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The New Peanut Allergy Guidelines

In the food allergy world, and the world of pediatrics, the buzz is all about peanuts and the new peanut allergy guidelines.

To read the media headlines, one would think it’s critical to feed baby peanuts as soon as he is ready to start solids. While the new peanut allergy findings certainly reveal some interesting data that flies in the face of current food allergy prevention practices, I’m excited to learn there are ways to prevent the development of food allergies.

new peanut allergy guidelines

Background on Food Allergy Prevention

For years {back when my babies were babies}, the recommendation to prevent peanut allergy was to hold off on introducing peanuts until kids were at least 4 years old.

In 2008, the message changed with the American Academy of Pediatrics’ (AAP) new recommendations, emphasizing there was no research to support the avoidance of peanuts in young children. In other words, as long as peanuts didn’t present a choking hazard, parents could introduce them after one year of age {along with all the other allergenic foods such as egg, fish, tree nuts, etc}.

Now, we have a new study from the UK, which, again, is poised to change the recommendations about introducing peanuts and peanut allergy prevention.  

In this study, called the LEAP study (Learning Early About Peanut Allergy), researchers looked at the incidence of peanut allergy in young children starting at ages 4 to 11 months (enrollment) and up through age 5 years. 

Essentially, babies who were already sensitive to peanut extract were divided into two main groups: one group consumed peanut products at least 3 times a week (6 g of peanut protein, which is equivalent to 24 g peanuts or 3 teaspoons of peanut butter per week) and the other group completely avoided peanut products for the first 5 years of life. 

The results of the study demonstrated a 13.7% prevalence of peanut allergy in high-risk infants (who had a negative skin prick result to peanut) who avoided eating peanuts and a 2% prevalence in those who ate peanuts in the first 5 years of life.

In those high-risk infants who showed a positive skin prick test to peanut at the outset of the study, 35.3% of those infants who avoided peanuts had a peanut allergy, while 10.6% of those who ate peanuts had a peanut allergy. In other words, if peanut was introduced between 4 and 11 months of age, a significant reduction of peanut allergy occurred.

You can read the full study here.

Fail-Proof Prevention?

Despite these enticing results, some children had peanut allergy during the study, showing that early introduction isn’t fail-proof–peanut allergy can still develop despite attempts at prevention.

This study included high-risk infants with minimal or negative skin prick test responses to peanut. What about low risk kids? This study does not address outcomes or a strategy for those without high risk factors for peanut allergy. But follow up studies do.

I still have other questions: what about higher or lower doses of peanut protein? What about other food sources of peanut protein?

How long do young children need to be exposed to peanut protein to have a lasting effect on prevention? What happens if your child doesn’t like peanut products and won’t eat them?

Another consideration is that this study was made possible by funding from the National Institutes of Health (NIH) and Food Allergy Research & Education (FARE), as well as other sources, including the National Peanut Board. Think what you will with that information.

{To clarify my position on research funding by corporations: I am all for free and clear funding (ie, no influence from grantors or funders), as long as the research design and study is sound and objective. After all, money for research doesn’t grow on trees…} 

The AAP in partnership with other leading organizations has put together interim guidelines for using this new research. There’s been swift movement by major organizations.

{If you’ve been following the hullaballoo around the Dietary Guidelines for Americans and the broad questioning of its research basis, you know what I mean.} See the link at the bottom of this post for the AAP’s guidelines.

Wrapping Up

If you have little ones (or even big ones), the new peanut recommendations may be frightening.

For one, it’s goes against everything you’ve been told about serving peanuts to little kids and the potential for developing a food allergy.

Even more worrisome, anaphylaxis can be deceptive, even silent, in a very young child. In other words, parents may not recognize what is happening to their child before it’s too late.

Even I misread my own son’s first allergic reaction to tree nuts (way back when)—and I am versed in food allergies and allergic reactions.

Parents will need more education about how to recognize and treat a food allergy reaction. And I believe all parents should consult with their pediatrician before taking steps to introduce peanuts {or at least do some independent research} into the diets of their children. 

These new findings about peanut allergy are encouraging—even promising. However, I believe we need more than one study to provide appropriate guidance for all young children {whether they are high-risk or low risk for food allergy} before we encourage babies to start digging into the peanut butter jar.

The AAP’s Interim Guidance for Peanut Allergy Prevention: http://pediatrics.aappublications.org/content/136/3/600.full

What do you think about this new research?

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