Thursday, September 3, 2015

Updated recommendations to help thwart the peanut allergy epidemic

From the desk of Shelly Flais, MD

Twenty or thirty years ago, it was rare to have a friend or classmate with a peanut allergy. Times have changed. The number of children in the U.S. with a peanut allergy has more than tripled between 1997 and 2008. These days anywhere from 6 to 9% of all kids have a food allergy of some kind, meaning in a typical classroom 2 or 3 kids can be affected. This is an issue near and dear to my heart, as 2 of my 4 kids have peanut allergies.

Why has peanut allergy been on the rise? What can we do to prevent allergies? Food allergy research continues and has begun to shed new light on the issue. For several years, in an attempt to combat the rising epidemic, national medical organizations recommended that if an infant was at high risk for a peanut allergy (either because of family history or eczema), they should not eat peanut containing products until the 3rd birthday. Unfortunately, this advice to delay peanut introduction did not seem to impact the overall number of new cases of peanut allergy.

This past winter, a new study was published in the New England Journal of Medicine that will change the recommendations from the American Academy of Pediatrics (AAP) and the American Academy of Allergy, Asthma, and Immunology (AAAAI). The study looked at 642 children between 4 to 11 months of age who either had eczema or egg allergy, and were therefore at risk of developing an allergy to peanut. These children underwent allergy skin testing to peanut to ensure they could safely tolerate peanut products. One group of babies was instructed to eat peanut products regularly (3 times per week), and the other group avoided peanuts completely. By the 5th birthday, only 3% of the kids eating peanut products were allergic to them, and 17% of the babies who avoided peanut now had a peanut allergy.

Important clarifications to the NEJM study: this new information helps to determine how we might be able to prevent an allergy to peanut in at-risk children, not how to cure an already-diagnosed peanut allergy. If your child has ever had a rash or other reaction to peanuts, or has already been formally diagnosed with a peanut allergy, he or she needs evaluation by your pediatrician, as well as continued avoidance of peanuts. They should have autoinjectable epinephrine and antihistamines available at all times.

Should you give your baby (aged 4 months to 11 months) a peanut-containing product? If your family has a history of food allergy, or your baby has eczema, please consult with your pediatrician first. In these cases, preliminary allergy testing may be recommended. As with the introduction of all solid foods to an infant older than 4 to 6 months of age, wait 3 days before the introduction of another new food so as to be able to determine the cause of any adverse reactions.

For more information about peanut allergy from FARE (Food Allergy Research and Education):

American Academy of Pediatrics information about peanut allergies:

American Academy of Pediatrics information regarding introducing solid foods:

For more allergy information from AAAI (American Academy of Allergy, Asthma, and Immunology):

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