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Dad making peanut butter sandwich for his child

Preventing Peanut Allergies With … Peanuts

Author: Children's Specialty Group, Dr. Angela Duff Hogan
Published Date: Monday, May 06, 2019

By Dr. Angela Duff Hogan, Allergy, Asthma and Immunology 

If you could prevent your child from having a peanut allergy, would you do it?

Of course you would.

But what a lot of parents don’t know is that weekly doses of a peanut-based product greatly reduce the risk of developing an allergy. Unfortunately, parents’ wariness of peanuts – based on past erroneous advice from experts – is proving hard to erase.

How we reached a point where 2 percent of children in the country have a peanut allergy takes a little explaining.

In 2000, the American Academy of Pediatrics Committee on Nutrition published guidelines to help prevent food allergies, responding to increases in allergic reactions. It was recommended that parents hold off on feeding their children peanuts until after they were 3 years old. The guidelines were for high-risk infants, but many people extended the advice to all children.

Guess what? Peanut allergies increased.

The recommendations were dropped in 2008 as studies began to show the futility of the advice, and also raised the prospect that withholding certain foods from children was working against their natural immunity system.

A landmark study called “Learning Early About Peanut Allergy” was published in the New England Journal of Medicine in 2015. It showed that giving babies weekly doses of a peanut-based product reduced their risk of developing an allergy by up to 86 percent. The babies in the study were 4 to 11 months old and prone to developing a peanut allergy.

The study resulted in revised recommendations. We’re not talking about giving babies whole peanuts, or a dollop of peanut butter, because we all know that’s a choking hazard. But peanut butter thinned with either breast milk, formula, cereal, or pureed vegetables will work. Peanut-flavored "puff" snacks, like Bamba, are also a kid-friendly peanut product.

The stories about the LEAP study have faded from the headlines, and many parents are not getting the word, so this is a good time to raise awareness.

At CHKD, we have a Peanut Allergy Prevention Clinic where high-risk children can be tested for allergies and undergo medically supervised peanut introduction. For questions about a referral, click here or call (757) 668-8255.

Here’s what you need to know:

  • Babies should be screened between 4 and 11 months of age if they have one, or both, of the following allergy risks: Severe eczema and an egg allergy.
  • Screening is done through blood or skin testing. Children with positive tests may have peanut introduced in the allergy clinic. If the screening is negative, baby-friendly peanut foods can be introduced at home.
  • Moderate-risk babies have milder eczema, typically treated with over-the-counter creams. Their parents should consider starting peanut-based foods around 6 months, at home.
  • Most babies are at low risk for allergies, and parents can introduce peanut-based foods at an age-appropriate time, no different from other solid foods.
  • Babies should try other solid foods before introducing peanut-flavored ones; to be sure they're developmentally ready.
  • Building tolerance requires making peanut-based foods part of the regular diet, about three times a week.
  • Whole nuts should not be given to children under 5 years of age.
  • Peanut butter directly from a spoon or in dollops should not be given to children younger than 4 years of age.
  • For babies, you can try two teaspoons of peanut butter mixed with two or three teaspoons of hot water, formula, or breast milk, and allowed to cool. Also, two teaspoons of peanut butter combined with two or three tablespoons of previously well-tolerated food, such as infant cereal, applesauce, yogurt, pureed fruits, or vegetables will work.

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About Children's Specialty Group

Children's Specialty Group is the only pediatric multi-specialty practice serving southeastern Virginia and northeastern North Carolina. The physicians of Children's Specialty Group base their practices at Children's Hospital of The King's Daughters and serve as faculty in the Department of Pediatrics at Eastern Virginia Medical School. Learn more about our specialists here.