Peanut allergy is one the rise. As one of the most common food allergies, it affects 1-2% of children, which doesn’t sound like much. But if your baby or toddler is among the 1-2%, it is one child too many.
Inside story: During a peanut allergy attack, the immune system misfires, regarding peanut proteins as harmful. Peanut allergy can bring on itchy skin or hives, which look like large or small welts, lip swelling, vomiting, and runny nose or congestion.
Airways can narrow too, making it hard to breathe. If your child is diagnosed with peanut allergy, you’ll have to do everything you can to help him/her avoid peanuts. Peanut allergy has no cure; it’s typically lifelong once it develops and it can be fatal.
Peanut protein is everywhere, even in the air. Avoiding peanuts is a lot of work—and the constant vigilance it takes to keep peanuts and peanut containing foods away from your child is scary and stressful. From daycare, play dates and birthday parties to school, summer camp and sleepovers, life is a lot more complicated when your child has a peanut allergy.
Peanut Allergy Prevention is Key!
That’s why the new guidelines for peanut allergy prevention published by the National Institute of Allergy and Infectious Diseases (NIAID) are such good a BIG deal.
For the first time, “we have an intervention that could potentially prevent peanut allergy,” says Anna Nowak-Wegrzyn, MD, associate professor of pediatrics at the Icahn School of Medicine at Mount Sinai and researcher at the Elliot and Roslyn Jaffe Food Allergy Institute in New York City.
The guidelines are based on a landmark 2015 New England Journal of Medicine study, the “Learning Early About Peanut” (LEAP) study, which suggested that giving infants peanut-containing foods could help prevent peanut allergy by 81 percent. That’s a HUGE reduction. “It’s a massive, dramatic effect,” Dr. Nowak-Wegrzyn says.
How can you safely give peanut containing foods to your baby to help prevent peanut allergy? What should you do, exactly? Dr. Nowak-Wegrzyn provides these basic steps, which are outlined in the guidelines, depending on your baby’s level of risk for developing peanut allergy.
Your baby is at high risk for developing peanut allergy if:
By 4 to 6 months of age, your baby has severe eczema or egg allergy or both.
Severe eczema = Eczema that’s frequent or persistent enough to require prescription-strength topical medication to treat it.
If your baby is high risk, do this:
- See your baby’s pediatrician/health care provider. At this visit, you’ll want confirm that your baby is, indeed, at high risk for peanut allergy. Your baby’s pediatrician will need to test for peanut sensitization, which means that your baby’s immune system has already been exposed to peanuts and recognizes peanuts as bad guys.“We know that children can become allergic to peanuts without every eating them,” Dr. Nowak-Wegrzyn says.If your child has severe eczema, for example, a peanut allergy can gain a foothold; peanut protein in the environment or on your hands can enter your baby’s body through microscopic breaks in the skin.Your pediatrician/your baby’s doctor will need to do a peanut skin prick test. If the pediatrician doesn’t do this test (many don’t), a blood test, known as Peanut sIgE will do.These tests measure peanut specific immunoglobin E, which are antibodies to peanuts. They can be done in the pediatrician’s office. In the case of the blood test, your baby’s blood work will be sent to a lab for actual testing. If your doctor isn’t comfortable doing these tests, you may be referred you to a specialist.
Go on peanut patrol. If your baby’s skin test or blood test is highly or significantly positive, your baby may already be allergic to peanuts. Unfortunately, it’s too late for prevention. Expect your doctor to talk with you about how to manage your child’s peanut allergy, which means peanut avoidance.
A supervised feeding. If your baby’s skin or blood test is negative or somewhat positive (there are lots of false positives on skin tests), your baby’s doctor should do a supervised feeding test in the doctor’s office. Bring a copy of the guidelines, which tell your pediatrician exactly how to do an in-office supervised feeding, just in case.
A feeding test just involves giving your baby a small dose of peanut butter (2 teaspoons) mixed with two to three teaspoons hot water, after it has cooled or 21 pieces of softened Bamba, which is corn pop cereal that contains peanut butter powder.
If your baby doesn’t have a reaction, expect your doctor to give you specific recommendations for introducing peanut-containing products at home. “You will need to introduce peanuts in a way that’s appropriate,” Dr. Nowak-Wegrzyn says.
At 4 to 6 months, babies aren’t developmentally ready for whole peanuts (radar: choking hazard). But if they’re already starting to eat “solid” food, such as infant cereal and mushy fruits and veggies, they can probably manage a slurry of peanut butter and water or breast milk.
If your baby is at a point in which he’s eating Cheerios, you can try feeding him Bamba; you can soften Bamba with a few teaspoons of water (recommended for babies under 7 months of age).
Keep in mind that feeding infants peanut products doesn’t prevent peanut allergy in all infants. In the LEAP study, 19 percent of infants who were fed peanut containing products still became allergic. Still, the method worked in 81 percent of the children in the LEAP study.
- Check back in. Your pediatrician will likely tell you to come back in six months just to see how your at-home peanut product feedings are going. The support can be helpful and reassuring.
Your baby is at moderate risk for developing peanut allergy if:
By 4 to 6 months of age, your baby has mild-to-moderate eczema.
Mild-to-moderate eczema = Ask your baby’s doctor if your baby falls into this category.
If your baby is at mild to moderate risk, do this: Start introducing peanut-containing foods into your baby’s diet starting at 6 months of age.
Note: You don’t need to visit the pediatrician for a skin or feeding test, Dr. Nowak-Wegrzyn says.
Your baby is at low risk for developing peanut allergy if:
By 4 to 6 months of age, your baby doesn’t have eczema or any food allergy.
If your baby is low risk, do this: Start introducing peanut-containing foods into your baby’s diet starting at 6 months of age, along with other solid foods, according to whatever peanut-containing foods your family likes to eat. Again, avoid feeding your child whole peanuts until age 4.
Important: Keep Up the Good Work!
If your baby is at high risk for peanut allergy, you have a window of opportunity to train your baby’s immune system to tolerate peanuts by feeding your baby peanut-containing products. “It’s racing against time,” Dr. Nowak-Wegrzyn says.
No matter what your baby’s risk, feeding foods containing peanuts to your baby “is not a one-time deal,” Dr. Nowak-Wegrzyn says. Especially if your baby in the high-risk category, you should feed your baby peanut-containing foods at least three times per week for at least the next year. In the LEAP study, kids ate peanut-containing food at least three times per week for five years. Researchers aren’t sure if five years is necessary.
But they do know this: You must make the commitment to feeding your baby peanut-containing products, “otherwise it’s not going to work,” Dr. Nowak-Wegrzyn says. If you just feed your baby food containing products for one or two months then quit, it could even be counterproductive by causing your baby to become allergic to peanuts, especially if your baby is in the high risk category.
Making an effort to give your baby peanut-containing products “really pays off,” Dr. Nowak-Wegrzyn says. “Regular intake for a long time makes a big difference.”
Practicing peanut allergy prevention for a few years is challenging, but it’s a lot easier than peanut allergy management, which is typically a forever endeavor.
In all cases, your baby should be firmly on solids before you add to peanut-containing foods to his diet.
For feeding your baby a peanut containing food at home for the first time (double check this strategy with your baby’s pediatrician):
–Give your baby’s first peanut product feeding at home, not at a restaurant or at daycare.
–Offer only a small amount on the tip of a spoon.
–Wait 10 minutes.
–If there’s no allergic reaction after this tiny taste, give the rest of the serving to your child. A full serving might be a 2 teaspoons of peanut butter mixed with a little breast milk.
–Spend the next two hours with your baby so you can watch for any signs of an allergic reaction.
Check out this post for more baby food for thought.
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