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Tuesday, February 24, 2015

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 early introduction.

And it gets better...

A newer study shows 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. Skin prick testing can be done to show if they are allergic before introducing peanuts. 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 is 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. Offer peanut products several times each week.
  • 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.
  • I'm waiting for the US food industry to start making baby peanut products... I'm sure they'll see money in it. The study from Israel mentioned above used Bamba. I'm waiting for those to enter our market!
  • Talk to your pediatrician with any questions!