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Reassuring new evidence suggests that feeding children creamy peanut butter during early childhood may help reduce their risk of developing a peanut allergy, even years later.
Compared to avoiding peanuts, starting peanuts in childhood – from around 4 months of age, for example in soft puree form – and continuing regularly until around 5 years of age was associated with a 71% reduction in peanut Peanut allergy rates among adolescents in the United Kingdom, according to a study published Tuesday in the journal NEJM Evidence.
“I wasn’t entirely surprised because infants in Israel are exposed to peanuts very early and allergies don’t seem to appear in adolescence or adulthood. This suggests that protection is long-term,” Gideon Lack, professor of pediatric allergy at King’s College London and author of the study, said in an email.
“Peanut allergy develops very early in most children, between six and 12 months of age. If you want to prevent disease, it has to be done before the disease develops,” Lack said of children’s exposure to peanuts. “This biological phenomenon is based on an immunological principle called oral tolerance induction. We have known for many decades that young mice or other laboratory animals fed foods such as eggs, milk or peanuts cannot develop these allergies later.
Starting in 2000, the American Academy of Pediatrics recommended delaying the introduction of peanuts for up to 3 years, but ended this recommendation in 2008.
About a decade later, In 2019, the AAP updated its guidelines to state that delaying the introduction of allergenic foods does not prevent disease and that “there is now evidence that early introduction of peanuts can prevent peanut allergy.” peanuts.”
Food allergies have become a growing public health problem in the United States, and peanut allergy is estimated to affect approximately 2% of children in the United States, or nearly 1.5 million people under the age of 18. . Peanuts are among the types of foods that can cause the most serious allergic reactions, including the risk of a life-threatening anaphylactic reaction.
“Today’s results should increase the confidence of parents and caregivers that feeding their young children peanut products from infancy, according to established guidelines, can provide long-lasting protection against “Peanut allergy”, Dr. Jeanne Marrazzo, director of the US National Institute of Allergy and Infectious Diseases. , said Tuesday in a press release. “If widely implemented, this simple and safe strategy could prevent tens of thousands of cases of peanut allergy among the 3.6 million children born each year in the United States.”
The new study, called the LEAP-Trio trial, included data on children in the United Kingdom who participated as babies in a peanut allergy study called the LEAP trial.
This previous study included infants with eczema and egg allergy who were followed until age 5 and found that at this age, the prevalence of peanut allergy was approximately 17% in the group of children who avoided peanuts, compared to about 3% in the group of children who avoided peanuts. group that ate peanut products, representing an 81% relative reduction in peanut allergy.
The LEAP-Trio trial aimed to examine whether this reduced risk of peanut allergy would persist into adolescence.
About 500 children were re-evaluated in the LEAP-Trio trial, which looked at the rate of peanut allergy around age 12.
At this age, peanut allergy remained “significantly more prevalent” among children who initially avoided peanuts, with about 15% having a peanut allergy. Among those who initially consumed peanuts, about 4 percent had a peanut allergy, the researchers found. They wrote that this represents “a 71% reduction in the prevalence of peanut allergy at the time of LEAP-Trio.”
But overall, when children started consuming peanuts in early childhood and continued until around age 5, it appeared to provide “long-lasting tolerance” to peanuts through adolescence, according to researchers based in the United Kingdom and the United States.
The new findings are “great assurance” that not only did the early introduction of peanuts reduce the development of peanut allergies, but The protection lasted until adolescence, even when children stopped eating peanuts consistently after age 5, Dr. Purvi Parikh, an allergist and immunologist at NYU Langone in New York and a spokesperson of the Allergy & Asthma Network, which was not involved in the new research, said in an email Tuesday.
“So ideally, if there are no other risk factors, we should continue to introduce these allergens early, between 4 and 6 months, and consistently until age 5, but after that we don’t need to be so consistent,” Parikh said.
She added that introducing peanuts to children at low risk of allergies can be done around 4 to 6 months of age under the guidance of a pediatrician, but children with severe eczema and Egg allergy should consult an allergist before early introduction.
“Since babies cannot yet eat solids, it is recommended that they have a thin consistency, similar to breast milk or formula, and can be mixed in to prevent choking. They can start with a small amount and slowly increase as tolerated every 3-4 days,” Parikh said.
When introducing peanuts to an infant’s diet, it is recommended to use creamy peanut butter mixed with a puree and to avoid peanut pieces which could pose a choking hazard.
“It can generally be said that ‘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 eczema. food allergies and develop these allergies much earlier in the first year of life. life.
“However, the child must be developmentally and neurologically ready to eat solid foods and be able to coordinate chewing and swallowing without the risk of choking. Most babies will be able to start weaning between four and six months, but each baby is an individual and needs to be assessed individually,” he said. “In addition, food should be given in a soft puree form to facilitate swallowing and reduce the risk of choking. We do not recommend introducing solid foods before the age of three months.
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The finding that early introduction of peanuts induces tolerance has also been supported by previous studies, but introducing peanuts to your child should be a shared decision with your pediatrician, according to Dr. Daniel DiGiacomo, a pediatric immunologist at the K. Hovnanian Children’s Hospital of Jersey Shore. University Medical Center in Neptune, New Jersey, which was not involved in the new study.
“Current expert advice is to use a shared decision-making approach to food introduction once the infant is developmentally ready and has tolerated a few other complementary foods without problem,” DiGiacomo said in an email Tuesday.
“I usually start by slowly introducing a pea-sized amount, doubling the amount each day until you reach an age-appropriate portion (or at least 2 teaspoons). Then continue this diet several times a week,” he said. “I usually have the family blend the nut butter into a tolerated puree until the correct consistency, they can also dissolve the peanut sprouts (if you are making peanuts) in water, or make a peanut sauce from powdered peanut butter or peanut flour. Again, we look at the appropriate consistency and start slowly with instructions to stop and contact your allergist if there are any concerns.