The best way to avoid peanut allergies is to introduce them into the diet in infancy. That’s according to a new study funded in part by the National Institute of Health. The study finds that early introduction provides protection no matter how often kids eat peanuts in later childhood.
Dr. David Morris, chief of pediatric allergy at Dayton Children’s, spoke with WYSO’s Jerry Kenney about the study, and the course correction that health officials are now making.
Dr. David Morris: In 2000, the American Academy of Pediatrics, largely based upon expert opinion, recommended that we delay peanut introduction for children, especially children at risk, who may have something called eczema or atopic dermatitis, until three years of age. And so they delayed peanut introduction.
What they found is between about 2000 and 2008, the peanut allergy roughly tripled in the United States. In the United Kingdom. And they looked back at this recommendation, and suddenly in 2008, they said, 'you know what? We're not going to have you delay introduction of allergenic foods anymore. We're not quite sure what's going on here.'
And so when they did that, they then embarked in the UK on a study. And that study was largely based upon a comparison between, Jewish people in the U.K. and in Israel. It was a practice in Israel to introduce peanut early. It was not a practice in the U.K. to introduce peanut early because of these recommendations. And so there was a perfect, different dichotomy there. And what they found is the peanut allergy in Israel had not climbed and so they thought, 'maybe we're on to something here.' So they went ahead and did a prospective study, long-term prospective study, where they enrolled over 600 children, and they all had severe eczema. And when they started, they had half the children each peanut, and they had the other half, avoid peanut.
"And so the best thing that you could do — and I implore a lot of children, or parents of children, in that age group — please introduce peanut early."
And they confirmed at the very beginning of the study that everyone can tolerate peanut. They went five years into the study. And what they found is at the end of it, those who avoided a peanut had an 81% chance of having a peanut allergy higher than those who had consumed it.
And so compared to that consumption group, the relative risk reduction for the consumption group was 81% — meaning there was less peanut allergy in the consumption group, more peanut allergy in those who had avoided it.
That kind of confirmed what we thought had happened, which is that when we told people to avoid in 2000, between about 2010, that peanut allergy went way up. And that's why, somebody of my age doesn't really remember seeing children with peanut allergy. But now it's roughly estimated one child in every classroom has a peanut allergy.
Jerry Kenney: So this study is a big correction over past advice on this subject.
Dr. Morris: Yes. And the the hope now is, is that we can start early introduction of peanut. And the unfortunate thing is that that study left some other questions, such as how often does a child need to eat peanut in that vulnerable time period, maybe infancy to five years? How much peanut do they need to eat? And will this affect be long lasting? And this most recent study answers that last question of, it does appear that even if you stop eating it after the age of five and you're eating it very intermittently, you still seem to have that protection into adolescence.
Kenney: Are there recommendations on the ways that parents should introduce peanuts into the diets of infants?
Morris: Yes. And so actually, there is an addendum guideline that was produced by the NIH regarding introduction of peanuts to infants. And in fact, I know off the top of my head because I recommend it so often. It's very easily found online about addendum guidelines. It's Appendix D, and it actually has recipes in there on how you should go about introducing your infant to peanut. Because obviously peanuts and nuts are a choking hazard to young children.
So we don't recommend whole peanut, but there's recipes in there about diluting it or placing it into a puree or other means by which you can get peanut into your infants diet. And it is recommended, they as soon as they can eat complementary foods — meaning solid foods, which is usually around six months — that you do introduce peanut you.
The only other thing that I would highlight is, they also looked at the other side, of how much allergy developed even in those who had avoided it. Obviously those who had avoided, some of those or remained allergic, because they had developed the allergy during that time, and roughly the same amount remained allergic. And so it sustains that idea that this is an allergen that does sustain. And so, once you get past that window, and you have an allergen, it may not go away. And so the best thing that you could do — and I implore a lot of children, or parents of children in that age group — please introduce peanut early.
