By Dr. JJ Levenstein
Food allergies occur in approximately 8% of kids, with peanut allergies reported in 2.2% of US children. Because peanut allergy is outgrown less frequently than other allergies like milk and egg, it has become an increasing public health concern, as well as a source of anxiety and common topic of conversation amongst parents. Surely you may already have felt the “peanut panic” amongst some of your fellow parents, in the media, and even within your own families.
In response to escalating rates of food allergy, and peanut in particular, the LEAP (Learning Early about Peanut) study was initiated after its investigators observed that children who ingested baby-safe peanut foods in infancy as part of cultural norms (like in Israel or parts of Africa) had but a fraction of peanut allergies compared with the US, UK and Australia and other countries with similar feeding practices. The stunning results of this randomized clinical trial showed an up to 86% reduction in peanut allergy prevalence in babies who were at high risk for food allergies.
As a result of LEAP, current guidelines, based on solid science, recommended early introduction of peanut in children – an about face from past recommendations to delay peanut and other allergens. And more and more research shows that, in addition to peanut foods, introducing other potential allergens, such as eggs, early may also reduce the development of allergy to those foods.
It’s estimated that up to 90,000 children develop peanut allergies yearly in the US. Early introduction of peanut and regular consumption of peanut-containing foods has the potential to spare many children a lifetime of discomfort, anxiety, exclusion, and adverse reactions associated with peanut allergy. Introducing peanut foods early may make it easier to find nutritious and affordable food options for your family.
Face it, the pandemic and our worldwide public health occupies so much of our attention. During this time, you have the power as a parent to reduce risks to your family through things like handwashing, mask use, keeping up on vaccines, using car seats and seat belts, and making sure your babies is well nourished and nurtured.
Your child’s pediatrician may be practicing differently during this time of uncertainty – limiting visits, seeing fewer patients, and perhaps conducting shorter visits. It’s possible the subject of early introduction of peanut foods may not come up as your child’s pediatrician leads your appointment. If it doesn’t, take the initiative to ask your doctor – we love when parents engage us with questions, and we share decision making.
Here are some tips for parents to plan for healthy feeding your babies:
- When you are pregnant, you should eat a wide variety of foods and not exclude peanuts or other allergens (unless you are allergic). There is no compelling evidence that restricting foods from your diet is protective for your baby.
- Try to breastfeed as your baby’s primary nutrition source. Eat a balanced and varied diet while breastfeeding. The LEAP study demonstrated that breastfeeding success was not hampered by early introduction of peanut, nor did it affect the babies’ weight, growth or development.
- Never rub food on the skin of your baby, especially if the skin is dry, broken or inflamed with eczema/dermatitis. Introducing foods through the skin actually increases the chance that your baby develops a food allergy.
- Work with your pediatrician to ensure your baby’s skin is as healthy and intact as possible.
- If you are pregnant and interviewing pediatricians, pay attention to how well that professional listens to you, your concerns and questions. If he/she blows you off, that person may not be the right doctor for you.
- At your baby’s 2-4 month visit, start ask about when to begin solid foods in addition to continuing breastfeeding or formula. Under most circumstances, the answer will be “at about 6 months, when your baby shows curiosity and readiness.”
- If your doctor has handouts, FAQs or other information about introducing potential allergens, ask for them and take time to read and ask questions. If he/she doesn’t have material for you, you can go to www.peanutallergyfacts.org for tips on feeding, recipes, more information about the Guidelines and more.
- Create a feeding plan with your baby’s doctor based on your baby’s health and risk factors.
- Discuss with your doctor what a typical food allergy looks like and what to do if there is a reaction. Known as the Top 8, eight foods (milk, shellfish, fin fish, peanuts, egg, nuts, soy and wheat) cause 90 percent of food allergic reactions. I always advised my patients to introduce new foods early in the day, on a day they knew I was in the office or available by phone. Now that many parents are working from home, you are in a unique position to be able to observe your baby more.
- If your baby has severe eczema, egg allergy or both, he/she has a higher risk of developing food allergy. The 2 month visit, I believe, is an ideal time to talk about food allergy prevention and early introduction of peanut.
- What does that look like?
- You can inform your doctor you are aware that early introduction can reduce your baby’s risk of future peanut allergy. A majority of pediatricians are already aware of the published guidelines, but some are not fully up to speed. So ask away.
- For your high-risk infant, the doctor can order a blood test called “Peanut-specific IgE” to be done to assess whether there is evidence of peanut exposure (this is called sensitization, and likely occurs because peanut has been absorbed through broken skin). If the test is negative, peanut should be introduced closer to 4 months of age, rather than waiting. Delaying introduction, even by a few weeks, can increase the risk of developing a reaction.
- If the blood test shows convincing evidence of peanut sensitization, your baby should be referred to a pediatric allergist for continued allergy management.
- Parents, understandably, may be nervous about feeding peanut foods in this scenario – so a discussion with your pediatrician or allergist about when and where to do so is in order. Having severe eczema or having a positive peanut-specific IgE doesn’t mean every baby will develop peanut allergy, so a medically supervised feeding with peanut is in order to sort that out.
- What does that look like?
At a time when we feel somewhat powerless over the pandemic and world events, parents can actually be a part of preventing food allergies in our kids. As I have said to parents, and to many of my peers – “I’d take one nervous day introducing a new scary food or having a blood test, over a lifetime of carrying an epi-pen.” You have the power to make that happen.
Dr. JJ Levenstein, MD, FAAP, is a pediatrician and chair of the National Peanut Board’s Food Allergy Education Advisory Council.