Peanut Allergy

Peanut allergy management has made the news again this week.  That is because of the evolving recommendations for how to address the problem, which have essentially “done a 180” and are exactly the opposite of where we were with this topic as recently as just a decade ago.  Then, avoidance was the conventional wisdom.  And I have previously commented on the subject myself.  Note that peanut allergy has been a growing problem in the US, where it has increased from 0.7% to > 2% of children from 1999 to 2010.  While rare, peanut allergy causes by far the most mortality from food caused anaphylaxis.

The change grew out of a surprising observation by doctors in Britain who noted that the incidence of peanut allergy among British Jewish children was much higher than children in Israel.  And it was noted that many Israeli children enjoy a popular peanut based snack called Bamba.  So they studied peanut allergy prone children aged 4-11 months, introducing peanut based foods to half the kids and no early peanut introduction to the rest.  The findings were startling and definitive: peanut allergy developed in only 1.9% of the peanut fed group as opposed to 13.9% of those avoiding peanut.

Hence the new and very different guidelines–instead of avoidance, we now recommend earlier introduction.  For infants from non-allergic families or those kids with mild eczema only, introduce peanut after 6 months as before.  Never give a child under age 4 a whole peanut (or any small, hard food for that matter because of the risk of choking) and peanut based food should not be the first solid introduced.

For children from families with strong history of peanut or egg allergy, or for those kids with moderate to severe eczema, the approach is more involved.  Blood tests and skin testing performed by an allergist or dermatologist, to assess risk beforehand.  Then, for those who are deemed lower risk, introduction of small amounts of peanut food by 4-6 months old, preferably the initial ingestion in the doctor’s office.  This can be 6-7 gm of food divided in 3 meals.  A good way to do it is to mix a few tsp of peanut butter with an equal amount of warm water to make a slushy consistency.  As above, never give a child a whole peanut and the peanut food should not be the first solids introduced.

So after 31 years of clinical practice I’ve seen the recommendations go one way and now the other.  If I keep this up long enough maybe someday we’ll head back in the other direction again. But for now, this is the best available data so this is the way we should be doing it.

Please contact me with any questions or comments, and thanks for following.

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