Babies Going Nuts

This week’s guest columnist is Dr. Trey Halliburton, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Peanuts are great.  From Snickers candy bars to PB &J sandwiches, they’re tasty and healthy.  But as those with peanut allergies know, sometimes they cause a range of troubles, from itchy rashes to life threatening throat swelling and shock.  For years doctors have cautioned parents from administering peanut products to infants to avoid “sensitization,” where your immune system becomes responsive to an allergen.  However, there’s new evidence that maybe we’ve had it wrong.

I recently saw an 8 year-old girl in clinic who has a severe peanut allergy, and needed a refill of her Epipen.  The Epipen is a spring-loaded injector for when she might accidentally ingest a peanut product.  Then the nearest adult (parent, teacher, babysitter) would stick the pen on her thigh, push the button, and inject epinephrine, a fast-acting allergy antidote. During the visit I thought, “What a stress for her parents!”  Peanuts are in a vast array of food products.  The food labels spell this out, but who reads every label, particularly 8 year-olds?  A friend offers to share the wrong granola bar…

Food allergic reactions, including to peanuts, have been increasing in the population.  But now there’s a way to prevent such allergies for the coming generation.  In 2015 researchers concluded the LEAP Trial (“Learning Early About Peanut” allergy, not standardized testing!). LEAP examined infants ages 4-11 months at risk for allergy development (those with eczema or known food allergies), giving half the infants doses of peanut.  The other half got none.  Results: infants given peanut early had an 81% less risk of developing peanut allergy.  A follow-up study of these kids, LEAP-On, showed that the benefits persisted 12 months later.

Based on these studies, the American Academy of Allergy, Asthma, and Immunology recommends that infants 4 months and up be allowed to experience the wonders of this ground nut. If your infant is high-risk for food allergies however (having severe eczema or already known food allergic reaction), the Academy recommends your child be tested first, and have peanut product introduced in an allergist’s office under controlled conditions.

In the spirit of the LEAP trial, Dr. Hamilton conducted his own peanut experiment, on his feisty little poodle Milou.  Rest assured, no animals were harmed during this study.  In fact, the American Kennel Club states that peanut butter is good for dogs, as long as it doesn’t contain the artificial sweetner Xylitol.  He smeared peanut butter (non-chunky, to avoid choking hazard) on Milou’s palate, and proved his hypothesis: Milou licked and licked and licked his snout, for a recorded 47 seconds, amusing Dr. Hamilton no end.

Which raises the question: how to introduce peanut to an infant, as recommended by the LEAP Trial?  In the study, early peanut exposure in infants’ diets greatly reduces the chance of developing peanut allergy.  Certainly don’t give your baby whole peanuts, a choking risk.  Straight peanut butter isn’t safe either, as infants may choke on its sticky thickness as well.

Best is to dissolve a small amount of peanut butter, about 2 teaspoons, in cereal or formula.  Alternately, 2 teaspoons of peanut flour or powder can be mixed in yogurt or applesauce. Give the first spoonful, then wait several minutes to make sure baby doesn’t have a reaction.  No rash- chow on!  Continue feeding peanut product three times per week.

Again, like we said above, there’s babies who require a medical evaluation before starting peanut in their diet.  Kids at moderate or high risk for allergies need to see a doctor first. These are infants with moderate to severe eczema, or have already had allergic reactions to other foods.  Needless to say, don’t make peanuts the first food you introduce.  Start with the usual hypoallergenic foods, like fortified oat, barley, or multigrain cereals, followed by pureed fruits, vegetables, and grains.

High risk babies can certainly benefit from peanut introduction, but they should be tested to see that they don’t already have peanut allergy.  Then they should have it started under controlled conditions.  This means in an allergist’s office, with careful dosing, and allergy antidotes at hand.  So it may seem scary, but as the LEAP trial showed, early peanut exposure may prevent your child from developing a life-threatening allergy down the road.  Mr. George Washington Carver would be proud.