By Dr. Yonit Estrin

Everyone recognizes the sign when they see it.  A peanut in a big, red circle with a line running through it means this school or camp is a nut-free zone.  Parents whose children have life-threatening peanut allergies are relieved to see these signs.  But is there a way to prevent these serious allergies from developing in the first place?   My answer?   When starting solids, I recommend to include peanut products early and to feed them often!

Peanuts, tree nuts and seeds are among the most common food allergies with peanut allergy currently the leading cause of death by anaphylaxis in the US.  In 1999, approximately 0.4% of US children had a peanut allergy but by 2010 that rate had increased to 2%.  The highest rates of peanut allergy are in the US, UK, Canada and Australia with lower rates in other westernized countries such as France, Denmark and Israel.  Peanut allergies are rare in Asian countries.

Many parents may recall their own parents and grandparents advising that certain foods be avoided until the age of 3 years.  However, with allergy rates rising, it’s apparent that avoiding these foods is not the solution. 

In 2010 the American Academy of Pediatrics endorsed a new guideline published by the National Institute of Allergy and Infectious Diseases (NIAID) stating that evidence did not support delaying peanut introduction.  In 2015, the Learning Early About Peanut Allergy (LEAP) trial helped provide guidance on when to actually introduce peanut products.  Previously, it had been observed that rates of peanut allergy in Jewish children living in the UK were 10-fold higher than in Jewish children living in Israel despite their similar ancestry.  The major difference noted was in the timing of their diets.  In Israel, babies are commonly given a puffed peanut snack called Bamba at 7 months, while in the UK, children are often introduced to peanut products much later.  This led researchers to hypothesize that early introduction of peanuts to the diet might offer protection against the development of peanut allergy.   

The LEAP trial followed children 4-11 months old with severe skin rashes, egg allergy or both, conditions known to present increased risk of peanut allergy.  The subjects were divided according to their avoidance or consumption of peanut products.  At 5 years, all were given an oral peanut food challenge.  Fourteen percent of the children in the avoidance group were allergic compared to fewer than 2% of the peanut-consuming group. 

The LEAP trial was the first of its kind to study early allergen introduction as a means of preventing allergy.  With this new information, NIAID developed feeding guidelines placing babies into three groups: 

1. Those with severe eczema (persistent or recurrent dry skin who need prescription creams frequently) and/or egg allergy.  For these babies they recommended introducing peanut-containing food (not peanuts themselves which are a choking hazard, but foods like creamy peanut butter mixed in puree or baby cereal or Bamba,) as early as 4-6 months but after starting other solid foods. Parents of such children should talk with their doctors and possibly test for peanut allergy and/or see a specialist to further discuss peanut introduction. 

2. Those with mild to moderate eczema.  Peanut products can be introduced around 6 months old. 

3. Those without eczema or food allergy.  Peanut-containing foods can be introduced according to family preferences or cultural practice.

So, no need to fear the peanut.  In fact, eating these foods early can be the answer to preventing allergy! And as always, if there is any doubt, discuss concerns with your doctor at your child’s next well visit. 

Yonit Estrin, MD, with Senders Pediatrics in South Euclid is a board certified pediatrician and a fellow of the American Academy of Pediatrics.

 Call them at 216-291-9210 to make an appointment or visit www.senderspediatrics.com.