Moving Beyond Peanut Paranoia
Peanuts are a hot topic right now. I used to tell my parents to hold off on introducing peanuts and other nut products until after age one due to the risk of allergy. But things are changing. Peanut allergy is a huge problem--nearly 2 percent of kids have it, it’s often life-long, and it can be more severe than other allergies. About a decade ago, scientists realized that peanut allergies were skyrocketing after recommendations to avoid peanuts in at-risk kids for several years. They also noticed that in Israel, where infants universally get fed these little puffed peanut snacks, peanut allergy is super rare. Hmm . . .
The LEAP study (Learning Early About Peanuts), published in 2015, looked at infants older than four months who were at a high risk of peanut allergy (1). They found that those regularly given peanut through infancy and toddlerhood had 86% less peanut allergy than those who avoided it. That’s huge!
Putting these findings to use has been daunting, because it was unclear whether babies had to get allergy testing before getting peanut for the first time. In early 2017 the AAP finally issued some reasonable guidelines that stratify infants into three risk groups:
1. Severe eczema (or egg allergy)--This category of babies have itchy red rashes that are hard to control, even with the use of strong steroid cream. These babies should get allergy testing at four to six months, preferably skin prick testing with an allergist. If negative, they should be given six to seven grams of peanut protein over three or more feedings per week.
2. Mild to moderate eczema--These kids have rashes that come and go but can be controlled with lotions and weaker steroids. They should consume peanut products starting at six months. The first dose should be small and careful, but no testing is needed beforehand.
3. Everyone else--The remainder should be offered peanut products “in accordance with family preferences and cultural practices.” A very sensitive statement for those of you with deep family peanut traditions. They just mean treat it like other foods.
So what is six to seven grams of peanut protein equivalent to and how exactly are you supposed to get it into your kid? Peanuts are a choking hazard and peanut butter is too thick. Try mixing two teaspoons of creamy peanut butter with two teaspoons of warm water until it is nice and soupy. You can then feed this to your baby directly or mix it in with some cereal.
1. Randomized trial of peanut consumption in infants at risk for peanut allergy. Du Toit et al. New England Journal of Medicine. 2015;372(9):803-13.