Exciting New Guidelines Help Prevent Peanut Allergies

By Caren Kirschner, MD

I’ll never forget a phone call I received on call one Saturday night several years ago from a local emergency room. One of our patients named Samantha, an 11-year-old girl at the time, had gone to a local hoagie shop with her parents and two sisters. Samantha had been diagnosed with a peanut allergy when she was around 5 years old. Samantha’s parents had become very vigilant about checking there were no peanut-containing products in anything she ate, but unfortunately, they forgot to check this one time when they ordered her a hoagie.

Why would a good old-fashioned Philly hoagie have peanuts? Unbeknownst to the parents, this particular hoagie shop used peanut oil in their hoagies and neglected to inform their customers. Samantha developed an anaphylactic reaction and ended up in the emergency room after her parents used their EpiPen® in the restaurant. They needed to call 911 because she was having difficulty breathing. Luckily, she recovered but only after a very scary situation.

For years, the general recommendations that were intended to help prevent peanut allergies in children mainly involved avoiding peanut-containing products for the first several years of life. We routinely told parents to hold off in introducing these products to their babies. It turns out that a new comprehensive and convincing study revealed that early introduction of peanut-containing products actually prevents peanut allergies. This was first recognized when researchers observed Israeli children had a remarkably low incidence of peanut allergy. Israeli babies are frequently given a food called Bamba that contains peanut protein. Subsequently, a five-year study involving over 600 children was done that showed a significantly large decrease incidence of peanut allergy in babies exposed early to peanut-containing products.

In light of this new research, the National Institutes of Health (NIH) has issued the following new guidelines for introducing peanuts to babies. These guidelines are separated in three groups:

Group 1(highest-risk) This group includes babies with severe eczema and/or an egg allergy. These babies should undergo peanut allergy testing. They should be first introduced to peanut-containing products between 4-6 months at an allergist’s office.

Group 2 (milder-risk) This group includes baby who have mild to moderate eczema. They do not need to be tested for a peanut allergy. They should be introduced to peanut products at around 6 months at home.

Group 3 (low-risk) These infants have neither eczema nor any food allergies. For these babies, the parents can introduce peanut products with other foods based on their own personal and cultural preferences.

Of note, peanuts or any form of chunky peanut butter should never be given to babies and small children because they are choking hazards. Instead, parents can mix a small amount of peanut butter in some puréed food and offer it with a spoon. This should be given several times a week until they are 5 years old.

Over our many years of taking care of children here at Fox Chase Pediatrics, we have witnessed the decline of many illnesses as new treatments and vaccines have been developed. I am hopeful and excited that we will see the decline of peanut allergy so I never have to see a patient develop a life-threatening reaction because he/she was simply ordering a hoagie with their family.

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