Peanut allergies can be terrifying, especially for new parents. When is the best time to introduce these foods that may carry with them a trip to the emergency room or worse?
For a while, the conventional wisdom was to hold off on introducing peanuts for fear of young children developing peanut allergies. If the food was introduced later, the logic went, the allergic reaction could be less severe, or might not even manifest at all maybe not at all. And no parent wants to put their children at risk, but especially not their infants.
However, a variety of different studies over the last several years have caused many allergy- and child-focused health and safety organizations and agencies to rethink that philosophy. Based on evidence from theses studies, groups like the National Institute of Allergy and Infectious Diseases (NIAID) and the American Academy of Pediatricians (AAP) have determined that early introduction of peanuts and peanut-containing products (like peanut butter) is actually better!
The Evidence for Early Peanut Introduction
The old guidelines encouraged parents to feed breastmilk or formula to their infants for the first six months of life. Potential food allergens should be started later, such as cow’s milk at one year old, eggs at two years old, and nuts and seafood at three years old. In addition, mothers were instructed to avoid major allergenic foods during pregnancy and lactation.
These now outdated guidelines were based off a series of studies that found avoiding such foods could decrease allergen sensitivity during the first year of life. However, as it turned out, this decrease in sensitivity was only temporary. As children began to grow up under the old guidelines, doctors and researchers began to notice that delaying the introduction of allergens actually caused higher rates of allergies than introducing them early on.
Given the increasing incidence of peanut allergies in recent years, studies were undertaken in Germany, the United Kingdom, and other countries to try and determine the best course of action. Comparing the studies across various countries, researchers discovered that in countries where peanuts were consumed at an early age, such as Israel, children had a much lower incidence of peanut allergy than in countries where peanuts were not eaten by young children, such as the U.K. The lower prevalence in countries like Israel was credited to the early introduction and regular consumption of peanuts by both the mother and the child.
The most significant study in recent years is known as the Learning Early About Peanut Allergies (LEAP) study. Published in 2015, the study looked at 640 high-risk infants in the United Kingdom and compared the results of giving some infants a high dose of peanut protein in the first 4 – 11 months versus avoiding peanuts altogether. Researchers followed the children for five years and found that 35.3% of the children in the avoidance group had a peanut allergy, while only 10.6% of the high-dose group had a peanut allergy.
Understanding the New Peanut Allergy Guidelines
The updated peanut allergy guidelines, which are issued by NIAID based on input from AAP and other organizations, are much simpler. For one thing, mothers no longer need to avoid peanuts during pregnancy and lactation (unless, of course, they are allergic themselves).
For infants, the guidelines are divided into three groups based on risk of developing an allergy:
- High Risk: Infants are considered high risk for a peanut allergy if they have severe eczema and/or an allergy to eggs. When the child is between 4 and 6 months old, parents should consult with an allergy specialist, who can perform a skin test and may introduce the first peanut protein in the doctor’s office. Even if the infant shows a sensitivity to peanuts, parents can introduce peanuts and peanut-containing foods into their diets, so long as the baby is eating solid foods.
- Moderate Risk: Moderate risk infants have moderate eczema. Peanuts can be introduced at home at about six months, so long as they are eating solid foods. There is no need for a specialist or introducing the peanuts in an office setting.
- Low Risk: Low-risk infants do not have eczema or an egg allergy. They can start eating peanut protein at around 6 months of age, so long as they are already eating solid foods.
So far, only the guideline for introducing peanuts early have been updated. As more scientific evidence for the early introduction of food allergens appears, these guidelines may be expanded to other foods. For now, however, parents should continue to follow their pediatricians’ advice about when it is safe to introduce food allergies to their children.