Avoiding Peanut Allergy with…Peanuts!
By: Amy Movius MD
Peanut allergy is quite common, affecting 1% to 3% of our population. Unfortunately, it is often severe and lifelong as well. Pretty much everyone has been affected in some way by peanut allergy. Obviously, those who are allergic are aware. The rest of us have likely been directly affected by knowing someone who has the allergy; or indirectly because of cautions distributed in classrooms, at parties or other gatherings warning against bringing any peanut containing products.
Historically, it was thought the best way to avoid getting a peanut allergy was to delay babies and young children from eating any peanut products. In 2000, guidelines to this effect were issued recommending zero peanut exposure in high risk children until they were over 3 years of age. In 2008, this was reconsidered since it did not appear to make any difference. Recently, however, very strong evidence was found that early peanut exposure greatly decreases the chances of developing allergy in those infants at highest risk for it!
It goes back to the LEAP trial (Learning Early About Peanut Allergy, for those interested) published in 2015. This study examined six hundred and forty babies, 4-11 months old, who had severe eczema or egg allergy – placing them at high risk for peanut allergy. They allergy tested the skin of all the infants to peanuts and removed those (76) who already had a severe allergic reaction. The babies who didn’t react at all and those who had a moderate reaction to peanut skin testing were split into 2 groups. One started receiving peanut products right away, the other not until 5 years of age.
Eating peanuts early decreased peanut allergy by 70% to 86 % in these high risk patients!
Or, to put it another way:
For babies with a negative skin test who ate peanuts, about 1/50 developed an allergy versus 1/8 for those who did not eat peanuts until age 5 years.
For babies with a positive skin test who ate peanuts, about 1/10 developed an allergy versus 1/3 for those who did not eat peanuts until age 5 years.
This dramatic finding has resulted in new interim guidelines that reflect these exciting results.
1. For the highest risk babies (severe eczema/egg allergy), parents should make a point of introducing peanut products between 4-6 months based on when they are developmentally able to handle more solid foods. It is advised to get some allergy testing, and if it’s positive to be referred to a specialist and to get their first “taste” under medical supervision.
2. For infants with mild to moderate eczema (increased risk, but not highest risk), introduce peanut products by 6 months of age. No need for testing or medical supervision.
3. For babies without specific allergic concerns, introduce as suits their family with other solid foods.
It’s important to emphasize that “introducing peanuts” does not mean actually feeding a baby peanuts – or peanut butter for that matter. Both of these are choking hazards! Rather, it usually means blending a small amount of peanut butter into some pureed fruit or vegetable. Your baby’s regular provider can discuss how to do this with you in detail.
Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics, 2105
New Guidelines Detail Use of “Infant-safe” Peanut to Prevent Allergy. AAP News, January 5, 2017>