New research reveals consuming peanut butter in infancy may shield against acquiring a peanut allergy later.
Starting the consumption of peanuts during infancy, as early as around 4 months old, and continuing until around 5 years old significantly decreases the risk of developing peanut allergies in adolescence, according to a study published in the journal NEJM Evidence.
Professor Gideon Lack from King's College London, one of the study's authors, was not surprised by the findings, as infants in Israel are frequently exposed to peanuts, and there is no evidence of peanut allergy appearing later in life.
"Peanut allergy usually develops between the ages of six and 12 months in most children. To prevent a disease, it must be done before it takes hold. This concept is known as oral tolerance induction, which has been well-established for decades in animals that are fed foods like eggs, milk, or peanuts," Lack said.
In the year 2000, the American Academy of Pediatrics (AAP) advised delaying the introduction of peanuts until a child was three years old. However, a decade later, in 2019, the AAP changed its guidance, stating that delaying the introduction of allergens does not prevent disease and recommending that peanuts be introduced during infancy to potentially prevent peanut allergies.
Food allergies, including peanut allergy, are a growing concern in the US, affecting approximately 2% of children, or nearly 1.5 million people under the age of 18. Peanuts are among the most common causes of severe allergic reactions, including the potentially life-threatening anaphylaxis.
The findings of the study should provide confidence to parents and caregivers that introducing peanut products to their children from infancy, following established guidelines, could provide long-term protection from peanut allergies. This could prevent tens of thousands of cases of peanut allergy among the 3.6 million babies born in the US each year from developing the condition.
The study, called the LEAP-Trio trial, included participants from the UK who were part of a previous peanut allergy study called the LEAP trial. This trial, which followed infants with eczema and egg allergy to the age of five, found that the rate of peanut allergy was around 81% lower in those infants who consumed peanut products compared to those who avoided peanuts.
The researchers analyzed these children at age 12 and discovered that the group that had initially avoided peanuts had a peanut allergy rate of about 15%, while the group who had consumed peanut products had a rate of only 4%. This indicates a 71% reduction in the prevalence of peanut allergy at that age.
According to the researchers, introducing peanuts during infancy and continuing consumption until age 5 provides "lasting tolerance" to peanuts into adolescence. This explanation is further reinforced by the fact that the protection against peanut allergies persisted even when children stopped eating peanuts consistently after age 5.
Dr. Purvi Parikh, an allergist and immunologist at NYU Langone in New York and a spokesperson for the Allergy & Asthma Network, commented on the research, stating that it reaffirms that early introduction of peanuts not only reduces the chances of developing peanut allergies but also ensures that the protection persists into adolescence.
Parikh suggested that parents of children at low risk for allergies can start introducing peanuts around 4 to 6 months old under the supervision of a pediatrician, while children with severe eczema and egg allergy should consult an allergist before early introduction. She advised mixing peanut butter into a puree and avoiding chunky pieces that could potentially cause choking.
Lack concluded by emphasizing that babies with eczema have a higher risk of developing food allergies and should receive peanuts early in their lives to ensure protection.
"But a baby must be emotionally and mentally prepared to consume solid meals and be able to synchronize chewing and swallowing without the risk of choking. Typically, children begin weaning around four to six months of age, although this varies from child to child. Each infant should be examined case-by-case," he stated. "Moreover, the food should be provided as a soft puree to simplify swallowing and decrease the chance of choking. We do not suggest introducing solids prior to three months of age."
The fact that early peanut consumption leads to immunological tolerance has been verified by research in the past, but parents should consult their pediatrician before introducing their child to peanuts, according to Dr. Daniel DiGiacomo, a pediatric immunologist at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center in Neptune, New Jersey, who was not involved in the new study.
"The present consensus is to adopt a shared decision-making approach for meal introduction once the youngster is prepared developmentally, and has quickly tolerated a few complementary foods," DiGiacomo said in an email on Tuesday.
"I usually begin slowly by providing a pea-sized serving, doubling the amount each day until you have reached the age-appropriate serving size (or at least 2 teaspoons). Subsequently, continue to maintain this quantity several times each week," he said. "I often recommend parents mix the nut spread into a palatable puree, dissolve peanut puffs (if applicable) in water, or cook up a peanut sauce out of powdered peanut butter or peanut flour. Once more, we review the correct consistency and start slowly, advising parents to discontinue and phone their allergist if any concerns emerge."
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Introducing peanuts to children at a young age, as recommended by the updated guidelines from the American Academy of Pediatrics, is based on the concept of oral tolerance induction, as explained by Professor Gideon Lack.
Following established guidelines, introducing peanut products to infants from around 4 to 6 months old, under the supervision of a pediatrician, could provide long-term protection from peanut allergies.
Source: edition.cnn.com
