Reassuring new evidence suggests that feeding children smooth peanut butter during infancy and early childhood can help reduce their risk of developing a peanut allergy even years later.
“Peanut allergy develops very early in most children between six and 12 months of life. If you want to prevent a disease this needs to be done before the disease develops,” Lack said of exposing children to peanuts.
“This biological phenomenon is based on an immunological principle known as oral tolerance induction. We have known for many decades that young mice or other experimental animals who are fed foods such as egg or milk or peanut cannot develop these allergies later.”
“If widely implemented, this safe, simple strategy could prevent tens of thousands of cases of peanut allergy among the 3.6 million children born in the United States each year.”
That previous study included infants with eczema and egg allergy who were followed through age 5, and it found that at that age, the prevalence of peanut allergy was about 17 percent in the group of children who avoided peanuts, compared with about 3 percent in the group that ate peanut products, representing an 81% relative reduction in peanut allergy.
The LEAP-Trio trial set out to examine whether that reduced risk of peanut allergy would last into adolescence.
About 500 children were assessed again for the LEAP-Trio trial, which looked at the rate of peanut allergy at around age 12.
At that age, peanut allergy remained “significantly more prevalent” among the children who originally avoided peanuts, with about 15 percent having a peanut allergy. Among those who originally consumed peanuts, about 4 percent had a peanut allergy, the researchers found. They wrote that represents “a 71 percent reduction in the prevalence of peanut allergy at the LEAP-Trio time point.”
But overall, when children started to consume peanuts in infancy and continued to around age 5, this appeared to provide “lasting tolerance” to peanuts into adolescence, according to the researchers, based in the United Kingdom and the United States.
“So ideally if there’s no other risk factors we should continue to introduce these allergens early at 4-6 months and continue them consistently until age 5 but after that we don’t need to be as consistent,” Parikh said.
She added that introducing peanuts for children at low risk for allergies can be done around 4 to 6 months old under the guidance of a pediatrician, but children with severe eczema and egg allergy should see an allergist before early introduction.
“Since babies cannot have solids yet it is recommended for it to be a thin consistency similar to breast milk or formula and can be mixed into it to avoid any choking and can start with a small amount and slowly increase as tolerated every 3-4 days,” Parikh said.
“It can generally be said ‘the sooner the better’ for parents, especially in babies with eczema,” Lack said, adding that babies with eczema are at much higher risk of developing food allergies and develop these allergies much earlier in the first year of life.
“However, the child needs to be developmentally and neurologically ready to eat solid foods and be able to coordinate chewing and swallowing without a risk of choking. Most babies will be able to start weaning between four and six months of age but each baby is an individual and needs to be assessed individually,” he said. “Also, the foods should be given as a soft puree to facilitate swallowing and reduce the risk of choking. We do not recommend introducing solids before three months of age.”
The finding that early peanut introduction induces tolerance has been supported by previous studies too, but introducing your child to peanuts should be a shared decision with your pediatrician, according to Dr. Daniel DiGiacomo, a pediatric immunologist at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center in Neptune, New Jersey, who was not involved in the new study.
“The current expert opinion is to utilize a shared-decision making approach for food introduction once the infant is developmentally ready, and has tolerated a couple of other complementary foods without issue,” DiGiacomo said in an email Tuesday.
“I usually start off slowly introducing a pea sized amount, doubling the amount every day until you get to an age appropriate serving size (or at least 2 teaspoons). Then continue this in the diet several times per week,” he said.
“I typically have the family mix the nut butter in a tolerated puree to the correct consistency, they can also dissolve peanut puffs (if doing peanut) in water, or make a peanut sauce out of powdered peanut butter or peanut flour. Again, we review the proper consistency and start slow with instructions to stop and contact your allergist if there are any concerns.”