Your] fantastic and extraordinary pioneering LEAP Study has changed guidelines in the UK and also in the US – which is very rare to have a scientist sitting here actually make a public health change in the guidelines.” -Sarah Ann Macklin, host of Live Well, Be Well podcast

“It is about helping these kids grow strong, grow mighty … I can tell you are on a mission when it comes to food allergy prevention and to really changing what we’re seeing in the medical community, and the impact and burden it has on families and also on our healthcare system in general.”  -Dr. Whitney Casares, host of Blueberry Pediatrics podcast

Dr. Lack’s work has positively changed lives and forever altered the landscape of the food allergy prevention field – We are grateful and we can’t wait to see what he uncovers next.