Peanut Allergy Prevention

By Aliza Beer MS, RD

An allergy to peanuts is among the most common food allergies found in children in the United States. Many schools, including most yeshivas, have declared that they are nut-free,” meaning that the onetime staple for kids’ lunches, a peanut butter and jelly sandwich, is nowhere to be found on school grounds these days. That is because peanuts are one of the food allergens most commonly associated with anaphylaxis, a sudden and potentially deadly condition that requires immediate medical attention and treatment. Peanut allergies effect about 2% of the children in the United States, and the numbers are growing every year. The question is, can we prevent a peanut allergy from developing? A recent study in Israel and the UK suggests yes.

In Israel, there is a custom of feeding infants Bamba snacks as soon as they possibly can. Bamba contains 50% peanuts. In Israel the rates of children with a peanut allergy are also extraordinarily low, much lower than Jewish children in the UK. Dr. Gideon Lack, a professor of pediatric allergy at King’s College London, led an international team of researchers in this groundbreaking study based on the idea that Israeli children have lower rates of peanut allergy compared to Jewish children of similar ancestry residing in the United Kingdom. The study tested the hypothesis that the very low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption beginning in infancy.

Researchers recruited 640 children who already had an egg allergy or eczema, both indicators of children prone to a peanut allergy. The children, aged 4-11 months, were divided into two groups. The first group of 530 children did not have a peanut allergy in the initial skin-prick allergy test, while the second group of 98 infants had a weakly positive test when the study began. These groups were then divided again into two groups: in one group parents were asked to feed their babies peanut butter or Bamba three times a week until the age of five. The second group was told to keep their children’s diets peanut-free until age five. The children were tested for allergies again when they turned five. Researchers found that exposing infants to peanuts within their first year helped prevent a peanut allergy by as much as 81%! These children were tested again a year later and all the kids who did not have a peanut at age 5 still did not have a peanut allergy at age 6.

This study has helped to change the recommendations on how and when to introduce peanuts to children. Recommendations fall into three categories. The first category includes children who are believed to be most likely to develop a peanut allergy infants who have severe asthma, egg allergy or both. Parents can introduce these children to peanut-containing food at 4-6 months, or see an allergist to determine if the infant is allergic to peanuts. If not allergic, then parents may follow the recommendation of introducing peanut-containing foods at 4-6 months. However, if the infant is allergic, parents should avoid feeding them peanut-containing foods. The second category includes children with mild to moderate eczema, and therefore, less likely to have an allergy. These infants can be introduced to peanut-containing foods at about 6 months of age. Finally, the third category belongs to children with no eczema or food allergies and no family history of such. These children can either be fed peanut-containing foods or not at any age, based purely on family and cultural preferences.

It is now known that the developing immune system samples the environment early in life as part of its training. A question can be asked: will a similar technique prevent other common food allergies, such as milk, eggs or soy? There have been some small studies that suggest this will work for other food allergens, but none as large or rigorous as the peanut study. If your infant is not allergy prone, then discuss with your pediatrician the idea of introducing peanut-containing food like Bamba early on.

Always discuss any possible changes in diet with your physician first before implementing them.