By Peter Jung, MD
The unfortunate recent death of a 15-year-old girl in Florida has once again brought peanut allergies to the forefront of the news cycle. It is a tragedy that recurs too often and highlights the real dangers of food allergies, particularly to peanuts and tree nuts.
The prevalence of peanut, tree nut allergies
Although up to one-third of parents report adverse reactions to food, the true rate of food allergies is significantly lower. Approximately 5 to 10 percent of children are sensitized or allergic to foods.
The prevalence of either peanut or tree nut allergies is about 0.4 to 1.3 percent in children, and 0.5 to 1 percent in the overall population. However, peanut and tree nut allergies often coexist together: 30 to 40 percent of patients with an allergy to one or the other are actually allergic to both.
Risk factors for children developing a peanut allergy include:
- a history of eczema
- a history of peanut allergies in the family
- the presence of a known egg allergy
- severe eczema as a baby
New recommendations for first exposure to peanuts
The timing of first exposure to peanuts probably influences whether an allergy will develop or not. In countries where peanuts were recommended to be delayed until three years of age, the rate of peanut allergies was double compared to other countries where no such recommendation existed. Further, the Learning Early about Peanut Allergy (LEAP) trial showed a benefit to introducing peanuts between 4 to 11 months of age.
In 2000, the American Academy of Pediatrics (AAP) had previously recommended to delay high-risk foods such as peanuts until certain ages — three years of age in the case of peanuts, tree nuts and fish. However, evidence to the contrary has now led the AAP to reverse this recommendation.
In the majority of the population, early introduction to certain foods is helpful to reduce the risk of developing an allergy to them. However, in children with severe eczema or having a known egg allergy, it is prudent to consult an allergy specialist prior to introducing high-risk foods such as peanuts and tree nuts.
How to introduce your child to peanuts
There are a number of commonly used methods to introduce peanuts to babies who are tolerating solid foods.
- Mix 2 teaspoons of peanut butter with hot water until an easy-to-swallow mixture is created. Allow the puree to cool before serving.
- Mix 2 teaspoons of peanut butter powder with infant cereal, yogurt, or applesauce.
- If your child is able to eat puffed foods, introduce a peanut-containing snack.
The very first time you serve peanuts, allow your baby to eat a small spoonful of food and then wait ten minutes. If no reaction occurs, proceed to feed the rest of the meal and observe the baby for two hours after the meal. If at any point a reaction such as vomiting, a rash, or breathing issues occur, call your pediatrician for advice or seek emergency medical care.
It’s important to note that whole peanuts and undiluted peanut butter can pose choking hazards to infants and should be avoided.
The future of food allergy management
For children who are already sensitized to peanuts and tree nuts, a number of new therapies aimed at desensitization are being researched and show promise. However, because these treatments are new, parents should be cautiously optimistic. Those interested should consult a pediatric allergist who is well versed in the latest research.
As Benjamin Franklin once said, “an ounce of prevention is worth a pound of cure.” Hopefully, as more children are introduced to peanuts at an early age, we will see fewer news stories highlighting their danger.