Study finds eating peanuts as a child may help protect against future allergies

(CNN) — New evidence suggests that feeding soft peanut butter to children during childhood may help reduce the risk of developing a peanut allergy even years later.

Compared with avoiding peanuts, starting peanut consumption in infancy (about 4 months, such as in a smooth, pureed paste form) and regularly continuing until about 5 years of age was associated with a 71% reduction in levels, according to a study published Tuesday in the journal NEJM Evidence, peanut allergy among UK teenagers.

“I wasn’t very surprised because children in Israel start eating peanuts very early, and allergies don’t seem to occur in teenagers or adults. This suggests that the protection is long-lasting,” Gideon Lack, a professor of pediatric allergy at King’s College London and an author of the study, said in an email.

“Most children develop a peanut allergy very early, between 6 and 12 months of age. If you want to prevent disease, you need to do it before it develops,” Lack said about the effects of peanuts on children. “This biological phenomenon is based on an immunological principle known as oral tolerance induction. “We have known for decades that young mice or other experimental animals fed foods such as eggs, milk or peanuts cannot later develop allergies.”

Beginning in 2000, the American Academy of Pediatrics (AAP) recommended delaying the introduction of peanuts until age 3, but rescinded this recommendation in 2008.

About a decade later, in 2019, the AAP updated its recommendations, stating that delaying the introduction of allergenic foods does not prevent disease and that “there is now evidence that early introduction of peanuts may prevent peanut allergy.”

Food allergies have become a growing public health problem in the United States, with peanut allergy estimated to affect approximately 2% of children in the United States, or nearly 1.5 million people under the age of 18. Peanuts are among the foods that can cause the most serious allergic reactions, including the risk of life-threatening anaphylaxis.

“The findings should reinforce the confidence of parents and caregivers that feeding their young children peanut products from infancy, according to established recommendations, can provide long-term protection against peanut allergy,” said Dr. Jean Marrazzo, director of the US National Institutes. Allergy and Infectious Diseases, in a press release Tuesday. “If implemented widely, this simple and safe strategy could prevent tens of thousands of cases of peanut allergy among the 3.6 million children born in the United States each year.”

The new study, called the LEAP-Trio, included data from children in the United Kingdom who participated in a peanut allergy study called LEAP during infancy.

This earlier study included children with eczema and egg allergies who were followed until age 5, and found that at this age the prevalence of peanut allergy was about 17% in the group of children who avoided peanuts, compared with about 3% in the group of children who avoided peanuts. children avoid peanut products, representing an 81% relative reduction in peanut allergy.

The purpose of the LEAP-Trio study was to determine whether the reduction in the risk of peanut allergy would persist into adolescence.

About 500 children were re-evaluated for the LEAP-Trio study, which looked at the incidence of peanut allergy at about 12 years of age.

At this age, peanut allergy was still “significantly more common” among children who initially avoided peanuts, with about 15% having a peanut allergy. The researchers found that among those who initially consumed peanuts, about 4% had a peanut allergy. They wrote that this represented “a 71% reduction in the prevalence of peanut allergy during the LEAP-Trio.”

But overall, when children started eating peanuts in infancy and continued to do so until around age five, it appeared to provide “long-term tolerance” to peanuts into adolescence, according to researchers from the UK and US.

The new findings provide “strong evidence” that early peanut introduction not only reduces the development of peanut allergy, but that protection continues into adolescence, even when children stop eating peanuts consistently after age 5. an allergist and immunologist at New York University and a spokesman for the Allergy and Asthma Network, who was not involved in the new study, said in an email Tuesday.

“So ideally, if there are no other risk factors, we should continue to introduce these allergens early, between 4 and 6 months, and continue to use them consistently until age 5, but after that we don’t need to be as consistent.” said.

Parikh added that introducing peanuts to children at low risk of allergies can be done around 4 to 6 months of age under the guidance of a pediatrician, but children with severe eczema and egg allergies should consult an allergist before early introduction.

“Since babies cannot yet swallow solid food, it is recommended that they have a liquid consistency similar to breast milk or formula and can be mixed with it to avoid choking, and start with a small amount and gradually increase it depending on tolerance every 3-4 times. days,” Parikh said.

To introduce peanuts into your child’s diet, it is recommended to use smooth peanut butter mixed into a puree and avoid chunks of peanuts, which may pose a choking hazard.

“In general, you can tell parents, ‘the earlier the better,’ especially for children with eczema,” Lack said, noting that children with eczema have a much higher risk of developing food allergies and develop them much earlier in the first days of life. year of life.

“However, the child must be neurologically and developmentally ready to eat solid foods and be able to coordinate chewing and swallowing without the risk of choking. Most babies will be able to start weaning between four and six months, but every baby is different and needs to be assessed individually,” he said. “In addition, food should be given as a smooth puree to make swallowing easier and reduce the risk of choking. “We do not recommend introducing complementary foods before three months of age.”

The finding that early introduction of peanuts induces tolerance has also been supported by previous studies, but the decision to introduce peanuts to your child should be discussed with your pediatrician, according to Dr. Daniel DiGiacomo, a pediatric immunologist at K. Hovnanian Children’s Hospital. Jersey Shore University Medical Center in Neptune, New Jersey, which was not involved in the new study.

“Current expert opinion is to take a general approach to making decisions about introducing solid foods when the baby is developmentally ready and has tolerated a couple of other solid foods without problems,” DiGiacomo said in an email Tuesday.

“Usually start by slowly introducing a pea-sized portion, doubling it each day until you reach an age-appropriate portion (or at least 2 teaspoons). Then continue this into your diet several times a week,” he said. “I usually ask family members to blend nut butters into an acceptable puree until they get the consistency they want; You can also dissolve peanut brittle (if using peanuts) in water or make peanut sauce using powdered peanut butter or peanut flour. Again, we make sure the sequence is correct and start slowly, with instructions to stop and contact an allergist if any problems arise.”