During my time as a culinary instructor, I was given the opportunity to teach in several of our local elementary schools. During my time walking the halls I began to notice that almost every single classroom had a “SEVERE PEANUT ALLERGY” warning on the door.
Back when I was in elementary (in the early 2000s- chill out, I’m not THAT old), I only remember about 2-3 kids at all with a peanut allergy! Granted I was a kid and not really paying attention- but after some research, I found my hypothesis to be correct!
According to FARE (Food Allergy Research and Education),
- The Centers for Disease Control & Prevention reports that the prevalence of food allergy in children increased by 50 percent between 1997 and 2011.
- Between 1997 and 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children.
Because the allergy to tree nuts has become so prevalent, many researchers have set out to find out WHY?
A study released in 2015 that was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and was conducted by the NIAID-funded Immune Tolerance Network(link is external) (ITN), found that early introduction to peanuts in infancy prevents the peanut allergy!
More than 600 high-risk infants between 4 and 11 months of age were assigned randomly either to avoid peanut entirely or to regularly include at least 6 grams of peanut protein per week in their diets. The avoidance and consumption regimens were continued until 5 years of age. Participants were monitored throughout this period with recurring visits with health care professionals, in addition to completing dietary surveys by telephone.
The researchers assessed peanut allergy at 5 years of age with a supervised, oral food challenge with peanut. They found an overall 81 percent reduction of peanut allergy in children who began early, continuous consumption of peanut compared to those who avoided peanut.
Here is a link to the study if you want to read more.
Because of recent research findings, the American Academy of Pediatrics now advises you follow these guidelines when deciding to introduce peanuts.
Guideline #1 recommends that the highest risk infants — those with severe eczema and/or egg allergy (see definitions below) — be introduced to peanut as early as 4-6 months of age, following successful feeding of other solid food(s) to ensure the infant is developmentally ready. Allergy testing is strongly advised prior to peanut introduction for this group.
Guideline #2 suggests that infants with mild to moderate eczema, a group also at increased risk of peanut allergy, should be introduced to peanut “around 6 months of age, in accordance with family preferences and cultural practices, to reduce the risk of peanut allergy.” These infants may have peanut introduced at home following successful ingestion of other solid food(s) without an in-office evaluation, although an evaluation can be considered.
Guideline #3 addresses infants without eczema or food allergy who are not at increased risk, suggesting that peanut be introduced “freely” into the diet together with other solid foods and in accordance with family preferences and cultural practices.
Definitions in the addendum guidelines
Severe eczema is defined as persistent or frequently recurring eczema with typical morphology and distribution, assessed as severe by a health care provider and requiring frequent need for prescription-strength topical corticosteroids, calcineurin inhibitors or other anti-inflammatory agents despite appropriate use of emollients.
Egg allergy is defined as a history of an allergic reaction to egg and a skin prick test wheal diameter of ≥3 millimeters with egg white extract or a positive oral egg food challenge.
How to Introduce Peanuts
- Is the baby ready to eat solid foods? This is the first consideration. They should already be eating other solid food before introducing any peanut-containing foods.
- Introduce foods that will be served in with peanut butter- yogurt, bread, oatmeal, etc.
- Never give an infant whole peanuts, chunks or undiluted peanut butter. The baby could choke.
- Never offer plain peanut butter on a spoon- this can also be a choking hazard.
- Use smooth (not chunky) peanut butter until age 2.
In the beginning, the toast with peanut butter will be the easiest to serve because they can hold it much more easily. However, this is a great time to start working on “self-spoon-feeding”. This can be taught by having the parent PRE-LOAD the spoon then hand it to the baby or set it on the tray. Then the child is able to practice self-feeding but the adult is able to facilitate re-loading the spoon to eliminate frustration. Around 10 months to one year old your child will begin to try to load the spoon him/herself!
With a potentially huge public health impact, new AAP-endorsed guidelines outline a new approach that promises to reduce the risk of peanut allergy. The new guidelines recommend that before 11 months of age, all infants should start eating age-appropriate peanut-containing foods. The ideal age is closer to six months.
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