For years pediatricians told parents to avoid peanuts for the first years of life to help prevent peanut allergies. Now we know that earlier introduction of peanut products can help prevent peanut allergy.
New studies to prevent peanut allergy
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 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. I had preached caution for 10 years in practice to wait until after 2-3 years of age. Not only was it an allergy risk (we thought), 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…
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. They should also carry an epinephrine device at all times to use in case of accidental exposure.
But if they aren’t 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 in those who were sensitized to peanut at the beginning of the study.
In the study one group ate a peanut-containing snack at least three times a week while the other group didn’t eat any foods with peanut. By 5 years of age, 3% of the children who ate the snack developed peanut allergy compared to 17% in the avoidance group.
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.
No more living in fear?
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. They must avoid foods that cannot be served at school and be aware of risks to others when serving peanuts.
This new research showing that there’s a way to prevent this potentially deadly allergy is very exciting!
Take away points:
High risk Infants
Infants are considered high risk if they have moderate to severe eczema, egg allergy, or family history of peanut allergy.
If this is the case, talk to your pediatrician before your baby starts peanuts. Consider visiting an allergist after the 2 or 4 month well visit. It may be recommended to start peanut products in a controlled setting as early as 4-6 months of age.
Low risk infants
If there are no risk factors for peanut allergy, it’s okay to begin peanut products when other foods are introduced. These may include peanut flour, thin peanut butter, or peanut butter in baked goods.
Offer peanut products several times each week after initial introduction.
Do not give any texture of food that increases choking risk to your baby. These include 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!
My blog on Introducing peanuts