Peanut allergies in children

New Approach to Peanut Allergies

No one is sure when peanut allergies began to rise in children, nor can anyone say what causes them. Doctors, including the concierge physicians at MD 2.0 Jupiter, began to see a rise in the 1980s, which then soared into the 1990s and beyond.

Numerous hypotheses were offered, from the so-called “hygiene hypothesis” (the idea that children today are growing up in households that are too clean, and thus not exposed to healthy bacteria) to the notion that pregnant women were exposing their in utero babies to more peanuts through everything from the food they consumed to the cosmetic products they used. The latter theory caused obstetricians in the late 1990s and early 2000s to recommend that their patients avoid all exposure to peanut products to shield the developing fetus and nursing baby from peanut allergens.

This approach did nothing to protect the women’s children, however, and—as peanut allergies continued to rise—it was largely discarded by 2008.

Several small studies then seemed to take the opposite approach, recommending immunotherapy—exposure to small amounts of the offending substance—as a way to treat peanut allergies in susceptible children. Doctors had used this type of therapy for years to successfully treat various allergies in adults, and some researchers began to wonder if this approach would work for peanut allergies, as well.

In early 2014, a larger-scale study performed in Cambridge, England, published in the medical journal Lancet, found that after six months of increased exposure to peanut allergens, 91% of the children, ages 7 to 14 years, were able to ingest up to five peanuts with little or no reaction.

Last week, the National Institutes of Health (NIH) released new guidelines that seem to confirm these earlier studies. It said that most babies should regularly eat peanut-containing foods starting at around six months of age, some as early as four months. The guidelines contain specific instructions on how to expose infants to peanut allergens, depending on whether their doctors consider them to be at high, low, or moderate risk of developing future peanut allergies.

Babies considered high risk are those with either a severe form of eczema or an egg allergy. The NIH guidelines say that these babies should be introduced to peanut-containing foods only under the strict supervision and guidance of a physician.

For low-risk infants (most infants), the NIH guidelines recommend: 1) introducing other solid foods before peanut-containing ones; and, 2) introducing peanut-containing foods at around six months.

For moderate-risk infants with mild eczema, the guidelines say they can be introduced to peanut-containing foods at around six months.

For all these infants, the key to building tolerance is to make these foods are a regular part of the child’s diet, about three times a week.

One caution: NEVER give whole peanuts to any young child, as they are a choking hazard. For more information, please consult your concierge physicians at MD 2.0 in Jupiter, FL.

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