Over the past decade, there has been an uptick in children with peanut allergies. The usual recommendation is children that are high risk for the allergy to avoid all peanut products before the age of three. A recent study is challenging the idea of total peanut avoidance. The LEAP study has come out with new guidelines that might prevent high risk children from developing the allergy.
Dr. Gerald Nepom is the emeritus director of Benaroya Research Institute and has published over 350 scientific papers in the areas of immunology, genetics and autoimmunity. He joins us to explain LEAP, the study’s findings, and the new guidelines on peanut allergies.
The LEAP study or Learning Early About Peanut allergy, was conducted to discover if you could train your child's immune system to not develop a peanut allergy, even if they are at risk for one. In a controlled setting they were able to discover how you could potentially prevent the allergy. The new guidelines have been endorsed by the American Academy of Pediatrics as well as other prominent organizations.
What are the new guidelines?
When dealing with the risk of peanut allergies, the old recommendation was to avoid any peanut product for the first year of life. Now, and especially in children that would be considered high risk, the LEAP study found that exposure as early as four months old could be beneficial.
“We recommend early introduction of peanut flour into the diet as early as four months of age. As the babies are being weaned off of breast feeding and begin to ingest other kinds of food,” says Nepom. “That’s the perfect time to start introduction of peanuts and most children will tolerate that just fine and don’t need medical supervision.”
Nepom recommends creamy peanut butter or formula made with peanut flour to reduce the choking risk with whole peanuts. As for how much and how long you should be giving your baby regular feedings of peanut products, there isn’t a clear time table, but the study did find success with one feeding schedule.
“In terms of the LEAP trial, we made sure the children experienced oral peanut flour three times a week, and they maintained that for five years, for the first five years of their life,” said Nepom.
This is supposed to help train the immune system not to react to a non-dangerous item. Since the immune system learns what not to and what to react to training it early is beneficial.
“Our immune system experiences our environment and that turns out to be very important for educating the immune system to be in the future, as we grow up safe and protective,” says Nepom. “We feel there have been substantial changes in the way we protect our babies during that first year in what they get exposed to and the immune system hasn’t caught up yet. It makes mistakes.”
What makes a child high risk?
Some children are at a higher risk of developing a peanut allergy than others. The risk factors include:
- Family history
- Present eczema
- Egg allergy
It is recommended to introduce peanut products to the child in a doctors office for the first time. Not only can they do a skin test to check for an allergy, but if the child does have a reaction to peanut flour they are under supervision.
“If the parents are concerned about this, or if the child has the family history, the eczema, or the egg allergy we recommend that they be introduced to oral peanut flour the first under supervision in a physician’s office just to be sure because that way if there is an allergic reaction which would be extremely unusual but could happen, they will be under medical supervision at the time,” said Nepom.