Have peanuts, avoid allergies

Peanut allergies are responsible for more deaths from anaphylaxis, than any other food allergy

Peanuts are back on the menu. In a significant reversal from past advice, new national health guidelines call for parents to give their children foods containing peanuts early and often, starting when they’re infants, as a way to help avoid life-threatening peanut allergies.

The new guidelines, issued by the National Institute of Allergy and Infectious Diseases on Thursday, recommend giving babies pureed food or finger food containing peanut powder or extract before they are six months old, and even earlier if a child is prone to allergies and doctors say it is safe to do so. One should never give a baby whole peanuts or peanut bits, experts say, because they can be a choking hazard.

If broadly implemented, the new guidelines have the potential to dramatically lower the number of children who develop one of the most common and lethal food allergies, said Anthony Fauci, the institute’s director, who called the new approach “game changing.”

Could the new guidelines mark the end of the peanut-butter-and-jelly sandwich bans so common in school lunchrooms? “If we can put this into practice over a period of several years, I would be surprised if we would not see a dramatic decrease in the incidence of peanut allergies,”  Fauci said.

Peanut allergies are responsible for more deaths from anaphylaxis, or constriction of the airways, than any other food allergy. Though deaths are extremely rare, children who develop a peanut allergy generally do not outgrow it and must be vigilant to avoid peanuts for the rest of their lives. “You have the potential to stop something in its tracks before it develops,” said Matthew Greenhawt, chairman of the American College of Allergy, Asthma and Immunology’s food allergy committee, and one of the authors of the new guidelines. It appears there “is a window of time in which the body is more likely to tolerate a food than react to it, and if you can educate the body during that window, you’re at much lower likelihood of developing an allergy to that food,” Greenhawt said.

The guidelines, published in Annals of Allergy, Asthma and Immunology and several other journals, represent an about-face from the advice given out by the American Academy of Pediatrics as recently as 2000, when parents were told to withhold peanuts from children at high risk for allergies until they were three years old.

Despite those recommendations, the prevalence of peanut allergies kept increasing. Ten years later, around two per cent of children in the United States had the allergy, up from less than half of one per cent in 1999, and the academy started retreating from its advice, which didn’t seem to be working.

The new guidelines grow out of several studies conducted in recent years that challenged the advice to ban peanuts in infancy, long a standard practice in the United Kingdom, Australia and the United States.

One report, published in 2008, was carried out by scientists intrigued by anecdotal reports that Jewish children in Israel rarely suffered from peanut allergies. Gideon Lack, the senior author of the study and a professor of pediatric allergy at King’s College London, compared the allergy rates of Israeli Jewish children with those of Jewish children in Britain, and found that British children were 10 times as likely to have peanut allergies as Israeli children, a disparity that could not be explained by difference in genetic background, socioeconomic class or tendency to develop other allergies.

One of the main differences between the two populations was that starting in infancy, Israeli children ate foods containing peanuts, often in the form of Bamba, a popular peanut-butter puffed corn snack that has the consistency of a cheese puff but is 50 per cent peanuts, according to the manufacturer, Osem Group. Was it possible that early exposure to peanuts actually protected the Israeli kids from allergies?

Lack and fellow scientists tested the hypothesis in a large clinical trial in England. They recruited hundreds of infants aged four to 11 months, all of whom were deemed at high risk of developing a peanut allergy because they had eczema or an allergy to eggs. After running skin-prick tests on the babies and excluding those who were already allergic to peanuts, they randomly assigned some babies to be regularly fed peanut products, and others to be denied all peanut-containing foods.

By the time they turned five, only 1.9 per cent of 530 allergy-prone children who had been fed peanuts had developed an allergy, compared with 13.7 per cent of the children who were denied peanuts. Among another group of 98 babies who were more sensitive to peanuts at the start of the study, 10 per cent of those who were given peanuts developed an allergy, compared with 35 per cent of those denied peanuts. The findings, published in The New England Journal of Medicine in 2015, “shook the foundation of the food allergy world,” Greenhawt said.

The new guidelines divide children by risk. Low-risk infants, who don’t have eczema or an egg allergy and who have started solid foods, can be introduced to peanut-containing foods around six months at home by their parents. So can moderate-risk children, who have mild eczema.

©2017 The New York Times News Service