Australia has the highest rates of childhood food allergies in the world, with peanut allergies alone affecting about three in every 100 children by one year of age.
It can create anxiety for the child and caregivers, as the risk of a life-threatening allergic reaction (known as anaphylaxis) makes it critical to avoid the allergen or ensure quick treatment.
On Wednesday, the federal government announced it is funding a nationwide treatment program called Adapt that will see babies under 12 months with peanut allergies fed daily doses of peanut powder. Advice for carers of children with food allergies is to avoid the allergen completely.
The babies in the program will be carefully monitored by allergists and researchers emphasise exposure therapy must not be attempted if children are not participating in the trial.
Paediatric allergist and the leader of the program, Prof Kirsten Perrett, spoke to Guardian Australia about how treatments for childhood peanut allergies are developing.
Why are researchers exposing babies to their trigger?
Perrett, who is also the director at Murdoch Children’s Research Institute’s National Allergy Centre of Excellence, said a child’s immune system rapidly develops during their first years.
Previous research has found gradual inclusion of peanut powder in the diets of children aged between one and three (known as oral immunotherapy) led to most becoming less allergic.
One-fifth went into remission, which is defined as being able to eat 1.5 tablespoons of peanut butter without a reaction, six months after completing the treatment.
Perrett said the younger the child, the more likely they seemed to be to go into remission. That is why for Adapt, which makes exposure therapy mainstream, “we aim to get that treatment started as soon as the diagnosis is made, so that we can really have the best chance of changing the trajectory for that child”.
“This must be done in a medically supervised program under the care of a hospital allergy team … if it’s not done under carefully planned dosing schedule, there are risks and that includes anaphylaxis.”
Are there ways to prevent food allergies?
Australian infant guidelines recommend babies, including those at high risk of allergy, be introduced to common allergens such as peanut butter, well-cooked eggs, dairy and wheat products about twice a week, before they’re 12 months old.
Pregnant women should also eat these foods and continue to eat them while breastfeeding, unless they are allergic to them.
It is not known what quantities of foods such as peanut butter or eggs should be ingested during pregnancy to protect the baby, but Associate Prof Debbie Palmer, of the Telethon Kids Institute, is conducting a study into this.
Perrett said if a parent is allergic to certain foods, a carer who is not allergic can introduce those foods to the infant when appropriate.
Why are childhood allergy rates in Australia so high?
There is growing evidence of increasing food allergies in several countries, but Australia has among the highest rates and the highest childhood food allergy rates.
Research is ongoing as to why, including whether changing environmental factors, evolving diets, types of infections people are exposed to in childhood, less exposure to helpful bacterias due to sanitisation, or certain vitamin deficiencies are involved.
“We’ve certainly identified with our research several risk factors for allergy, so we know that the infant diet and delayed introduction of cooked egg and peanut can result in increased risk of those food allergies,” Perrett said.
“We know people have decreased risk of food allergy if they have a dog that is allowed inside the house, or if they live rurally.
“There are lots of other environmental factors related to our modern lifestyle that may be contributing to the increased risk of food allergy in Australia, and we’ve got research under way investigating the role of things like hygiene practices, sun exposure, lack of routine vitamin D supplementation and exposure to other environmental stimuli.”
How can I get my child involved in a study?
Allergist and program lead at the Children’s hospital at Westmead, Dr Lara Ford, said: “One of the biggest concerns for families living with peanut allergy is the fear of accidental exposure. This program has the potential to remove that burden.”
However, the program, which is free, may not be suitable for all children. Eligible babies will be referred into Adapt by their allergist from one of the 10 children’s hospitals involved.
The hope is more hospitals and private allergy clinics will adopt the program.
The National Allergy Centre of Excellence also hosts an Allergy Studies Directory that lists the trials and cohort studies currently recruiting and under way.
The centre also launched a Clinical Trials Network earlier in 2024 to fast-track new trials and improve access to the latest prevention options and treatments.
