The New England Journal of Medicine recently published two studies that strengthen evidence that feeding peanuts and other allergy-inducing foods to babies is more likely to protect them than to cause problems. Given previous recommendations, focused on food-avoidance, parents may be surprised by the latest research. In this Q & A, Dr. Wan-Yin Chan, CHOC Children’s allergist and immunologist, offers the following explanation and highlights the newest approach to preventing peanut allergies and other food allergies.
How many children are living with food allergies in the United States?
Food allergies strike approximately eight percent of children in the U.S., with less than two percent dealing with peanut allergies. These allergies can present in a child as early as infancy, with the most common reactions being hives, itching, skin flushing (redness accompanied by a warming sensation), vomiting, facial swelling, wheezing, coughing, closing of the throat and cardiovascular collapse.
What do you think about the two new studies?
I am not surprised by the findings that early introduction can lead to a decrease in peanut allergies. The first study demonstrated tolerance to peanuts after an avoidance period of 12 months. This study is a follow-up to an earlier study last year that found a reduction in peanut allergy at the age of 5 after introducing peanut proteins to high-risk infants from 4 – 11 months of age.
The second study looked at introducing six common allergic foods in breastfed infants at 3 months of age (alongside continued breastfeeding) versus waiting until 6 months of age. The study showed significantly lower relative risks of peanut allergy and egg allergy in the early introduction group by 3 years of age; however, the risk of milk, sesame, fish and wheat allergies was not significantly impacted.
Will your team make any changes to the way you introduce allergy-inducing foods to patients?
We plan to allergy test high-risk patients (history of severe eczema and/or egg allergy) before deciding whether to introduce peanut into their diets.
What are different ways to introduce peanut into the diet?
For low risk infants, parents can introduce peanuts at home through peanut powder sprinkled into pureed foods, thinned smooth peanut butter or Bamba (peanut puff snack). Actual peanuts should not be given to children less than age 3 as they are choking hazards.
What do you anticipate will be parents’ reactions to these new guidelines?
Parents will probably be very surprised at first, given the old recommendations. However, the latest research results provide scientific evidence that early introduction leads to a decrease in the incidence of peanut allergies and sustained tolerance. Parents should address any concerns with their pediatrician, who may refer them to a pediatric allergist.
What additional research would you like to see conducted?
I’d like to see more research related to other common allergenic foods such as tree nuts and seafood, which can cause life-threatening reactions.
Dr. Wan-Yin Chan is board certified in pediatrics and allergy & immunology. Prior to joining CHOC Children’s, she attended medical school at the College of Medicine at East Tennessee State University in Tennessee. She completed her pediatric residency and fellowship training in Immunology, Allergy and Rheumatology at the University of California, Los Angeles. Dr. Chan speaks fluent Cantonese.