We knew that delaying the introduction of high risk food allergens did not help reduce the incidence of food allergies. Instead, the prevalence of food allergies doubled during that time. Over the last 5 years, the guidelines changed and we recommended earlier introduction of all foods including the high risk food allergens- fish, shellfish, peanut, and tree nut. We were still unsure of how this recommendation would impact those who were at higher risk for developing a food allergen.
The new findings from the LEAP study indicate that even infants at high risk for peanut allergy can benefit from earlier introduction of peanuts- if sensitized, in a controlled setting and if not sensitized (skin test is negative), they often can be introduced at home. The concept is that oral exposure induces the development of T regulatory cells that help to balance our immune systems. Topical exposure can lead to sensitization and further food allergies.
I often emphasize that it is the eczema that contributes more to the development of food allergies than food allergies leading to an increase in eczema symptoms. However, every patient is an individual and the rules do not always apply to everyone.