Large-scale research has shown that the early introduction of peanut, in powder or puree form, into babies’ diets reduces the risk of peanut allergy.
“Teach Babies to Eat Peanuts”
When I read the title of this article to my wife, she responded with more interest than usual: a cynical “What?” followed. She knows from personal experience how dangerous peanuts can be for a child with a peanut allergy. For years, the advice for children at increased risk of allergies has been to completely avoid peanuts.
In recent years, however, research has shown that issues related to peanut allergy can be approached very differently. A major study in 2015 marked a breakthrough. This has since had a worldwide impact on recommendations regarding peanut allergy. In the U.S., this has led to new national guidelines advising the early introduction of peanuts to babies (in paste or powder form). This would reduce the risk of peanut allergy [1, ].
For those who never read beyond a title and introduction:
Important!
Whenever this article mentions adding peanuts to baby food, it always refers to peanuts in powder, puree, or butter or cheese form.
Whole peanuts and peanut pieces pose a choking hazard!
Consult a doctor and have the sensitivity to peanut protein tested.
Peanut Allergy
Peanut allergy can have serious consequences. No other allergy leads to more deaths due to respiratory problems. Previous guidelines advised keeping peanuts as far away as possible from children at increased risk of allergies. In the U.S., this advice applied from 2000 to children up to 3 years old. However, the result was that ten years later, the number of children with a peanut allergy had quadrupled [2]. Several studies in recent years have shown that a different approach can be more effective. Researchers from Kings College in London, in particular, have played a major role in this development.
The starting point of their research was the difference between Jewish children in Israel and Jewish children in Great Britain regarding the prevalence of peanut allergy. In Great Britain, this was found to be 10 times more common [3]. This difference could not be explained by differences in genetic or socio-economic background. A major difference between them is that children in Israel consume food containing peanuts from a very young age.
The researchers at Kings College then wanted to test in a large-scale clinical trial whether this was the reason for the low number of cases of peanut allergy among them [4].
Clinical Trial in England
The study group consisted of 640 children aged 4 to 11 with severe eczema or an egg allergy. Egg allergy is an allergy that is relatively common among children under 1 year old. The researchers likely selected this group to have a greater chance of including children who might later develop a peanut allergy.
The group was divided into 2 cohorts based on a test for pre-existing sensitivity to peanuts (skin-prick test). There were 530 children who showed no reaction to the test (lower risk of peanut allergy) and 98 who were found to be sensitive.
These two groups were then subdivided, with one half receiving peanut protein from a young age and the other half not. This allowed them to see the effect this had on children with and without an increased sensitivity to peanuts. The children were then followed until they were five years old.
Results:
- Of the 530 children who showed no previous reaction, in the “peanut group,” 1.9% developed a peanut allergy by the time they were 5 years old. In the “non-peanut group,” this was 13.7%.
- Of the 98 peanut-sensitive children, 10% developed a peanut allergy in the peanut group. In the non-peanut group, this was as high as 35%.
It was also found that children who received peanut (protein) had many more antibodies that reduce the risk of an allergy.
The shocking results quickly spread worldwide. If a child was not already sensitive to peanuts (but was to other allergies), apparently excluding peanuts in the first year increased the risk of a peanut allergy by a factor of 7.
“Peanuts for a Baby?”
Since last week, there are new American guidelines that, depending on the risk profile, advise starting the introduction of food containing peanut (protein) from 4 to 6 months. Provided the children have already transitioned to solid foods. For high-risk cases, it is advised to start at 4 months instead of the 6 months recommended for others.
In the Netherlands, this guideline has not yet been adopted. Pediatricians would like more clarity on how to add peanuts to the diet.
Parents may be shocked by the American guidelines. Personal stories about dangerous reactions to peanuts are shared, questioning how on earth one could advise feeding peanuts to babies[5]. However, no child who received peanuts in the studies died. There have been cases where a child had to be urgently treated for an allergic reaction. After all, this was a group consisting entirely of children at high risk of allergy or with an existing allergy. Almost every child had to be treated urgently during the study. However, the number of emergencies was comparable in both groups (4527 vs. 4287 times). In the study, peanuts in the diet did not pose (significantly) extra danger, while the positive effects were very large.
However, the Americans point out that a doctor may decide to keep a child away from peanuts if a test shows that the child is highly sensitive to them. Therefore, testing first is necessary! They also provide recommendations for when, how, and how much to give peanuts. These recommendations specifically address the amount of peanut protein. Children in the “peanut group” consumed an average of 6-7 grams of peanut protein per week, divided into three meals.
They also understand that the new guidelines may face resistance, no matter how clear the figures may be. They also take into account some weaknesses of the study, the most important being the lack of a placebo. Also, children at low or medium risk of allergy were not included. I can therefore imagine that some (including the researchers) would prefer to see more research.
Personally, I would find it convincing enough to give my child peanut protein early if no sensitivity has been found. I would think that the benefits (reduced risk of allergy later) outweigh the risk of an allergic reaction occurring when no sensitivity has been measured. If the child is found to be sensitive, the choice is more difficult. It may be important to start earlier in this case, as shown by the research. Instead of a 35% chance of a peanut allergy, you could reduce the chance to 10%. But yes, the risk in that group is also greater. As mentioned, always consult with a doctor, making sure to check if they are aware of this development.
What Form of Peanuts?
One way to incorporate peanuts into the diet is by mixing soft peanut butter (without peanut pieces!) with water to make a puree. Solid foods with peanuts should not be the first solid foods introduced. However, from the moment they are introduced, they should be added to the diet about 3 times a week. Another option is peanut protein in powder form.
References
- annallergy.org/article/S1081-1206(16)31164-4/fulltext
- Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL.The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011 Jul;128(1):e9-17. doi: 10.1542/peds.2011-0204. PubMed PMID: 21690110.
- Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, Fox AT, Turcanu V, Amir T, Zadik-Mnuhin G, Cohen A, Livne I, Lack G. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008 Nov;122(5):984-91. doi: 10.1016/j.jaci.2008.08.039. PubMed PMID:19000582.
- Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team.Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13. doi: 10.1056/NEJMoa1414850. Erratum in: N Engl J Med. 2016 Jul 28;375(4):398. PubMed PMID: 25705822; PubMed Central PMCID: PMC4416404.
- rtlnieuws.nl/nederland/pindas-geven-aan-een-baby-dat-had-mijn-kind-niet-overleefd
