New Study Reveals Introducing Peanut Butter in Infancy Reduces Risk of Peanut Allergy

New research shows that introducing smooth peanut butter to children during infancy and early childhood may lower their chances of developing a peanut allergy later on.

A recent study published in the journal NEJM Evidence found that children who started consuming peanuts as early as 4 months old, in the form of a soft pureed paste, and continued until around 5 years old, had a 71% lower risk of developing a peanut allergy compared to those who avoided peanuts altogether.

"I wasn't completely surprised by the findings, as infants in Israel are introduced to peanuts at a young age, and allergies don't typically surface in adolescence or adulthood. This indicates that the protection against peanut allergies lasts a long time," shared Gideon Lack, a professor of pediatric allergy at King's College London and one of the study's authors.

According to Lack, peanut allergies usually develop in children between six and 12 months of age. He emphasized the importance of early exposure to peanuts for disease prevention, stating, "If you want to prevent a disease, it needs to be addressed before it even has a chance to develop." This concept is based on the immunological principle of oral tolerance induction. Lack pointed out that research has shown that young mice and other experimental animals that are fed foods like egg, milk, or peanut are less likely to develop allergies later on.

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In 2000, the American Academy of Pediatrics advised waiting until children were 3 years old before introducing peanuts. However, this recommendation was reversed in 2008.

About ten years later, in 2019, the AAP updated its guidance regarding the introduction of allergenic foods. They stated that delaying the introduction of these foods does not prevent disease. In fact, there is now evidence suggesting that introducing peanuts early on may actually help prevent peanut allergies.

Food allergies have become a growing concern in the United States, with peanut allergy affecting around 2% of children, which is approximately 1.5 million individuals under the age of 18. Peanuts are one of the food types that can trigger severe allergic reactions, including the potentially life-threatening condition known as anaphylaxis.

Dr. Jeanne Marrazzo, director of the US National Institute of Allergy and Infectious Diseases, shared in a news release on Tuesday that parents and caregivers can feel reassured by the latest findings. Starting infants on peanut products following established guidelines can offer long-lasting protection against peanut allergy. This safe and straightforward approach, if widely adopted, has the potential to prevent numerous cases of peanut allergy among the 3.6 million children born in the United States each year.

The LEAP-Trio trial, a recent study, included information on children from the United Kingdom who took part in the LEAP trial as infants to examine peanut allergy.

In a previous study, infants with eczema and egg allergy were tracked until age 5. It was discovered that at this age, the prevalence of peanut allergy was approximately 17% in the group of children who avoided peanuts. In comparison, it was only about 3% in the group that consumed peanut products, showing an 81% relative decrease in peanut allergy.

The LEAP-Trio trial was designed to investigate if this lower risk of peanut allergy would continue into adolescence.

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A follow-up study involving approximately 500 children was conducted as part of the LEAP-Trio trial, which aimed to determine the prevalence of peanut allergy among participants at the age of 12.

At that age, the children who avoided peanuts originally had a significantly higher prevalence of peanut allergy, with about 15% being allergic. On the other hand, among those who consumed peanuts from the start, only about 4% had a peanut allergy, according to the researchers. They noted that this shows a 71% decrease in peanut allergy prevalence at the LEAP-Trio time point.

The researchers, based in the United Kingdom and the United States, found that introducing peanuts to children at a young age and continuing this practice until around age 5 seemed to result in lasting tolerance to peanuts into adolescence.

The recent study findings provide great reassurance that introducing peanuts early can reduce the risk of peanut allergies. Dr. Purvi Parikh, an allergist at NYU Langone, mentioned that this protection can last until adolescence even if children stop consuming peanuts regularly after the age of 5.

According to Parikh, it is recommended to start introducing allergens like peanuts between 4-6 months and continue consistently until age 5. However, after reaching 5 years old, there is no need to maintain the same level of consistency.

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It is recommended by a pediatrician that children at low risk for allergies can start introducing peanuts between 4 to 6 months old. However, for children with severe eczema and egg allergy, it is important to consult with an allergist before introducing peanuts early.

When introducing peanuts into an infant’s diet, it’s recommended to use smooth peanut butter mixed into a puree and avoid chunks of peanuts that could pose choking hazards.

Since babies cannot have solids yet, it is suggested to make the food a thin consistency similar to breast milk or formula. It can be mixed into the milk to prevent choking. Start with a small amount and gradually increase every 3-4 days to see how well it is tolerated, advised Parikh.

Parents should consider starting solid foods for babies with eczema sooner rather than later, as these babies are at a higher risk of developing food allergies at an early age. It is important to wait until the baby is developmentally ready to eat solid foods, able to chew and swallow without a risk of choking. Most babies can begin weaning between four to six months, but each baby is different and should be evaluated individually. Soft purees are recommended to make swallowing easier and reduce the risk of choking. It is not advisable to introduce solids before three months of age.

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The idea that introducing peanuts early can help build tolerance has been supported by previous research. However, it is important to discuss this decision with your child's doctor. Dr. Daniel DiGiacomo, a pediatric immunologist from K. Hovnanian Children’s Hospital, suggests that parents should make this decision together with their pediatrician.

According to DiGiacomo, experts currently recommend a shared decision-making approach when introducing new foods to infants. This should happen once the baby is developmentally ready and has already tolerated other complementary foods without any issues.

"I usually recommend starting with a small amount, like a pea size, and gradually increasing it each day until you reach a suitable portion for your age (usually about 2 teaspoons). It's important to include this in your diet a few times a week," he advised.

"For easier consumption, I suggest mixing the nut butter with a puree that your body can tolerate. You can also mix peanut puffs (if using peanuts) in water, or create a peanut sauce using powdered peanut butter or peanut flour. Remember to maintain the right consistency and start slowly. If you have any concerns, don't hesitate to stop and consult your allergist," he added.

Editor's P/S:

The latest research findings on introducing peanuts to infants and young children offer promising news for reducing the risk of peanut allergies. The study's results suggest that early exposure to peanuts, starting as early as 4 months old, can significantly lower the chances of developing this allergy later in life. This finding aligns with previous research that has demonstrated the benefits of early allergen introduction in preventing allergies. The concept of oral tolerance induction suggests that exposing the immune system to potential allergens at a young age can help it develop tolerance and prevent allergic responses.

It is important to note that while introducing peanuts early may be beneficial, it should be done under the guidance of a healthcare professional, especially for children with a higher risk of allergies. Parents should consult with their pediatrician or allergist to determine the appropriate timing and method of introduction. Additionally, it is crucial to ensure that the peanuts are introduced in a safe and appropriate form to prevent choking hazards. By following these guidelines, parents can harness the potential benefits of early peanut introduction to protect their children from the development of peanut allergies.