Of ALL food allergies, peanut allergy is probably the one you do not want your child to get. (I know, sorry for the negativity, but I also have a peanut allergic boy). It is often more severe (the leading cause of anaphylaxis), with reactions to even tiny amounts, and it is difficult to outgrow compared to other childhood food allergies such as milk and eggs. So actually, if there is a way you can prevent peanut allergy in the first place it is well worth the effort.
Well, now it seems there is.
When Sarah was first diagnosed with peanut allergy (among numerous others) 8 years ago, the medical advice was that peanut avoidance during pregnancy and in infancy/early childhood was PROTECTIVE against peanut allergies developing. Pregnant women were told to avoid peanuts, and nuts were always on the bottom of the weaning list.
The reverse is now true.
The LEAP study in 2015 showed that feeding high-risk infants peanuts prevented the development of peanut allergy. (Yes, nuts are a choking hazard for children under 5 years, so they used a peanut snack called Bamba which melts in the mouth, or smooth peanut butter but note even peanut butter, if thick and consumed on its own, can be also be a choking hazard. See below for link to some recipe ideas). They recruited 640 infants aged between 4 and 11 months who were at high risk of developing peanut allergy (defined as having severe eczema, egg allergy, or both). They then randomly allocated the children into two groups: one who ate peanut-containing food 3 times a week, and another who avoided peanuts completely, until the age of 5 years. The results were astounding: 17% of the children in the group that avoided peanuts developed a peanut allergy by the age of 5. However, only 3% in the group who consumed peanuts regularly developed peanut allergy – a reduction in risk of 81%. (interesting to note that the study was hypothesized on the observation that Jewish children in UK were 10 times more likely to develop peanut allergy compared to Israeli children of similar ancestry, with the main difference being peanut is eaten by Israeli kids much earlier than Jewish children in the UK). The LEAP-ON study has since shown that this result is likely to be long-term rather than temporary.
This is HUGE and so exciting because it means that we may have a way to prevent the peanut allergy epidemic.
So, how does this translate into real-life?
The National Institute of Allergy and Infectious Diseases has issued a guideline for parents in Jan 2017. (for the UK formal guidance is yet to be issued) This is very relevant if you have a strong family history of allergies and considering starting a family, already have allergic children and planning to have more, or have babies with severe eczema and egg allergy. Essentially the guideline says:
- For infants at high risk of peanut allergy (as defined by having egg allergy and/or severe eczema) – it is advised you try to introduce peanuts into your their diet between 4-6 months of age – It is important that you consult an allergist before introducing peanuts as they may need allergy testing to see if it is safe before the introduction (remember, peanut allergy can be severe so don’t try this at home without medical advice).
- For those with mild to moderate eczema, you can consider introducing peanuts into their diets at around 6 months of age. Again, it would be wise to do this in consultation with an allergist.
- For infants with no food allergy or eczema, peanuts can be introduced freely in an age-appropriate manner.
What if my child already has a peanut allergy?
This guidance does not apply to children who have already developed peanut allergy – it would not be safe to try and introduce peanuts without the guidance of an allergist in peanut-allergic children. However, DON’T DESPAIR! Desensitization immunotherapy is on the horizon (in fact, it is already taken on by many allergists in the US). In the UK, it is still not yet widely available (and I only know of private clinics that see patients from 7 years of age) but definitely something to keep an eye out for as things might change. If you want to find out more about immunotherapy, keep an eye out for my blog post on it.
One thing that we could perhaps extrapolate though, is that if you child is not yet allergic to another type of nut (or another highly allergenic food like egg), it is probably a good idea to try and incorporate these into their diets to prevent them BECOMING allergic (make sure they are age appropriate texture/size though… nut butters are good for children below the age of 5 when mixed into something e.g. on toast or intro puree rather than a spoonful straight into the mouth which, when thick, can be hard to swallow for very young infants). I often add a dollop of cashew butter or almond butter into home-made ice cream, smoothie or soup for increased nutritional value and richness.
RECIPES for early introduction of peanuts:
If your child has just been given the greenlight by doctors to start early peanut introduction, you might want to check out some recipes ideas here as it can be difficult to know HOW to give them peanuts…