Peanut consumption among infants has been a confusing and changing topic for years, and in the past decade, the thinking around it has changed considerably. It comes as studies now show the number of children living with peanut allergy appears to have tripled between 1997 and 2008. However, doctors say new research is promising and suggests there are ways to ward off peanut allergies.
“A recent study showed that Jewish children from Israel have a lower prevalence of peanut allergy compared to Jewish children in the UK,” said Jeremy Bufford, M.D., UnityPoint Health. “The theory is that this phenomenon is seen because Israeli children start eating Bamba (an Israeli peanut-flavored snack) at 6 months of age; whereas children in the UK do not have this early exposure to peanut protein.”
This study was one of the first to show that early introduction of peanut-based products is beneficial in promoting peanut tolerance rather than peanut allergy. Dr. Bufford says the approach to the early introduction of common food allergens potentially reducing the risk of food allergy started around 2008. Prior to these findings, it was suggested that parents not introduce peanuts and other highly-sensitive foods until age three.
Dr. Bufford suggests infants who are at high risk of developing a peanut allergy be evaluated by an allergist for peanut allergy sensitivity as early as four to six months, prior to beginning peanut exposure at home. Patients who are high risk include those who have a family history of food allergy, have a personal food allergy to other foods or have eczema or other skin irritation conditions.
“An allergist can perform skin testing in clinic and/or blood allergy testing to determine if peanut allergy antibodies are already present. The allergist can then determine if it is appropriate to introduce peanuts at home or wait until they are older. Children who have not previously had known peanut exposure could have become sensitized in utero or through peanut proteins passed through breast milk if breastfeeding,” Dr. Bufford said.
Usually, parents try rice cereal when a child is around six months of age, as directed by their pediatrician or provider. Dr. Bufford says after that is established, you can add new foods every five to seven days. When it is clear they are able to tolerate cereals and other baby foods and solids, it is ok to start offering peanuts in a tolerable form, with the exception of whole or crushed nuts.
“There appears to be an immunologic window at this age that promotes tolerance of these foods rather than allergy. These common food allergies include milk/dairy, egg, wheat, soy, peanuts, tree nuts, fish and shellfish,” Dr. Bufford said.
Acceptable Peanut Forms
Peanuts can be introduced in a variety of ways, although infants should not be given whole peanuts because it’s a choking hazard. If you plan to use peanut butter, Dr. Bufford suggests starting with a small amount, then, over time, increasing to a normal serving size of two tablespoons. Dr. Bufford also suggests an Israeli snack called Bamba, which is a peanut-flavored corn puff snack, like a cheese puff, but flavored with peanut protein instead of cheese.
“Once the child starts eating peanut products, it is best for them to get exposure several days per week, as opposed to eating it just intermittently. Intermittent doses may actually increase the risk of developing peanut allergy,” Dr. Bufford said.
He says it’s best to begin introducing peanut products before the one-year mark. Parents who wait until after the child’s first birthday may miss the window for promoting tolerance, which may increase the risk of developing a peanut allergy. He also stresses that while early introduction of peanuts is promising, there is no guarantee that children who initially tolerate peanuts won’t develop peanut allergies later on.
Existing Peanut Allergies in Children
There are currently no guidelines or FDA approved products or protocols for desensitizing children to peanuts who are already allergic or who become allergic despite following the current recommendations of early exposure.
“The allergy community is getting closer and closer to treatments that can help desensitize children with peanut allergy, including dosing under the tongue, adhesive patches or Chinese herbal medicine. However, more studies are needed in order to get these products FDA approved for the market,” Dr. Bufford said.
If you have questions regarding peanuts make sure to contact your child’s UnityPoint Health pediatrician or provider.