Give babies peanuts to avoid allergies, guidelines suggest

A federal panel of experts recommended Thursday that parents feed most babies peanuts to help prevent allergies, a reversal from the prevailing view just 10 years ago.

Experts used to recommend that babies at high risk of allergies avoid peanuts, a strategy that might have contributed to a national increase in childhood peanut allergies, said Dr. Allison Freeman, an allergist and immunologist at Allegheny Health Network.

Studies in the mid-2000s weakened that view, and a study published in February 2015 definitively overturned it, Freeman said.

“It is revolutionary for our specialty,” she said of the study, known as the LEAP study.

The National Institute of Allergy and Infectious Diseases now recommends that infants with severe eczema or egg allergies — which often signal peanut allergies — start eating peanut products along with other solid foods when they are 4 to 6 months old. Infants with moderate to mild eczema or egg allergies should start eating peanuts around 6 months old, and infants without either condition should start eating peanuts whenever their parents normally would introduce them, according to the guidelines.

Gideon Lack, a researcher at King's College in London, launched the LEAP study after noticing that Israeli children, who customarily eat a peanut-based teething biscuit called Bamba, developed allergies at lower rates than Jewish children living in the United Kingdom.

He designed a randomized, controlled study of infants with severe eczema or egg allergies. Some of the infants consumed peanuts from 4 to 6 months old and the rest avoided peanuts.

Researchers further divided the peanut-eating group based on how sensitive they were to peanut extract in a skin-prick test. Infants who responded most strongly to the skin-prick test were presumed to be allergic to peanuts and were excluded from the study. The rest were divided into infants whose skin swelled in response to the test and those whose skin didn't.

Ninety-eight infants showed swelling. Among those who ate peanuts, 10.6 percent were allergic to peanuts at 5 years old. Among those who didn't, 35.3 percent were allergic at the same age.

Five-hundred and 30 infants didn't have skin swelling. Two percent who ate peanuts were allergic at 5 years old, while 14 percent of those who didn't eat peanuts were allergic at the same age.

“The LEAP study was a really significant study because of what a dramatic, positive impact it seemed to show,” said Dr. Todd Green, an associate professor of pediatrics and an allergist at Children's Hospital of Pittsburgh of UPMC.

The guidelines resulting from the study say that tests such as the skin-prick test should be “strongly considered” for children with eczema or egg allergies before parents feed babies peanut products.

Green said parents of children with severe eczema or egg allergies should visit an allergist before introducing peanuts.

Freeman's view differed. Babies are better at rejecting dangerous substances than adults, she said, and the dramatic stories of adults dying or nearly dying of peanut allergies do not apply to babies. The worst reactions she has seen in 25 years have been vomiting and rashes, she said. Nonetheless, parents should take their babies to an allergist if they notice adverse reactions, she said.

Peanut products — not whole peanuts, which are choking hazards — may be introduced along with other solid foods while babies are still being breast-fed, according to the guidelines.

The LEAP study could spur more research into the effects of early exposure to other allergens such as dairy and shellfish, the allergists said.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.