By Dr. Jim Mattey
Have you heard the news about peanut allergy and feeding peanuts to infants
as young as four months?
The LEAP study (Learning Early About Peanut Allergy) was designed to answer
the question of whether eating peanuts at an early age can actually prevent
peanut allergy. The results were just released at the annual American Academy
of Allergy, Asthma and Immunology meeting in Houston, Texas. I was on hand
for the exciting revelation that children who were at high risk of developing
peanut allergy who were fed peanut regularly, beginning anywhere from 4 to 11
months of age and followed for 5 years, had a dramatic reduction in their risk
of developing peanut allergy. We allergists have suspected this, but haven’t been able to recommend early feeding of allergenic foods without some evidence it would be beneficial. This is a first very big step to provide some proof that changing the way we feed these foods early in life can reduce the chance of developing a food allergy. There are many studies underway to try to answer the bigger questions of what predisposes our children to food allergy and why it occurs in the first place.
But before we start adding peanut butter to all of our babies’ rice cereal, there are a few important details to understand about the study and how this can be safely done. All of the elements that go into our feeding recommendations - developmental stage, safety, nutrition, and the balance of foods we feed our babies - must be carefully considered when we choose their foods. This new piece of information has yet to be assimilated by pediatric experts and how it will fit into the big picture for feeding is still to be determined. Both pediatric and allergy specialists are scrambling to give us new guidelines.
The infants who were chosen for the study were remarkable in several ways. First, they were considered to be at high risk of developing peanut allergy because they already had significant atopic dermatitis and/or egg allergy. These infants were tested for peanut allergy and many were found to already have positive tests to peanut. Some had allergic reactions when given peanut at the start. The researchers concluded that similar babies should not be given peanut until they underwent a skin test to determine if they were already allergic. Another unique and hard to copy trait was that almost all of these children were religiously fed the equivalent of two tablespoons worth of peanut butter three times a week for 5 years. This technique worked, but we don’t know what would happen if they ate less, skipped the peanut regularly or went for longer stretches without eating peanut. Add to this the complicating factor that peanuts and peanut butter are considered “chokers” for infants and toddlers; a convenient form is hard to find.
So--don’t feed your baby that peanut butter yet, but stay tuned and talk to us at your next visit about the evolving recommendations on how to feed your baby.