Peanut allergy symptoms is a hot topic among parents, and a recent study made headlines with its finding that early introduction of peanuts may help prevent the development of peanut allergy among at-risk children. This finding calls into question the advice many parents have received over the past 10-20 years to avoid highly allergenic foods during pregnancy, nursing and infancy, especially for children considered at high risk of developing allergies.
What was the new study about and what does it mean for you?
The Learning Early About Peanut Allergy (LEAP) Study: Inspired in part by the observation that children in countries where peanut is routinely introduced early (e.g., Israel) tend to have fewer allergies than those in countries where peanut introduction tends to be delayed (e.g., the U.S. and U.K.), researchers studied a group of 4-11 month old infants considered at high risk for developing a peanut allergy. After excluding any infants already allergic to peanuts, the researchers assigned half of the 600 infants to regularly consume peanut products (in specific doses on a set schedule) and half to avoid such products. By age 5, far fewer of the exposed children (3%) had developed a peanut allergy than the avoiding children (17%). Due to the high quality of the study, the findings are being hailed as a groundbreaking step in understanding food allergies and their prevention. It is important to note, however, that some children in both groups did develop allergies, demonstrating that while the controlled exposure to peanuts reduced the likelihood of developing a peanut allergy among these high-risk children, it was not a guarantee of avoiding such an allergy. So, does this mean that parents should start feeding their infants peanut butter at home? Not necessarily. First, consider your risk factors and speak with your child’s doctor.
Low risk infants: If your infant does not have any risk factors for developing peanut allergy, such as other allergies, eczema, or a family history of allergies, then the latest recommendation from the American Academy of Pediatrics (AAP) do not call for delaying the introduction of allergenic foods beyond 4-6 months of age, reflecting a 2008 change in policy from the prior recommendations to avoid such foods. Although the current study did not directly assess low-risk infants, it does lend support to the notion that early introductions of peanuts to low-risk infants in unlikely to be harmful and may even be beneficial. You should discuss these results with your child’s doctor when your baby is ready to begin eating solid foods and ask about the best ways to introduce peanuts to your low-risk child. It is important to note that separate from allergy concerns, young children should never be fed whole peanuts or large globs of peanut butter due to the choking risk.
Higher-risk infants: If your infant has any known allergies, eczema, or there is a family history of any allergic condition (not just peanut or food allergies), then you may be wise to have him or her tested for peanut allergy. In the New England Journal of Medicine editorial accompanying the report from the LEAP study, Drs. Rebecca S. Gruchalla and Hugh A. Sampson recommend that any infant between 4 and 8 months old who is at risk for developing a peanut allergy be tested for this allergy. If not allergic, they state that the child “should be started on a diet that includes 2g of peanut protein at least 3 times a week for at least 3 years”, and suggested that official guidelines for introducing allergenic foods would be revised soon to reflect the new study results. Talk to your child’s doctor to discuss allergy testing and ensure that this recommendation is appropriate for your specific child.
Allergic children: It is important for parents to understand that this study does not offer any information on curing a peanut allergy in a child who is already allergic. Individuals with peanut allergies should absolutely not attempt to cure their allergies on their own by consuming peanuts in any amount. Nor should you feel that this new study means that you caused your child’s peanut allergy. For parents of children who are already allergic to peanuts, the question shifts from how to prevent peanut allergy to how to manage it. Guidelines from the Food Allergy Research Network (FARE) focus primarily on preventing exposure and remaining prepared to treat a reaction. Several promising treatments for peanut allergy are being studied, but are not yet FDA approved or widely available. In the meantime, parents whose children are allergic to peanuts must be vigilant about avoiding exposure, as even a trace amount of peanut protein can cause a serious reaction. Reactions can range from hives or mild itching to anaphylaxis, a systemic reaction that is life threatening and requires emergency medical intervention. Even those who have previously had only mild reactions can have a severe one at any time. Parents of peanut-allergic children should work to:
- Prevent exposure by reading labels carefully and avoiding foods with even trace amounts of peanut protein.
- Ensure that anyone who cares for your child knows how to recognize the symptoms of an allergic reaction, especially anaphylaxis.
- Always have emergency medications available, including epinephrine, which is the first-line treatment for anaphylaxis. Ensure that anyone who cares for your child has access to this medication and knows when and how to administer it. Always contact emergency personnel (i.e., call 911) for follow-up care after a reaction requiring epinephrine.
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