In early 2017, the National Institutes of Health released recommendations on introducing peanut foods to infants as an approach to preventing peanut allergy. One of the guidelines recommends that infants who are at high risk of developing peanut allergy should have peanut-containing foods introduced into their diets as early as 4 to 6 months of age, in an effort to reduce the risk of developing an allergy to peanuts.
This is a complete paradigm shift from what was previously recommended. As a dietitian and mother of two, I waited until both of my kids were 3 years old before introducing peanut products. I was following previous American Academy of Pediatrics recommendations from 1998 to avoid offering allergenic foods to young children in an effort to decrease their risk for food allergy. Unfortunately, we quickly found that my second daughter has a life-threatening peanut allergy after introducing a small amount of peanut butter to her as a toddler. Like many children, she will have a lifelong allergy to peanuts, as only about 20 percent of children diagnosed will outgrow it.
But we are now learning about a different approach to treating food allergy. New research shows that regular consumption of peanut products, beginning in infancy, has led to a significant reduction in the development of peanut allergy in high-risk infants. In fact, investigators in the Learning Early About Peanut Allergy (LEAP) Study believe that the previous recommendations to avoid allergenic foods at a young age may have actually led to the rise in food allergy in children. This clinical trial followed more than 600 infants and found that high-risk infants who regularly consumed peanut products through the age of 5 had an 81 percent reduction in the development of peanut allergy. Seventeen percent of infants who avoided all peanut products developed a peanut allergy, while only three percent of infants who consumed peanut products at least three times each week developed an allergy.
How was this complete change in treatment conceived? Gideon Lack, M.D., a pediatric allergist in London, discovered that children in Israel had lower levels of peanut allergy than those in the U.K. The primary difference was that the children were given Bamba (a peanut butter-flavored snack) at an early age in Israel. Lack then developed the LEAP study and discovered a striking benefit from early intervention.
Emily McGowan, M.D., assistant professor in the division of allergy and clinical immunology at the University of Virginia School of Medicine, has implemented these new recommendations with her patients.
“Based on the new guidelines, if a child is at high risk for developing a peanut allergy (e.g., they have eczema), then parents should strongly consider introducing peanuts into the diet at an early age (4-6 months).” Dr. McGowan said via email. “If the eczema is severe, or if the child already has an egg allergy, then it would be important to see an allergist first for testing, because there is a chance that an allergy to peanut may have already developed by 4 months of age.”
Dr. McGowan advises parents to introduce a peanut product after the child has tolerated a few of the first foods.
“I recommend using the peanut powder PB2 when introducing peanuts at 4–6 months, because you can mix it with another food that the child already tolerates and feed it easily with a spoon. When they're a little bit older, and developmentally ready to hold food, Bamba is a good vehicle. I also typically recommend that parents feed the child at least 2 grams of peanut three times a week, as this is what was done in the LEAP study, and we don't yet have any further data to suggest that a smaller amount is effective,” she said.
Dr. McGowan has first-hand experience with implementing these new guidelines in her own household as a new parent.
“I have a severe peanut allergy, and my husband has a shellfish allergy,” Dr. McGowan says. “My daughter had mild eczema at 2 months of age, so we decided to introduce solids around 4 months of age. As soon as she was able to tolerate three foods — we used oats, bananas, and squash — we started mixing in 2 grams of PB2 with banana. She is now 18 months old and continues to eat peanuts in some form at least three times a week, and has been doing well.”
The bottom line
Peanut allergy continues to be a growing health problem, and no cure or treatment currently exists. Constant vigilance about food safety is crucial for those living with a peanut allergy to prevent a severe or life-threatening allergy. The results from the LEAP study offer hope for the future of food allergy treatment. Talk with your allergist or pediatrician for assistance in implementing these recommendations.
Carmen is a registered dietitian who specializes in weight management and nutrition therapy for chronic disease. In addition to nutrition counseling at Johns Hopkins in Baltimore, Carmen teaches undergraduate health and wellness courses and provides corporate wellness seminars on exercise and nutrition.