Early Introduction of Peanuts to Reduce Occurrence of Allergies

Healthful Vitality | 08/22/2019 | By Sarah Schulze, MSN, APRN, CPNP | Early Introduction of Peanuts to Reduce Occurrence of Allergies

One of the most difficult childhood issues for parents to navigate is food allergies. Finding foods, the child is able to eat, reading labels, making substitutions when cooking, and worrying about or screening any food the child gets from someone else can be very overwhelming and time consuming for parents, particularly for children with multiple or severe allergies. Among one of the most common, and often most dangerous, is the peanut allergy.

Why the early introduction of peanuts to reduce occurrence of allergies?

It is currently estimated that 1-2% of the population has an allergy to peanuts, nearly triple the number affected in the 1990s (3). Allergy symptoms can range from mild itchy skin, runny nose or congestion, and nausea to facial swelling, chest tightness, difficulty breathing, and a compromised airway. The common occurrence and life-threatening consequences of peanut allergies have led many public places to implement a “nut free” policy, prohibiting peanuts and sometimes tree nuts, as well as nut-containing products from common areas such as schools, ballparks, churches, and airplanes. Food labels are required to list peanuts and other common allergens in bold, easy to find sections so as to avoid accidental consumption.

Children most at risk of developing a peanut allergy are those demonstrating other signs of atopy, such as those children with eczema, other food allergies (particularly eggs), and wheezing or asthma. Recent years have shown a spike in the rate of peanut allergies and while an exact cause is unclear, emerging evidence is beginning to suggest that dietary restriction and avoidance of nuts in the hopes of preventing allergy may be to blame (3).

How it began in favor of the early introduction

In the last several years, allergy experts have begun to reverse the advice to avoid common allergens, in favor of early introduction. Breast milk is recommended as a baby’s sole source of nutrition for the first 4-6 months of life and is also considered protective against developing eczema or wheezing (1). Once a child is old enough to begin eating solid foods, it is recommended to introduce common allergens just as early as other foods that are not common allergens (1). Ground peanuts, or peanut powder, is typically considered the safest way to introduce peanuts around six months of age without presenting the choking hazard of whole peanuts or peanut butter. The powder can be easily mixed into any typical baby foods, and the American Academy of Pediatrics recommends three different methods of introduction based on the child’s likelihood of allergies.

Some background is required for the early introduction

For children with no family history, no known food allergies, and no eczema, dermatitis, or history of wheezing, peanut powder or peanut products can be introduced freely into the diet at the same time as other foods. As with any new food, 3-4 days should be allowed for each new item before adding another new food and parents should watch for any rashes, watery eyes, runny nose, or vomiting after ingesting new foods (3)

Children at an increased risk of allergy, such as those with mild-moderate eczema or a history of wheezing, should be introduced to peanuts at home with extra attention being paid for any signs of allergy. An in-office evaluation afterward may be beneficial but is not necessary (3).

And finally, those at highest risk, such as children with severe eczema, recurrent wheezing, a strong family history, or other known food allergies should have peanut allergy testing performed before introducing peanuts into the diet. If testing indicates an allergy, referral to an allergy specialist for further management and to consider a trial of ingesting peanut products is appropriate (3).

Favorable results of the early introduction approach

This tailored approach, rather than the blanketed avoidance that used to be recommended, has quickly been shown to reduce the incidence of allergies in the few years that it has been implemented. A 2018 compilation of evidence revealed that by age 5, children exposed early to peanuts had a 3.2% rate of allergy vs. the 17.2% in the avoidance group (2). These results are incredibly significant and have been repeated across several studies, leading to an overhaul of anticipatory guidance for food introduction and infants (2).

Although many children with a peanut allergy do eventually outgrow it, a large number do continue to be allergic for their entire lives, particularly those with the most severe reactions. Because of this, and the threat anaphylaxis poses on a child’s life, any intervention to reduce the number of those affected is a beneficial one. Knowledge about when and how to introduce peanuts into the diet is a simple and greatly effective tool for health care providers to implement in the primary care setting and beyond.

Also Read: Vaccine Hesitancy, a Modern Problem

References:

1. AAP (2019). Clinical report highlights early introduction of peanut based foods to prevent allergies. Retrieved from: https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Clinical-Report-Hi ghlights-Early-Introduction-of-Peanut-Based-Foods-to-Prevent-Allergies.aspx.
2. Perry, D., Lindblad, A. J., Bonnieca, I., Korownyk, C. (2018). Benefits of early peanut introduction. Canada Family Physicians 64 (3). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851397/
3. Sicherer, S. (2017). New guidelines detail use of “infant-safe” peanut to prevent allergy. AAP News. Retrieved from: https://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

Author:

Sarah Schulze is a board-certified pediatric Nurse Practitioner. She earned a B.S. in Nursing from Indiana State University and an M.S. in Nursing from the University of Illinois at Chicago.