Peanut allergy prevention

For years pediatricians told parents to avoid peanuts for the first years of life to help prevent peanut allergies. 

It appears we were wrong.

Studies for the past several years have supported giving infants peanut products as early as 4 months of age as long as there was no increased risk of allergy to peanuts. This seemed to help prevent them from becoming allergic to peanuts.

I know I was nervous for at least a year every time I told parents it was okay to start peanut products during that first year of life since I had preached caution for 10 years in practice. Not only was it an allergy risk, but also a choking risk for infants.

In the years that I’ve recommended it, I do think the number of kids I see with peanut allergy has dropped and I haven’t heard of any problems with cautious early introduction.

And it gets better…

Several studies now show that even in children at high risk for peanut allergy, giving peanut products starting at 4 months might prevent them from developing allergy.

Of course if there is a family history of peanut allergy or if the child has significant eczema or egg allergy, parents should use caution and talk with their pediatrician to see if skin prick testing should be done before starting peanut products.

If they are allergic, they must avoid peanuts and carry an epinephrine device at all times in case of accidental exposure until they are desensitized and given clearance by an allergist.

But if they aren’t yet allergic, giving peanut product regularly seems to prevent the allergy from developing in 86% of the high risk children by age 5 years. They even show a 70% reduction in peanut allergy among those who were sensitized to peanut (positive skin prick test) at the beginning of the study.

In the study a group of children ate a peanut-containing snack at least three times a week while the other group did not eat any foods containing peanut. By the age of 5, just 3% of the children who ate the snack developed peanut allergy, while 17% in the avoidance group developed peanut allergy. Future studies will be done with those children who were high risk but without allergy to peanuts stop the peanuts for a year to see if they develop allergies later in childhood.

Families of allergic children live in fear of accidental exposure and must change lifestyles to prevent deadly exposures. It can even be difficult for families without allergic children because they must avoid a list of foods that cannot be served at school parties. This new research showing that there’s a way to prevent this potentially deadly allergy is very exciting!

Take away points:
  • If your child is high risk of having a peanut allergy due to moderate to severe eczema, egg allergy, or family history of peanut allergy, talk to your pediatrician before your baby starts peanuts to decide if allergy testing is recommended.
  • If there are no risk factors for peanut allergy, it’s okay to begin peanut products (such as peanut flour, thin peanut butter, peanut butter in baked goods) when other foods are introduced, between 4 and 6 months of age. (The AAP recommends exclusive breastfeeding until 6 months, so talk with your pediatrician about timing of food introduction in general.)
  • Offer peanut products several times each week after initial introduction.
  • Do not give any texture of food that increases choking risk to your baby, such as a thick layer of peanut butter or hard nuts.
  • The study from Israel mentioned above used Bamba. I finally bought some at Trader Joes last weekend. They’re great!
  • Talk to your pediatrician with any questions!

for more information:

Guidelines for diagnosis and management of food allergies

Addendum to the Guidelines (Jan 2017) This includes a great flow chart!

Instructions for home feeding of peanut protein for infants at lower risk of an allergic reaction to peanut

My blog on Introducing peanuts

Share Quest for Health

Introducing Peanuts

For years I’ve been recommending peanut products to infants who are low risk for peanut allergy due to growing evidence that it’s beneficial.

Studies have highlighted the benefit of early introduction of peanut product decreasing peanut allergy risk, so more parents are wanting to know exactly how to give a baby peanut products without increasing the choking risk.

bamba, peanut
Bamba’s a popular snack in many areas of the world. Photo source: Wikimedia

The study above was done using a product similar to Cheetos, made with peanut butter instead of cheese. Bamba is a snack food that has been sold in Israel for many years is now available in the US.

Parents can of course give a product like this, but what else can you do on a regular basis once your baby’s doctor clears him for peanuts?

Be careful of choking risks!

It’s important that your baby doesn’t get too much peanut butter or a chunk of nut itself because these are choking risks, so a nice thick slab of peanut butter just won’t work.

peanut allergy, feeding infantsSome ideas for introducing peanut products:
  • Look for peanut butter that doesn’t have added sugar – babies don’t need the sugar! I like the peanut powders that are available now, but I don’t think you need to spend the extra cash on the ones made just for babies.
  • Most kids love Cheerios (or other brand oat circle cereal). They do make a peanut butter flavor, made with real peanut butter. Again, look at labels to avoid cereals with high sugar content.
  • Add peanut butter powder or peanut butter to oatmeal – check the texture to be sure it isn’t too thick for your baby, add water, breast milk, or formula to thin it as needed.
  • Add peanut butter  or peanut butter powder to applesauce (or other pureed fruits).
  • Add peanut butter or peanut butter powder to yogurt.
  • Make a peanut butter smoothie. There are many recipes online, but be sure yours doesn’t have honey if baby is under 12 months! If the recipe calls for milk, use your breast milk or formula for infants. Find one that is made with real foods, such as banana + milk + peanut butter. Babies don’t need chocolate or added sugars. If your baby doesn’t like it cold, use water instead of ice and don’t use frozen fruits.
  • Offer an occasional treat with peanut butter cookies. I like this recipe because it doesn’t have added sugar. You can leave out the raisins if your baby would choke on that texture.
  • Another occasional treat would be peanut butter muffins. Look for one without too much sugar and no honey. I couldn’t find one without any added sugar — if you do, please share below!
  • Put a thin layer of peanut butter on bread, cracker, or even your finger. You can add a little water to the peanut butter to thin it out if needed.
  • Chinese chicken with peanut sauce and other foods made with peanut butter sauces can be a treat for babies who can eat solid foods. The whole family can enjoy these meals!

Once you start peanut products, give the equivalent of 1 teaspoon peanut butter three times a week to help prevent peanut allergy!

Share your favorite recipes that can be adapted for babies and toddlers below.

related blog:

Peanut Allergy Prevention

Share Quest for Health