Pediatric Associates of Richmond

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Peanut Allergies

Recent reports regarding food allergies may leave some parents confused.  A study recently published in the New England Journal of Medicine (www.nejm.org/doi/full/10.1056/NEJMoa1414850) caught both our attention and the attention of the media.

It was noted that the incidence of peanut allergies has been on the increase over the last 10 years. Researchers had found that the risk of developing peanut allergy among Jewish children growing up in the UK was 10 times greater than Jewish children growing up in Israel.  The noted difference between these two groups was the fact that in Israel, children were introduced to peanut in the diet at an early age, while in the UK, peanuts were avoided until later in life.  This left an important question, could the early introduction of peanuts in the diet actually protect against developing a peanut allergy later?  In this study, titled” Learning Early About Peanut Allergies (LEAP)” researchers set out to examine the risk of developing peanut allergies in a group of over 600 infants ages 4 to 11 months, in order to determine a strategy for the prevention of peanut allergies.

The infants studied were considered to be at high risk for developing a peanut allergy as they had been previously diagnosed with severe egg allergies or severe eczema.   The infants were randomly put into one of two groups; one group was fed either soft peanut snacks or peanut spread at least 3 times weekly until age 5, and the other group avoided peanuts and peanut products.  The results were very interesting.  Among the 530 infants completing the study, peanut allergy was found in 13.7% of the group that avoided peanuts vs. only 1.9% of infants in the group that was fed peanut from an early age.  Therefore, the study authors concluded that the early introduction of peanuts significantly decreased the frequency of development of peanut allergy.

As you may remember, the American Academy of Pediatrics previously recommended avoidance of peanuts and peanut containing products until age three years.  By 2008, it was recognized that this strategy was having no impact on the increasing rate of peanut allergy, so the recommendation was dropped.  The above study may provide one piece of evidence to this confusing picture, but it doesn’t answer all questions regarding peanut or other food allergies.

So, what does this study mean for your family?  Until we have more evidence, we must proceed with some caution.  If your child has ever had any reaction to peanut, such as a rash or vomiting, we recommend that child continue to AVOID peanuts and peanut containing products.  Additionally, if your child has a history of other food allergies or eczema, it is suggested that you do not introduce peanut unless you discuss it with your doctors first.  In the study cited above, all children were skin tested for sensitivity to peanut before any peanuts were offered.  In this higher risk situation, that may be a good first step, and we would refer you to an Allergist for that.  If your child has a strong family history of food allergies, we may also recommend testing or another approach.

If your child has no history of food allergies or other risk factors, you may consider introducing peanuts to the diet.  Peanuts and many peanut containing products, however, fall into the category of choking hazards.  You should never give whole peanuts or peanut pieces (including chunky spread) to a child under age 4 years.  Consider instead a very thin layer on a small amount of soft bread or other peanut containing soft foods to give your child.

Please remember that there is a very high incidence of peanut allergy in the community, and that these allergies can be life-threatening.  It is still important to avoid or carefully label any peanut containing treats offered to children or brought to schools or parties.  We ask that you continue to be aware of peanut allergies when offering your child snacks in public places or waiting rooms.  While ongoing research may help us to answer the question of how best to avoid development of peanut allergies, we must also continue to work to protect the health of the many children who have this potentially deadly allergy.

 

Last updated 5/30/2015