A new study, published in the New England Journal of Medicine, has turned conventional wisdom on its head and suggests that feeding young children peanuts could actually prevent them from developing a peanut allergy. Peanut allergies can be life-threatening, with some sufferers going into anaphylactic shock with just a whiff of peanut dust in the air. The number of allergies to peanuts has risen drastically, quadrupling over the last decade. It has long been thought that infants and toddlers should not be given peanuts in case they are allergic and even because the avoidance might protect them from developing the allergy. The latest research counters this and turns the established advice around.
Avoiding Peanuts to Prevent Allergies
Conventional wisdom had already begun to change before this most recent study. For more than a decade, the advice has been to avoid peanuts in infants and toddlers and also for women to avoid peanuts during pregnancy, especially when there is any family history of peanut allergies. It was thought that this avoidance would prevent the child from developing an allergy to peanuts, although there was never strong evidence to back it.
The American Academy of Pediatrics (AAP) used to recommend that peanuts be avoided in children until the age of 3. They changed those guidelines in 2008 to say that there was no evidence that allergens like peanuts needed to be avoided beyond 4 to 6 months of age. The current guidelines do not actually recommend giving infants and toddlers peanuts, though. Now, the restriction is being rethought once again, although the AAP has not yet made any official changes to their advice on peanuts and other allergens.
Peanuts: To Feed or to Avoid
The current discussion about feeding or avoiding peanuts for infants and toddlers began in earnest in Israel several years ago. Dr. Gideon Lack, King’s College London professor of pediatric allergies, noticed an important difference between allergies in Israel and Great Britain. He informally noticed that there was a greater incidence of peanut allergies among British children, which led him to conduct a formal survey.
Dr. Lack found that the rate of peanut allergies in children in Israel was only a tenth of that in British Jewish children. He also found that children in Israel were more likely to eat peanut products as infants. The logical conclusion was that avoiding peanuts was not only failing to protect the British children, but that consuming peanuts may actually protect the Israeli children from allergies. The survey was interesting and informative, but more research was needed to prove that eating peanuts could really prevent the development of allergies.
To investigate the idea, researchers in London conducted an experiment using 640 infants. The participating infants had either egg allergies, severe eczema or both, conditions that put them at risk for developing a peanut allergy. These babies, who were between the ages of 4 and 11 months, were randomly assigned to either avoid peanuts completely or be given foods with peanuts regularly, until the age of 5 years.
The results were clear: avoiding peanuts did not help at-risk children avoid developing peanut allergies. By age 5, nearly 14 percent of the children in the peanut avoidance group had a peanut allergy. For the group that ate peanuts, the rate was just under 2 percent.
All of the infant participants were tested for peanut sensitivity before beginning the experiment. A subgroup of 98 infants was found to be sensitive to or at particular risk for developing a peanut allergy. Of these children in the avoidance group, 35 percent ended up with a peanut allergy, and in the consumption group only 10 percent did. These results represent a 70 percent reduction in the risk of developing a peanut allergy by consuming peanuts rather than avoiding them.
The children were also tested for peanut-specific antibodies throughout the study. Those in the avoidance group had higher levels of the antibody that is characteristic of having an allergy. The children in the consumption group showed higher levels of factors that protected against peanut allergies and allergic reactions.
The results of this recent study are stunning and strongly demonstrate that avoiding peanuts does not protect children. More research is needed to verify the results, to include more children and to include children from more varied backgrounds, but it seems that eating peanuts is actually protective and that avoiding them is more harmful than helpful.
This was not the first study to suggest that eating potential allergens could protect children, but it is the first to use a randomized trial and to control for other factors that could affect the development of a peanut allergy. In other words, this study is the most conclusive to date, suggesting that children and infants at risk for peanut allergies should be eating foods containing peanuts rather than avoiding them.