title: Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy.
abstract: BACKGROUND
  Despite guidelines recommending avoidance of peanuts during infancy in the United Kingdom (UK), Australia, and, until recently, North America, peanut allergy (PA) continues to increase in these countries.
  
  
  OBJECTIVE
  We sought to determine the prevalence of PA among Israeli and UK Jewish children and evaluate the relationship of PA to infant and maternal peanut consumption.
  
  
  METHODS
  A clinically validated questionnaire determined the prevalence of PA among Jewish schoolchildren (5171 in the UK and 5615 in Israel). A second validated questionnaire assessed peanut consumption and weaning in Jewish infants (77 in the UK and 99 in Israel).
  
  
  RESULTS
  The prevalence of PA in the UK was 1.85%, and the prevalence in Israel was 0.17% (P < .001). Despite accounting for atopy, the adjusted risk ratio for PA between countries was 9.8 (95% CI, 3.1-30.5) in primary school children. Peanut is introduced earlier and is eaten more frequently and in larger quantities in Israel than in the UK. The median monthly consumption of peanut in Israeli infants aged 8 to 14 months is 7.1 g of peanut protein, and it is 0 g in the UK (P < .001). The median number of times peanut is eaten per month was 8 in Israel and 0 in the UK (P < .0001).
  
  
  CONCLUSIONS
  We demonstrate that Jewish children in the UK have a prevalence of PA that is 10-fold higher than that of Jewish children in Israel. This difference is not accounted for by differences in atopy, social class, genetic background, or peanut allergenicity. Israeli infants consume peanut in high quantities in the first year of life, whereas UK infants avoid peanuts. These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of PA.
authors.affiliation: King's College London, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Du Toit
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Katz
authors.forename: Peter
authors.initials: P
authors.lastname: Sasieni
authors.forename: David
authors.initials: D
authors.lastname: Mesher
authors.forename: Soheila J
authors.initials: SJ
authors.lastname: Maleki
authors.forename: Helen R
authors.initials: HR
authors.lastname: Fisher
authors.forename: Adam T
authors.initials: AT
authors.lastname: Fox
authors.forename: Victor
authors.initials: V
authors.lastname: Turcanu
authors.forename: Tal
authors.initials: T
authors.lastname: Amir
authors.forename: Galia
authors.initials: G
authors.lastname: Zadik-Mnuhin
authors.forename: Adi
authors.initials: A
authors.lastname: Cohen
authors.forename: Irit
authors.initials: I
authors.lastname: Livne
authors.forename: Gideon
authors.initials: G
authors.lastname: Lack
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D010367:Arachis / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004435:Eating / Q000276:immunology; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D021183:Peanut Hypersensitivity / Q000453:epidemiology / Q000276:immunology*; D011247:Pregnancy; D015995:Prevalence; D011795:Surveys and Questionnaires; D006113:United Kingdom