Literature review for - Flourish Paediatrics

iii. Animal studies that have been reported since 1998 suggest that maternal oral exposure to the
hens’ egg allergen, ovalbumin, during gestation and/or lactation, particularly at high doses, may
protect offspring from developing allergic responses to this allergen. There are no comparable data
for peanut proteins in animals, or for humans, but the finding raises the possibility that maternal
dietary consumption of peanut might in some circumstances reduce the risk of peanut allergy in
offspring.
iv. Overall, the evidence now available does not indicate whether maternal dietary consumption of
peanut during pregnancy or lactation is more likely to increase or decrease the risk of sensitisation
and allergy to peanut in the child. An effect in either direction is possible, and it is possible that the
direction of effect could differ according to the level of intake. Alternatively, there could be no effect
at all.
v. Human data relating dietary consumption or avoidance of peanut or other allergenic foods in
childhood to the development of sensitisation or allergy or tolerance to peanust, are limited and
inconsistent. Data from animal studies suggest that, for peanut proteins and ovalbumin, the nature of
the immune response may depend on dose, with high exposures tending to induce tolerance and low
exposures sensitisation. However, there are no comparable published data for humans at this time.
69. The shift in the balance of evidence since 1998 is such that the Committee believes that the
previous precautionary advice to avoid peanut consumption during pregnancy, breastfeeding and
infancy, where there is atopy or atopic disease in family members, is no longer appropriate.
70. However, the Committee considers that the basis of the more general recommendations made in
1998 is still justified and, therefore, recommends that:
(i) In common with the advice given for all children, infants with a parent or sibling with an atopic
disease should be breastfed exclusively for around 6 months;
and,
(ii) Infants and children who are allergic to peanuts or peanut products, should not consume them or
foods that contain them; and also recommends that:
(iii) those who are allergic to peanut should seek advice from medical professionals about avoidance
strategies.
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